First examination (1st row of images)

Clinical presentation: A 29-year-old woman was referred for evaluation of a thyroid nodule discovered by the patient herself. She had been treated for hypothyroidism for 3 years.

Palpation: Both lobes were firm. An elastic nodule was palpable in the left lobe.

Functional state: hypothyroidism on daily 50 microgram levothyroxine with TSH-level 11.7 mIU/L.

Ultrasonography: The thyroid was hypoechogenic and presented fibrosis. There was an echonormal lesion in the central part of the right lobe while a mixed, multichambered cyst occupied great proportion of the left lobe. The nodule in the left lobe presented signs of perinodular blood flow.

The results and follow-up of the lesion in the right thyroid is presented among case histories of "A new approach - oxyphilic lesions" - see case 5.

Cytology of the nodule in the left lobe resulted in cystic degeneration without any signs of malignancy.

Second examination 2 month later (2nd row of images)

Clinical presentation: The cyst has recurred 2 weeks after aspiration.

Ultrasonography was identical to the previous examination.

Ethanol sclerotherapy was advised. Three sessions of ethanol injection were given and a total amount of 8 mL alcohol was administered. The first session is presented in 2nd row of images.

Examination 2 years later (3rd row of images)

Summary of follow-up: The size of the nodule became significantly lower at 6-week follow-up and was unchanged in the course of follow-up investigations. The patient had no complaints.

Functional state: euthyroidism on daily 100 microgram levothyroxine with TSH-level 0.96 mIU/L.

Ultrasonography: The basic ultrasound pattern of the thyroid remained unchanged. An echonormal lesion was found corresponding to the former cystic nodule. The pretreatment volume decreased from 11.9 mL to 0.28 mL.

Suggestion: to continue the follow-up with ultrasound and TSH determinations every year.