Clinical presentation: A 55-year-old woman has been treated for hyperthyroidism for 6 years. She was known harboring a multinodular goiter. She wanted to avoid being operated on and requested for ethanol sclerotherapy.

Palpation: Both lobes were enlarged and contained multiple nodules.

Functional state: hypothyroidism on daily 10 mg methimazole (TSH 1.85 mIU/L, FT4 8.92 pM/L).

Ultrasonography. The thyroid was composed of multiple nodules with different echogenicities. The nodules presented various forms of intranodular hyperechogenic figures, including microcalcifications. Despite the presence of the latter, neither of the lesions was suspicious, they had regular and sharp borders.

Cytology was performed from two lesions and resulted in benign colloid goiter and benign follicular proliferation. The images of the latter smear are demonstrated which was gained from a moderately hypoechogenic nodule in the left lobe.

We told the patient that the thyroid status is not suitable for sclerotherapy and offered surgery.

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