Clinical presentation: A 40-year-old woman was referred for evaluation of a newly discovered hyperthyroidism. The patient had typical complaints. A multinodular goiter including a suspicious nodule was described on ultrasound.

Palpation. No abnormality.

Laboratory tests: TSH 0.001 mIU/L, FT4 42.5 pM/L, FT3 11.6, TSAb 6.5 U/L (normal value < 5).

Ultrasonography. The thyroid was echonormal and contained multiple hypoechogenic areas. The echogenicity index was 15% Except for one lesion in the lower pole of the left lobe none of these areas fit to a nodule in a pathological sense. The vascularization was not significantly increased.

The patient was afraid of the nodule described on previous ultrasound, therefore aspiration cytology was performed which resulted in benign hormonal atypia.

Daily 20 mg methimazole was administered.

For unknown reason the patient underwent a total thyroidectomy six months later. Histopathology resulted in diffuse goiter corresponding to Graves' disease.

Comment. Except for a lesion located in the lower part of the left lobe the discrete areas found in this thyroid are unlikely pathological nodules.