Clinical presentation: A 42-year-old hypothyroid woman was referred for evaluation of a nodular goiter. She has been treated for hypothyroidism for 2 years.

Palpation: Both lobes were moderately firm.

Laboratory tests: TSH 1.82 mIU/L, aTPO > 1300 U/mL on daily 200 microgram levothyroxine.

Ultrasound. The thyroid was echonormal and presented numerous discrete hypoechogenic areas. None of them corresponded to a nodule in pathological sense. There was a circumscribed echonormal lesion in the central part of the right lobe. This lesion had halo and lobulated margins and displayed punctate echogenic foci.

Aspiration cytology of the echonormal lesion in the right lobe resulted in Hashimoto's thyroiditis.

Comment. The echonormal lesion is probably a nodule in pathological sense while the hypoechogenic areas are unlikely true nodules.