Clinical presentation: A 44-year-old woman requested a second opinion. She has been treated for Graves' hyperthyroidism for seven months. (The disease had evolved after long-lasting severe familiar conflict.) She became allergic to methimazole, therefore propylthiouracil was administered. She felt to be mistreated because her complaints including fatigue, nervousness have not resolved, moreover she gained 7 kg in six months.

Palpation: No nodule could be palpated.

Hormonal evaluation: TSH 0.02 mIU/L, FT4 14.6 pM/L on daily 20 mg propylthiouracil.

Ultrasonography. The thyroid was hypoechogenic. There were several more hypoechogenic areas including a lesion presenting halo in the lower part of the right lobe. This lesion was more hypoechogenic than the other areas and in contrast with the latter this had intranodular echogenic figures, too. The vascularization of the thyroid was significantly increased while the lesion in question had signs of perilesional blood flow.

We tried to explain to the patient that her complaints are not yet linked to the previous hyperthyroidism but are caused by her severe unresolved familiar problems which have been itself provoked the initiation of the disease.

We were not very convincing because the patient saw a surgeon about her complaints and 2 months after our meeting she underwent near total thyroidectomy. Histopathology disclosed diffuse goiter and a follicular adenoma corresponding to the lesion in the right lobe.

Comment. The ultrasound categorization of the lesion in question is on our opinion doubtful, although this proved to be a true nodule, the discrete lesion cannot be considered a clear nodule on ultrasound appearance.