Clinical presentation. A 39-year-old woman went with her father to my consulting and she decided to request a thyroid examination. She has been treated with lithium for depression for more than 10 years. Two years after the initiation of antidepressant treatment hypothyroidism has developed. The patient was stopping the daily 50 microgram levothyroxine therapy one year ago because she felt no effect of the replacement treatment. Except for regular TSH determinations no other thyroid tests has been performed ever.

Palpation: both lobes were firm. There was a more firm nodule in the lateral part of the left lobe.

Laboratory tests: TSH 4.07 mIU/L, FT4 11.2 pM/L, aTPO 206 U/mL on daily 900 mg lithium.

Which type or types of hyperechogenic figures have the lesions in question?

Lesion 1: the hypoechogenic nodule in the upper-lateral part of the left lobe. Lesion 2: the nodule in the dorsal part of the left lobe.