Clinical presentation: A 58-year-old woman was referred for evaluation of a multinodular goiter detected on carotid Doppler examination.

Palpation: No abnormality.

Laboratory test: 1.14 mIU/L.

Ultrasound. The thyroid was echonormal. There were two types of discrete lesions. First, the thyroid had cystic areas presenting echogenic figures caused by posterior cystic enhancement. These lesions correspond either to an evolving multinodular goiter or dilated macrofollicles. Second, there were several moderately and deeply hypoechogenic islets which had irregular shape. These are more active foci of thyroiditis.

Additional laboratory test: aTPO 566 U/mL.

Aspiration cytology was performed from a hyperechogenic lesion located in the ventromedial part of the right lobe and from a hypoechogenic lesion having punctate echogenic foci and in both locations resulted in Hashimoto's thyroiditis.

Comment. It is doubtful whether the cystic areas are true nodules or simply dilated macrofollicles while the solid hypoechogenic areas are unlikely nodules in pathological sense.