Clinical presentation: A 32-year-old woman was referred for follow-up examination. She has been treated for recurrent hyperthyroidism for more than 3 years. The TSAb level was continuously high and she had severe eye symptoms.

Palpation. No abnormality.

Laboratory tests: TSH 0.94 mIU/L, FT4 17.3 pM/L on daily 10 milligram methimazole.

Ultrasonography. The thyroid was echonormal and presented several hypoechogenic areas. The largest of the latter was located in the lower part of the right lobe. It was a cystic lesion.

Total thyroidectomy was performed. Histopathology resulted in diffuse goiter corresponding to Graves' disease. Focal lymphocytic thyroiditis was also described.

Comment. It is difficult to decide on ultrasound whether the largest lesion is a nodule in pathological sense or isn't. In such doubtful cases we use the term 'nodule-like lesion' on ultrasound report.