Clinical data: A 70-year-old woman was referred for evaluation of a thyroid nodule which proved to be PET positive. PET CT scan was performed on staging of a ductal breast cancer.
The patient has been treated for hypothyroidism for more than 30 years. First, we met her 7 years before the present examination when a multinodular goiter was diagnosed. Aspiration cytology was performed from two hypoechoic nodules, one in the right and another one in the left lobe. Cytology yielded benign lesion. The goiter did not cause compression signs.

Palpation: Both lobes were nodular on palpation. No suspicious nodules were palpated.

Laboratory tests: TSH 2.57 mIU/L on daily 75 microgram levothyroxine.

Ultrasonography. The right lobe was composed of multiple discrete lesions, the pattern was close to a micronodular presentation. The left lobe had multiple nodules, including a hypoechoic one in the lower third which proved to be PET positive. Compared with the previous examinations neither the size of the lobes nor the size of the lesion in question have changed.

Cytology was performed form the lesion in the lower third of the left lobe and resulted in benign lesion. Wash-out thyroglobulin level exceeded 478 microgram/L.

Suggestion: continue with the daily 75 microgram levothyroxine replacement therapy. TSH in a year, ultrasound in three years.

Comment. It is worth comparing the ultrasound presentations of the nodule in the lower third of the left lobe by using different settings.