Clinical data: a 64-year-old woman was referred for a suspicious nodule in the region of the thyroid. She was operated on Graves' disease for 14 years. She suffered from intermittent vertigo for a year.

Palpation: a hard lump in the region on the left thyroid bed.

Functional state: euthyroidism with TSH 3.52 mIU/L.

Ultrasonography: the thyroid remnant was moderately hypoechogenic and contained several small inhomogeneous discrete lesions without any clinical or oncological significance. The carotid artery presented stenosis in the region of the left thyroid bed. 

We advised further evaluation of carotid artery stenosis and a significant stenosis was diagnosed which was resolved by surgery.