Palpable thyroid nodules can be seen on sonograms with a high degree of accuracy. Although most thyroid nodules are benign, it is important to recognize the sonographic features that make a nodule worrisome for malignancy. Thyroid cancer often appears sonographically as solid and hypoechoic. Fine punctate internal calcifications within a hypoechoic solid mass are features commonly seen with papillary thyroid cancer, which is the most common form of thyroid malignancy.