Clinical presentation: A 60-yr-old woman was referred for evaluation of a thyroid nodule detected on routine medical examination.

Palpation: a large firm nodule in the right lobe.

Laboratory tests: TSH 5.47 mIU/L, aTPO 172 U/mL.

Ultrasonography. The right lobe was substantially enlarged and hypoechoic. It had macrocalcifications. The issue was whether the lobe was composed of a large nodule or only diffuse enlargement was present. The left lobe was much smaller. This lobe was also hypoechoic but to a lesser extent as was the right lobe. The vascularity was increased in the right while decreased in the left lobe.

FNA of the nodule resulted in lymphocytic thyroiditis.

Comment.

1. The issue was whether the lobe was composed of a large nodule or only diffuse enlargement was present. On some still images, it seemed evident that there was a nodule. But we should never forget, that the reality is much more represented by videos. When we stop the continuous scan significantly affects what we see in a still image, which can therefore very easily be misleading. In the video, I highlighted those features on which we could decide considering only the ultrasound presentation that this very likely a nodule.

2. The most decisive fact was the palpation that this was a nodule.