Clinical presentation: A 71-yr-old woman was referred for follow-up of an autonomously functioning adenoma, which has been known for 17 years. The patient had 'lump in the throat feeling'.

Palpation: a large, not firm nodule in the right lobe.

Laboratory test: TSH 1.65 mIU/L, FT4 14.1 pM/L.

Ultrasonography. The right lobe had a large isoechoic nodule. Dorsal and lower to this lesion there was a hypoechoic nodule, which presented irregular, lobulated margins. The hypoechoic nodule presented irregularly increased intranodular vascularization.

Cytology of the hypoechoic lesion resulted in benign, colloid goiter.

Comment.

1. The hypoechoic nodule had irregular, lobulated margins.
   
2. The categorization of the larger nodule depends on the definition of heterogeneity and the interpretation of the ventral hypoechoic part. If the latter is counted as a cystic area than the proportion of hypoechoic areas is below the 10% threshold and the nodule is not heterogeneous.