Clinical presentation: A 38-year-old woman was referred for follow-up evaluation of a nodular goiter which has been known for almost 20 years. Cytology was benign 5 years ago.

Palpation: The left lobe was enlarged and had a firm nodule.

Result of blood tests: TSH 2.06 mIU/L, aTP0 102 U/mL.

Ultrasonography. The thyroid was minimally-moderately hypoechogenic. There was a large cystic nodule in the left lobe. The nodule belonged to the spongiform-type subgroup. The nodule did not increase in size in the last ten years.

Suggestion. To continue with follow-up: TSH in 2 years, ultrasound in 3 years.