Clinical presentation: A 55-year-old woman was referred for evaluation of a nodular goiter detected on evaluation of "lump in the throat" feeling.

Palpation: Both lobes had an uneven surface, the thyroid was firm. There was no unequivocal nodule on palpation.

Laboratory tests: TSH 1.78 mIU/L, aTPO 704 U/mL.

Ultrasound. Both lobes were composed of a central area having multiple discrete lesions and a peripheral echonormal rim. The discrete lesions had various echo patterns. From an oncological point-of-view two hypoechogenic lesions were remarkable, one in the isthmic part of the right lobe and another one in the lower pole of the left lobe.

Aspiration cytology from the lesion in the lower pole of the left lobe resulted in Hashimoto's thyroiditis.

Comments.

1. All but two of the discrete lesions are unlikely true nodules while the hypoechogenic areas are probably not true nodules.

2. The thyroid presents pseudonodular pattern.