Clinical presentation: A 38-year-old woman was referred for evaluation of a nodular goiter. The patients noticed thyroid enlargement two years ago, and she felt a slow and continuous increase in the lump, which has already led to difficulties in swallowing.

Palpation: Both lobes were enlarged and nodular.

Hormonal evaluation indicated euthyroidism with subnormal TSH (TSH 0.38 mIU/L, FT4 13.3).

Ultrasonography. The thyroid was greatly enlarged and was composed of numerous nodules. The non-nodular part appeared as echonormal islets within the thyroid. The nodules varied in echogenicity which ranged from moderately hypoechogenic to hyperechogenic. Most nodules had cystic areas, as well. There was no nodule of oncological significance.

Cytology of a nodule in the left lobe resulted in benign cystic-colloid goiter.

Suggestion: total thyroidectomy.

Histopathology. Benign, hyperplastic nodules.