Clinical presentation: a 42-year-old woman with an enlarged left lobe causing dysphagia.

Functional state: subclinical hypothyroidism (TSH 5.75 mIU/L, FT4 11.3 pM/L, anti TPO > 1000 IU/mL).

Ultrasonography: hypoechogenic lobes with multiple hyperechogenic circumscribed lesions in the left lobe. 

Cytological report: benign Hashimoto's thyroiditis. Surgery was advised because of the complaints caused by the goiter.

Histopathology: revealed diffuse Hashimoto's thyroiditis without any nodule in the left lobe.

Comments.

1. The multiple hyperechogenic nodule-like lesions are in fact pseudolobules not influenced by the underlying autoimmune process.

2. Papillarization is not a frequent finding in the case of Hashimoto's thyroiditis. In this patient it did not cause differential diagnostic problem, because the lack of inclusions and grooves excluded the possibility of papillary cancer. Moreover, the presentation of the papillary cluster was benign: the edges were not sharp, and the cells at border of the clusters had the tendency to dissociate.