Clinical presentation: A 55-year-old woman was referred for evaluation of a thyroid nodule which has been known for more than two decades. She has been treated for hyperthyroidism twice, first time for 17 years, second time for three years. She noticed a relatively rapid increase in nodule size in the past couple of years and had difficulties in swallowing. Previous scintigraphy disclosed a nodule with low radioiodine uptake. At the time of the last relapse of hyperthyroidism TSAb was 3.9 U/L at the while aTPO was 0.5 U/mL.

Palpation: a large, not firm nodule in the right lobe and in the isthmus.

Laboratory tests: TSH 0.27 mIU/L, FT4 13.4 pM/L.

Ultrasonography. The thyroid was partly echonormal partly minimally-moderately hypoechogenic. There was a large nodular area in the right lobe. This area was composed of multiple echonormal lesions. The left lobe contained multiple discrete echonormal and moderately hypoechogenic lesions. The volume of the nodule in the left lobe has doubled compared over the past 3 years.

A total thyroidectomy was advised. Histopathology: Benign hyperplastic nodules in the right lobe. Hashimoto's thyroiditis. There were no nodules described in the left lobe.