Clinical data: A 55-year-old man requested an evaluation after his twin-brother was diagnosed with papillary carcinoma. He had no complaints.

Palpation: Both lobes were a bit firm on palpation. There was a not firm nodule in the right lobe.

Laboratory tests: TSH 5.53 mIU/L, FT4 13.1 pM/L, aTPO 206 U/mL.

Ultrasonography. The thyroid was echonormal and presented numerous hypoechogenic discrete areas. One of them located in the upper part of the right lobe had punctate echogenic foci and was aspirated. There was an echonormal nodule in the middle-lower part of the right lobe. This lesion displayed halo sign and perinodular blood flow and presented taller-than-wide shape. The right lobe had numerous discrete lesions including a minimally hypoechoic one which showed taller-than-wide and taller-than-long shape.

Cytology was performed form the lesion in the upper part of the right lobe and resulted in suspicion of papillary carcinoma.

Total thyroidectomy was performed.  Histopathology: The echonormal nodule proved to be a hyperplastic nodule. Hashimoto's thyroiditis was found in other parts of the lobe, including the lesion which proved to be suspicious on cytology.

Comment. There were two lesions with nonparallel orientation. The large echonormal nodule which proved to be a hyperplastic nodule and a lesion in the dorsal part of the left lobe. There were two differential diagnostic issues in the event of the latter. First, it was located in a narrowed part of the lobe, medial the trachea, lateral the carotid artery hindered the growth of the lesion sideways. The second issue is that the lesion proved to Hashimoto's thyroiditis and not a true nodule on histopathology.