Clinical data: a 70-year-old woman was referred for evaluation of 'lump in the throat' feeling and difficulties in swallowing. She underwent bilateral subtotal lobectomy for 29 years. Her thyroid function was replaced with daily 137.5 microgram levothyroxine.

Palpation: both thyroids were nodular on palpation.

Results of blood tests: euthyroidism on daily 137.5 microgram levothyroxine (TSH 0.98 mIU/L).

Ultrasonography: the thyroids were moderately hypoechogenic and contained several discrete, circumscribed lesions. There was a hyperechogenic nodule in the lower part of the right lobe while a cystic nodule in the upper part of the left lobe.

Comments. It is worth to analyze the video.

1. The thyroid is hypoechogenic and is surrounded with a relatively thin echonormal rim. This makes an appearance if both lobes were composed of a large hypoechogenic nodule. However, the echonormal rim corresponds to thickened connective tissue; a frequent phenomenon in an operated thyroid.

2. The upper part of the right lobe seems to be nodular, i.e. composed of two nodules at first sight. However, an insertion of the connective tissue and an acoustic shadow of a coarse calcification divides this part of the thyroid to two lesions. These do not fit nodules in a pathological sense.