Clinical data: A 60-yr-old woman requested a second opinion. A nodular goiter has been known for a decade. Recently, she noticed neck discomfort, 'lump in the throat' feeling which was told not caused by thyroid disorder.

Palpation: Both lobes were nodular, none of the nodules was firm.

Laboratory test: TSH 0.79 mIU/L, FT4 14.9 pM/L.

Ultrasonography revealed a multinodular goiter. There was a hypoechoic nodule in the ventral part of the right lobe which caused bulging contours. However, there was a thin echonormal tissue ventral to the lesion. It means that the protrusion did not raise the suspicion of extrathyroidal spread. The left lobe has multiple nodules. A hypoechoic lesion was remarkable because of the presence of echogenic figures and longer-than-wide shape. Nevertheless, the non-parallel orientation was caused by the anatomical situation, the nodule was sandwiched between two other lesions.

Cytology was performed form the nodule in the right lobe and from the hypoechoic nodule in the left lobe and resulted in benign colloid goiter in both cases.

Comments.

1. Although the nodule in the right lobe has bulging contours but lacked abutment. It means that the protrusion has no relevance regarding extrathyroidal spread.

2. The taller-than-wide shape of the hypoechoic nodule in the left was caused by the location of the nodule and therefore the non-parallel orientation should not be interpreted as a suspicious sign.

3. The echogenic figure within the hypoechoic lesion in the left lobe cannot be interpreted as an unequivocal microcalcification because this was located dorsal to a tiny cystic area.