First examination (first row of images)

Clinical presentation: A 38-year-old woman was referred for evaluation of a nodular goiter discovered on ultrasound examination. She has been treated for hypothyroidism for 2 years.

Palpation: The left lobe was suspicious having a nodule.

Result of blood test: TSH 2.08 mIU/L, aTP0 4 U/mL on daily 25 microgram levothyroxine.

Ultrasonography. The thyroid was moderately hypoechogenic and inhomogeneous and presented fibrotic changes. There was an irregularly shaped hypoechogenic area in the right lobe while a hypoechogenic homogeneous lesion in the ventral part of the left lobe. The former is probably not a nodule while the latter is probably a nodule in pathological sense. There was another hypoechogenic lesion in the dorsal part of the left lobe. It is worth comparing the two discrete areas in the left lobe.

Aspiration cytology was performed from the lesion in the right lobe and from the nodule in the ventral part of the left lobe. The diagnosis was Hashimoto's thyroiditis in both cases.

Second examination 15 months later (second row of images)

Clinical presentation: The endocrinologist indicated a follow-up examination at the 19th week of pregnancy.

Palpation: no abnormality.

Result of blood test: TSH 2.40 mIU/L on daily 62.5 microgram levothyroxine.

Ultrasonography. The thyroid became a bit less hypoechogenic. Both lesions have significantly decreased in volume compared with the previous examination.