Clinical presentation: A 49-yr-old woman was referred for evaluation of a nodular goiter which was discovered by the patient herself. The patient had no complaints.

Palpation: a moderately firm nodule in the left lobe.

Laboratory tests: TSH 0.97 mIU/L.

Ultrasonography. The thyroid was echonormal. A large, heterogeneous nodule occupied almost the entire left lobe. The echonormal parts of the lesion exceeded the hypoechoic parts, therefore the nodule was dominantly echonormal. The lesion showed various hyperechogenic figures, including macrocalcifications. The presence of microcalcifications could not be excluded. The nodule presented perinodular blood flow.

Cytology resulted in benign lesion.

Suggestion: Considering the size of the nodule and the nodular lobe, surgery was advised. We told the patient, that if she does not accept our suggestion, the nodule should be followed-up every year.

Comment. The issue is whether the lesion is composed of one or more nodules. In the former case it has lobulated margins, in the latter this is a non-pathological lobulation. Nonetheless, the question is only theoretical because the nodule requires cytological evaluation.