Clinical presentation: A 50-yr-old woman was referred for evaluation of a nodular goiter detected on ultrasound screening.

Palpation: a not firm nodule in the left lobe.

Laboratory test: TSH 1.26 mIU/L.

Ultrasonography. The thyroid was echonormal. There were some discrete lesions in the right lobe. The largest one in the lower third was composed of hypoechoic and echonormal parts. The left lobe has a large nodular mass. It was equivocal whether it was a large solitary nodule composed of areas with different echogenicities or a large mass composed of nodules having different echo pattern.

Cytology resulted in benign lesion.

Comment. The issue is whether the lesion is composed of one or more nodules. In the former case it is a dominantly hypoechoic, heterogeneous nodule. The problem is not of great significance because the hypoechoic nodule or area should be evaluated by FNA.