Clinical presentation: A 46-year-old woman was referred for evaluation of a multinodular goiter detected on carotid Doppler examination. The patient has been treated for hypothyroidism for more than 20 years. We met her several times and have found no nodules.

Palpation: Both lobes were firm.

Laboratory tests: TSH 7.41 mIU/L. The aTPO level was 632 U/mL 14 years ago.

Ultrasound. The thyroid was moderately hypoechogenic and contained several discrete echonormal and more hypoechogenic areas. None of them corresponded to a nodule in pathological sense. Compared with the last ultrasound examination, there was no change in the ultrasound presentation.

Aspiration cytology from a discrete lesion in the right lobe in Hashimoto's thyroiditis.

Comment The lesions are probably not nodules in pathological sense.