First examination:

Clinical presentation: A 53-yr-old woman was referred for evaluation and percutaneous sclerotherapy of a nodular goiter detected on screening.

Palpation: no abnormality.

Laboratory test: TSH 1.18 mIU/L.

Ultrasonography. The thyroid was echonormal. There was a mixed, cystic-solid nodule in the right lobe. The solid part was echonormal. The lesion presented taller-than-wide shape, had a halo and perinodular blood flow. The dimensions of the nodule were 18, 20 and 26 mm, width, depth and length, respectively. There was small, echonormal lesion in the lower pole of the right lobe.

Three mL brown fluid was aspirated. Cytology resulted in benign cystic lesion.

Suggestion. Repeat ultrasound in 2 years.

Second examination 28 month later:

Clinical presentation: The patient had no complaints.

Palpation: no abnormality.

Laboratory test: TSH 1.73 mIU/L.

Ultrasonography. The cyst has refilled. The cystic, echo free part of the nodule has been replaced with a deeply hypoechoic solid mass. The dimensions of the nodule were 18, 19 and 27 mm, width, depth and length, respectively.

Suggestion repeat ultrasound in three years, in the event of neck complaints, sooner.

Comments.

1. In our opinion, ethanol sclerotherapy should be reserved for cases that would require surgery. Otherwise, an excess use of sclerotherapy cannot be avoided. A benign nodule, which causes neither complaint to a patient nor enlargement of the lobe is not a candidate for surgery and therefore also not for sclerotherapy.
   
2. This is not a rare situation, that a cystic part becomes seemingly solid over time. In most of such instances this mass is composed of clot. In this case, this change caused no differential diagnostic problem, because we could be aware of the previous presentation of the nodule. Otherwise, we should have said that that this was a heterogeneous, dominantly deeply hypoechoic nodule.