Clinical presentation: A 69-year-old woman was referred for evaluation of a nodular goiter. The patient had been treated for hypothyroidism for 3 years. Four months prior to present investigation, she underwent cardiac by-pass surgery, and an enlarged nodular goiter was discovered which caused stricture of the trachea.

Palpation: Both lobes were enlarged and nodular on palpation.

Hormonal evaluation indicated euthyroidism on daily 50 microgram levothyroxine (TSH 2.53 mIU/L).

Ultrasonography. The thyroid was minimally-moderately hypoechogenic and was composed of multiple discrete areas. The right lobe presented a micronodular pattern and had a hyperechoic lesion which was suspicious being a pathological nodule. The left lobe contained multiple nodules, one of them located in the middle part was moderately hypoechogenic.

Cytology was performed form the moderately hypoechogenic nodule and resulted in benign lesion.

Considering the stricture of the trachea, surgery was advised.

Histopathology: Hashimoto's thyroiditis in both lobes. Hyperplastic nodules in the left thyroid.

Comments.

1. It is worth to compare the thyroid lobes: the right did not prove to be containing nodule is pathological sense, the large hyperechoic lesion was the only intact part which was not or less infiltrated by the thyroid. On the other hand, the left lobe had multiple lesions.

2. The cytological pattern corresponds to a mixture of Hashimoto's thyroiditis and colloid goiter.