Clinical presentation: A 71-year-old woman was referred for evaluation of a slowly growing nodule has been known for more than 30 years. The patient had difficulties in swallowing.

Palpation: a large firm nodule in the isthmus and in the left lobe.

Functional state: euthyroidism (TSH 0.98 mIU/L).

Ultrasonography. The thyroid was hypoechogenic. A large lesion occupied the lower 2/3 of the left lobe and the isthmus. The lesion was composed of multiple hyperechogenic areas. There was another nodule in the upper part of the left thyroid. This smaller lesion presented macrocalcification.

Cytology resulted in benign lesion.

A left lobectomy was performed. Histopathology disclosed benign hyperplastic nodules. There was no lymphocytic thyroiditis.

Comment. The non-nodular part of the thyroid was hypoechogenic. It would be almost diagnostic for autoimmune thyroiditis in a younger patient, however in older patients, even such degree of hypoechogenicity may be a normal finding.