Clinical presentation: A 73-yr-old woman was referred for evaluation of a newly detected hypothyroidism and nodular goiter.

Palpation: There was a firm nodule in the ventral part of the right lobe.

Laboratory tests: TSH 5.06 mIU/L, aTPO was 230 U/mL.

Ultrasound. The thyroid was minimally-moderately hypoechogenic and had many discrete areas. There was a partly moderately hypoechogenic, partly echonormal lesion in the middle part of the right lobe. The lesion had sharp borders and regular geometrical shape and presented both perinodular and intranodular blood flow. This lesion is probably a nodule in pathological sense.

Aspiration cytology from the lesion resulted in oxyphilic cell proliferation.

We suggested follow-up instead of surgery.

Comment. The lesion in the right lobe has a heterogeneous pattern. The peripheral parts of the nodule are hypoechoic which raises the possibility that the nodule is not a heterogeneous lesion, but an echonormal nodule which is infiltrated by the underlying thyroiditis.