Clinical data: An 83-year-old woman came to a follow-up. She had no complaints. She has been treated with ethanol sclerotherapy for 19 years. An autonomously functioning adenoma caused hyperthyroidism and she refused both surgery and radioiodine therapy. The dimensions of the nodule were 37x34x51 mm (33.6 mL), width x depth x length, respectively. Eight sessions of sclerotherapy were applied. The hyperthyroidism ceased, the patient stopped taking thyrostatic therapy and the size of the nodule was significantly reduced.
Sixteen years after the therapy, the dimensions of the nodule were 27x28x39 mm (15.4 mL) and the TSH was 1.09 mIU/L.

Palpation: The left lobe was substantially enlarged and had a hard nodule.

Laboratory tests: TSH 0.18 mIU/L, FT4 13.4 pM/L.

Ultrasonography. The thyroid was echonormal. The right lobe was minimally enlarged and had several discrete lesions. The left lobe was very enlarged. An isoechoic nodule occupied great part of this lobe. The lower pole of the lobe could not be visualized even during swallowing. The dimensions of the nodule were 38x49xminimum 50 mm, the volume of the nodule was at least 48.7 mL.

CT scan disclosed that the thyroid extended 8 cm below the level of clavicula. The diameter of the trachea was halved by the goiter.

Surgery was suggested. The patient rejected the proposal because the thyroid lesion did not cause her a complaint.