Clinical presentation: A 44-year-old woman was referred for evaluation of a thyroid nodule detected on routine medical check-up.

Palpation: a firm nodule in the left lobe.

Hormonal evaluation: TSH 3.21 mIU/L, aTPO 94 U/mL.

Ultrasonography. The thyroid was minimally hypoechogenic and had several more hypoechogenic discrete lesions. There was a large, minimally hypoechogenic nodule in the left lobe. The nodule presented both perinodular and increased intranodular blood flow. One of the small hypoechogenic areas located in the left lobe just upper to the large nodule showed hyperechogenic figures including punctate echogenic foci.

Cytology of the nodule resulted in oxyphilic tumor while the cytology of the hypoechogenic area above the nodule did in Hashimoto's thyroiditis.

Histopathology disclosed Hürthle-cell adenoma and Hashimoto's thyroiditis.