Clinical presentation. A 24-year-old woman was referred for evaluation of an elevated TSH and a multinodular goiter detected on evaluation of weight gain. We met the patient 8 years ago when the examination resulted in euthyroid Hashimoto's thyroiditis based on a 60% echogenicity index despite a normal aTPO level (10 U/mL). At that time we did not find any nodules in pathological sense.

Palpation: Both lobes were moderately firm.

Laboratory tests: TSH 5.26 mIU/L, FT4 12.7 pM/L, aTPO 7 U/mL.

Ultrasound. Great proportion of the thyroid was composed of hypoechogenic areas. These were not of geometrical shape, had an irregular border and presented echonormal tissue. None of them fit to a true nodule.

Aspiration cytology from the hypoechogenic lesion in the isthmus resulted in Hashimoto's thyroiditis.

Comment. The lesions are unlikely being nodules in pathological sense.