Clinical presentation: A 49-year-old woman was referred for aspiration cytology of a nodular goiter which was detected on ultrasound screening two years ago.

Palpation: no abnormality.

Result of blood test: TSH 2.44 mIU/L.

Ultrasonography. The thyroid was echonormal. Beside several hypoechoic and cystic lesions without any clinical significance, both lobes had a hypoechoic nodule. The presentation of them was very similar, both had echogenic granules and showed peripheral vascularity. However, the echogenic figures in the right nodule were probably back wall figures while those in the left nodule were microcalcifications. Regarding the vascularity, the left nodule showed perinodular blood flow while the right did not.

Aspiration cytology was performed from both nodules, and it resulted in benign cystic-colloid goiter and in oxyphilic tumor, right and left nodule, respectively.

A lobectomy was suggested, however, the patient wished the right nodule also to be removed. Histopathology disclosed benign hyperplastic nodule and oxyphilic variant of follicular adenoma, right and left nodule, respectively.

Comment. It is worth comparing the ultrasound presentations of the two nodules. There are small but important differences between them regarding the echogenic figures and the vascularity.