Clinical presentation: A 71-year-old man was referred for evaluation of a thyroid nodule detected on carotid Doppler examination. The nodule in the left lobe was described as suspicious because of the presence of microcalcifications.

Palpation. No abnormality.

Laboratory tests: TSH 1.07 mIU/L, aTPO 318 U/mL.

Ultrasonography. The thyroid was minimally hypoechogenic and presented several more hypoechogenic discrete areas. The lesion in question was located in the left lobe and synchronously presented echogenic granules and lines. These figures were in fact not microcalcifications but ultrasound presentation of connective tissue. Similar figures were found in discrete lesions of the left lobe.

Aspiration cytology resulted in Hashimoto's thyroiditis.

Comment. The ultrasound presentation of connective tissue is frequently misinterpreted and even the presence of this type of figure is only exceptionally mentioned in the thyroid literature. We have to be aware of the characteristic pattern, i.e. the synchronous presence of both echogenic figures and lines.