Clinical presentation: A 43-year-old woman was referred for evaluation of a nodule discovered on screening.

Palpation: no abnormality.

Ultrasonography revealed a minimally hypoechogenic thyroid. There were several cystic areas. The largest one was in the left lobe and had an inhomogeneous solid part.

Laboratory tests: TSH 1.80 mIU/L, anti-TPO 1.0 U/mL.

Aspiration cytology was performed from the lesion in the left lobe and resulted in Hashimoto's thyroiditis.

Comments.

1. It is doubtful whether the aspirated lesion is a nodule in a pathological sense or not. I mean that this is a dilated follicle and next lower to this cystic area there is an inhomogeneous lesion.
   
2. The judgement of the solid part depends on the reference tissue: if it is the extralesional tissue than the lesion is echonormal or hyperechoic. If the reference tissue is the healthy thyroid than the lesion is minimally hypoechoic.