Clinical presentation: A 23-year-old woman was referred for evaluation of a recurrent nodular goiter. She was operated for 12 years when a bilateral subtotal lobectomy was performed. The insufficiency of the operation was revealed within weeks after the surgery. The patient has got levothyroxine therapy for a decade which was inefficient: her thyroid gradually increased and caused already difficulties in swallowing.

Palpation: Both lobes were enlarged and contained multiple nodules.

Functional state: subclinical hyperthyroidism on suppression therapy with daily 87.5 microgram levothyroxine (TSH 0.07 mIU/L, FT4 22.1 pM/L).

Ultrasonography: The thyroid was echonormal-minimally hypoechogenic and contained numerous nodules with different echogenicities. One of the nodules located in the lower part of the right lobe presented intranodular hyperechogenic granules and an increased intranodular blood flow.

Cytological diagnosis: benign colloid goiter.

A bilateral total thyroidectomy was performed. Histopathology disclosed benign hyperplastic nodules.