Clinical presentation: A 61-year-old woman was referred for evaluation of a nodular goiter detected on CT scan which was performed on pneumonia. The patient had been treated for hypothyroidism for more than 15 years. We met the patient five years ago when she requested a second opinion after the cytological diagnosis of "oxyphilic metaplasia of unknown significance (AUS - Bethesda 3)" from two lesions, one in the dorsal part of the right and another one in the dorsal part of the left lobe. We offered a wait-and-see.

Palpation: The left lobe was palpable, it was firm. No nodules could be palpated.

Laboratory test: TSH 2.09 mIU/L on daily 75 microgram levothyroxine. The aTPO level was 885 U/mL 6 years ago.

Ultrasound. The thyroid was moderately hypoechogenic. There were two discrete lesions in the dorsal part of both lobes. The echo pattern of the discrete lesions was basically the same as the non-lesional part of the thyroid. Great proportion of the thyroid was composed of hypoechogenic areas. Neither of the lesions had increased in size over the last 5 years.

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

Comment.

1. It was doubtful whether these lesions were true nodules or not.

2. 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.