Clinical presentation: a 44-year old man was referred for an evaluation of a nodular goiter. He noticed difficulties in swallowing.

Palpation: both thyroids were enlarged and firm and nodular on palpation.

Hormonal evaluation: euthyroidism with TSH 1.07 mIU/L.

Ultrasonography: the thyroids were hypoechogenic and were composed of multiple discrete echonormal areas none of them fitting to a nodule.

Cytology: resulted in Hashimoto's thyroiditis.

Combined sonographic-cytological diagnosis: Hashimoto's thyroiditis.

The patient was operated because of compression signs.

Histopathology: disclosed Hashimoto`s thyroiditis. No nodules were found.