Clinical presentation: A 77-year-old woman was referred for evaluation of a nodular goiter which has been known for years. A mass was found in the left upper mediastinum on CT scan 6 weeks ago on evaluation of pneumonia. The patient had no neck complaints.

Palpation: Both lobes were nodular on palpation.

Hormonal evaluation indicated euthyroidism (TSH 0.51 mIU/L).

Ultrasonography. The thyroid was enlarged and had numerous nodules of different echogenicities. From an oncological point-of-view, the nodule located in the isthmic part of the left lobe was the most important. The lower pole of both lobes could be visualized on ultrasound examination.

Aspiration cytology of the nodule in the isthmic part of the left lobe resulted in benign cystic-colloid goiter.

Suggestion: ultrasound in 2 years.