Clinical presentation. A 43-year-old woman was referred for evaluation of a nodular goiter. The patient had been treated with hypothyroidism for more than 20 years. She visited a new endocrinologist who performed an ultrasound examination and detected a nodule in the left lobe.

Palpation: No abnormality.

Laboratory tests: TSH 2.90 on daily 75 microgram levothyroxine.

Ultrasound. Both lobes were hypoechogenic. There was an echonormal area in the left lobe which was infiltrated by hypoechogenic tissue. It is doubtful whether the echonormal area is a true nodule or the only intact part of the thyroid.

Aspiration cytology was performed from the lesion and resulted in Hashimoto's thyroiditis.

Comment. The size of the lesion argues for a true nodule while the irregular borders stand against a pathological nodule. We described this area as a nodule-like lesion on ultrasound report.