First examination (first row of images)

Clinical presentation: A 47-year-old woman was referred for a newly diagnosed hypothyroidism and nodular goiter. A nodule in the ventrolateral part of the right lobe was described as suspicious because of the presence of microcalcifications.

Palpation: The right lobe was firm, no nodule could be palpated.

Results of blood test: TSH 5.99 mIU/L, aTPO 37 U/mL.

Ultrasonography. The thyroid was minimally-moderately hypoechogenic and presented several less hypoechogenic and a few echonormal areas. These fields did not fit to pathological nodules. The lesion in the ventrolateral part of the right lobe contained not only echogenic granules but also echogenic lines. Therefore, these figures corresponded not to microcalcifications but connective tissue. (This lesion is better seen on the video than in images.)

Aspiration cytology resulted in lymphocytic thyroiditis.

Suggestion: daily 50 microgram levothyroxine, repeat TSH in 3 months.

Second examination 2 years later (second row of images)

Clinical presentation: The patient became euthyroid and had no complaints. On carotid Doppler examination a "TIRADS 5, suspicious" thyroid nodule was described. The patient was referred for aspiration cytology.

Palpation: unchanged.

Result of blood test: TSH 2.26 mIU/L on daily 50 microgram levothyroxine.

Ultrasonography. The pattern was unchanged except for the discrete areas becoming better demarcated.

Cytology was performed from a hypoechogenic area located in the right lobe and resulted in Hashimoto's thyroiditis.

Comments.

1. None of the discrete areas fit to nodule in pathological sense.

2. We have to avoid using the term suspicious or similar words on an ultrasound report.