Clinical presentation: A 56-year-old woman was referred for evaluation of a nodular goiter. Her thyroid gradually increased over decades. She decided to have her thyroid investigated because the goiter already caused difficulties in swallowing.

Palpation: a multinodular right thyroid.

Functional state: subclinical hyperthyroidism with TSH 0.05 mIU/L, FT4 16.2 pM/L, FT3 4.50 pM/L.

Ultrasonography. The right lobe was composed of multiple nodules including a large hyperechogenic one. There were several small, moderately hypoechogenic lesions presenting fibrotic changes.

One of the discrete lesions in the left lobe was aspirated. Cytology resulted in benign colloid goiter.

We indicated scintigraphy which disclosed a "warm" nodule corresponding to the large hyperechogenic lesion in the right lobe.

We advised surgery. We told the patient that she has to decide to undergo on a total thyroidectomy or only a right lobectomy. In the latter case, the appreciated the risk of a repeat surgery decades later is around 10%.