Clinical presentation: A 40-year-old hypothyroid woman was referred for evaluation of a nodular goiter discovered on carotid Doppler examination. We met her several times in the previous years and found no nodule on ultrasound.

Palpation: No abnormality.

Laboratory test: TSH 2.64 mIU/L on daily 75 microgram levothyroxine.

Ultrasound. The right lobe was composed of a central hypoechogenic area which was surrounded by less hypoechogenic parenchyma. There was a deeply hypoechogenic area in the left lobe. None of the lesions fit to nodule in pathological sense. The pattern did not change over the past ten years.

Suggestion. Daily 75 microgram levothyroxine. TSH determination in every year.