Clinical data: a 61-year-old woman was operated on multinodular goiter for 17 years. Bilateral subtotal thyroidectomy was performed and histopathology disclosed benign hyperplastic nodules. She was referred for aspiration cytology because of a "suspicious nodule" in the isthmus.

Palpation: multiple hard nodule were palpated in both lobes.

Results of blood tests: euthyroidism on daily 100 microgram levothyroxine (TSH 1.47 mIU/L).

Ultrasonography: there were multiple hypoechogenic lesions containing amorphous hyperechogenic granules in both resected lobes. The lesions were avascular.

Aspiration cytology resulted in benign granulation around surgical thread.

Comment.

1. Granulation around surgical thread is usually very hard, therefore may suspicious on palpation.

2. Moreover, the sonographic presentation may also cause  fear to an inexperienced investigator not being aware about patient history.