Clinical presentation: A 57-year-old woman was referred for evaluation of a multinodular goiter detected on routine physical examination and thereafter on ultrasound.

Palpation: Both lobes were firm and nodular.

Laboratory tests: TSH 0.66 mIU/L, aTPO 763 U/mL.

Ultrasound. The thyroid was hypoechogenic. Great proportion of the thyroid was composed of echonormal and minimally-moderately hypoechogenic discrete lesions which corresponded to pseudonodules. There was a relatively large echonormal lesion in the upper part of the right lobe, the characterization of which was doubtful, but this lesion might be a nodule in pathological sense.

Aspiration was performed from a hyperechogenic lesion located in the ventromedial part of the right lobe and from a hypoechogenic lesion having punctate echogenic foci. Cytology resulted in Hashimoto's thyroiditis in both locations.

Comment. The thyroid presents the characteristic pseudonodular pattern of Hashimoto's thyroiditis.