Clinical presentation: A 56-year-old woman requested a second opinion. She has been treated for hypothyroidism for 24 years. On ultrasound performed because of difficulties in swallowing a suspicious nodule was described in the upper part of the left lobe. Aspiration cytology resulted in AUS (Bethesda 3 category). The patient was told that she has around 15% risk having thyroid carcinoma.

Palpation: No abnormality.

Laboratory tests: TSH 5.57 mIU/L, aTPO 1030 U/mL on daily 87.5 microgram levothyroxine.

Ultrasound. The thyroid was hypoechogenic and presented extensive fibrosis. None of the hypoechogenic fields corresponded to nodule.

Aspiration cytology resulted in benign Hashimoto's thyroiditis.

Comments.

1. The lesion is question is clearly not a nodule in a pathological sense.

2. There are no publications about the risk of carcinoma in AUS category depending on iodine intake, the risk of carcinoma is very likely much lower in iodine deficient countries than that in the USA. (E.g. the risk of carcinoma is around 3 to 5% in cytologically diagnosed follicular tumors in our country.)