Clinical presentation: A 41-year-old woman requested an evaluation of a nodular goiter. She has been known to harbor a nodule for four years. Recently, she noticed that the nodule increased in size and caused unpleasant feeling in recumbent position.

Palpation: a not firm nodule in the left lobe.

Laboratory evaluation: TSH 1.69 mIU/L.

Ultrasonography. The thyroid was echonormal. The right lobe had a cystic nodule. The extent of spongiform areas exceeded 50%. The nodule had intranodular vascularization and presented numerous back wall echogenic figures.

We tried twice to aspirate cystic fluid from the nodule, but only 0.8 mL cystic content could be removed. Aspiration cytology resulted in cystic degeneration.

Right lobectomy was suggested.

Comments.

1. The nodule has large fields of spongiform areas, however, on the EU-TIRADS classification, this lesion could not be regarded as a spongiform nodule.

2. The classification depends on the judgement of the echogenicity of the solid part. If it is considered hypoechoic, then the nodule is an EU-TIRADS 4 lesion, if it is considered echonormal, then the lesion is an EU-TIRADS 3 nodule.