Clinical presentation: A 62-yr-old woman was referred for evaluation of a nodular goiter detected on follow-up. The patient has been operated on for 21 years when a subtotal left lobectomy was performed.

Palpation: no abnormality.

Laboratory test: TSH 5.68 mIU/L on daily 75 microgram levothyroxine.

Ultrasonography. The right lobe was moderately hypoechoic and had a smaller echogenic lesion and a larger nodule. Depending on how accurately we were able to fit the transducer to the patient's neck, the echogenicity of the nodule was different. The nodule showed taller-than-wide sign.

Cytology resulted in benign lesion.

Comment. If we face a technical problem which alters the nodule' echogenicity, the brightest (most echogenic) pattern corresponds to reality.