Clinical presentation: a 68-year-old woman was referred for an evaluation of a hard nodule detected on a routine examination. She was operated for a multinodular goiter 13 years ago. Bilateral subtotal thyroidectomy was performed, histopathology disclosed a benign, hyperplastic nodulear goiter.

Palpation: a very firm nodule in the lower part of the right thyroid.

Functional state: euthyroidism on daily 137.5 microgram levothyroxine (TSH-level 3.91 mIU/L).

Ultrasonography : the right thyroid was minimally hypoechogenic. There was a hypoechogenic lesion with an echonormal inhomogeneous patch in the lower part of the right lobe. This area contained bright hyperechogenic granules and was avascular. The ventral part of the left lobe was hypoechogenic and the dorsal part was echonormal.

Cytology: was performed from the lesion in the lower part of the right lobe and resulted in benign granulation around a surgical thread.

Comments:

1. The ultrasound pattern of a granulation around surgical thread is very similar to that of an amyloid deposit observed in medullary cancer. Moreover, such lesions are always very firm or even hard.

2. The patient history is essential to a correct diagnosis and to avoid causing unnecessary anxiety in the patient.