Clinical presentation: a 40-year-old woman requested a second opinion. She was treated for hypothyroidism for 7 years. She was examined because of her infertility. No thyroid ultrasonography was performed, yet.

Palpation: both thyroids were firm on palpation. The right lobe was enlarged and nodular on palpation.

Functional state: euthyroidism on daily 75 microgram levo-tiroxin (TSH 1.09 mIU/L).

Ultrasonography: the thyroids were echonormal. There was a hypoechogenic nodule in the right lobe. The nodule displayed a halo sign and perinodular blood flow. There were smaller moderately hypoechogenic areas within both lobes.

Combined cytological-clinical-sonographic diagnosis: Hashimoto's thyroiditis and Hürthle-cell tumor.

Histopathology disclosed Hashimoto's thyroiditis and Hürthle-cell adenoma.

Comments:

1. To perform ultrasonography is mandatory in each thyroid patient.

2. Although follicular cells display atypia and prominent nucleoli, the cytological picture itself is not suspicious. Taking the sonographic pattern into account the patient must have had a follicular-type tumor with great probability.