Clinical presentation: A 50-year-old woman was referred for evaluation of a nodular goiter. She had typical complaints suggesting hypothyroidism. The TSH was elevated. On ultrasound multiple nodules were described including "a large, highly suspicious nodule with lobulated margins" in the right lobe.

Palpation: Both lobes were firm. No discrete nodule could be palpated.

Hormonal investigation: hypothyroidism with TSH 22.5 mIU/L.

Ultrasonography: The right lobe was composed of partly relatively well-demarcated, partly flowing-to-each-other hypoechogenic areas. The left lobe presented the so-called micronodular pattern of Hashimoto's thyroiditis.

Cytological diagnosis: Hashimoto's thyroiditis.

Comments.

1. Hashimoto's thyroiditis can present practically any form of hypoechogenic areas. The pattern even in the right lobe corresponds to micronodular form of Hashimoto's thyroiditis.

2. The larger masses present lobulated margins which is caused by the presence of multiple discrete lesions next to each other. It means that this is not a pathological lobulation, that should be always referred to a single lesion.