Clinical presentation: A 69-year-old hypothyroid woman was referred for evaluation of a nodular goiter detected on carotid Doppler examination. I have already met the patient for 11 years when hypothyroidism was diagnosed. At this time, an echonormal lesion was found with the dimensions of 12x10x15 mm.

Palpation: No abnormality.

Laboratory test: TSH 3.29 mIU/L on daily 75 microgram levothyroxine.

Ultrasound. The thyroid was minimally-moderately hypoechogenic. There was an echonormal lesion in the ventral part of the left lobe. The dimensions were 11x10x15 mm. The lesion had a geometrical shape, sharp borders and presented signs of perinodular blood flow. The lesion is probably a true nodule.

Suggestion. Continue with the daily 75 microgram levothyroxine therapy. TSH determination in a year.