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.

1. There were two issues in this case.

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

   • Secondly, the interpretation of the taller-than-wide side. If we take the anatomy into account, i.e. the shape of the lobe and the location of the nodule between the trachea and the carotid artery, doubts may arise as to whether the nonparallel orientation is pathological.

2. Therefore, the nodule can be classified as an EU-TIRADS 3 or EU-TIRADS 5 lesion.