Clinical presentation: A 43-year-old woman was referred for evaluation of a nodular goiter detected on screening.

Palpation: Both lobes had an elastic nodule.

Functional state: euthyroidism (TSH 1.22 mIU/L).

Ultrasonography. The thyroid was echonormal. There were numerous cystic lesions within both lobes. It was not clear whether the lesions were pathological nodules or dilated macrofollicles.

Cytology of the cystic lesion in the left lobe resulted in benign cystic-colloid goiter.

Suggestion: ultrasound in 5 years.

Comment. This case represents the difficulties of the seemingly most simple question: whether a discrete lesion is a pathological nodule or not. In fact, this issue might be the most problematic one, and the answer determines the entire evaluation of a patient.