Clinical presentation: A 52-year-old woman was referred for follow-up investigation. We met the patient 7 years ago when a hyperechogenic nodule-like-lesion had been aspirated. Cytology resulted in benign lesion. The patient noticed an increase of the whole thyroid over the past years which caused problems in recumbent position.

Palpation: Both lobes were moderately firm and uneven.

Hormonal investigation: euthyroidism (TSH 0.92 mIU/L).

Ultrasonography revealed a pseudolobular pattern, the thyroid was composed of multiple echonormal areas. There was a larger hyperechoic and a smaller hypoechogenic discrete lesion in the lower-central part of the left lobe.

On aspiration cytology oxyphilic cells were gained almost exclusively from the hypoechogenic lesion.

Combined sonographic-cytological diagnosis was Hashimoto's thyroiditis.

The patient was operated on because of compression of the enlarged thyroid.

Histopathology revealed Hashimoto's thyroiditis. No nodule was found.