Clinical presentation: a 58-year-old woman requested a second opinion. She was known to harbor a multinodular goiter for decades. The goiter slowly increased in size and already caused neck complaints in supine position. She wished to undergo on sclerotherapy instead of surgery.

Palpation: the left lobe was enlarged and contained a larger elastic nodule in the upper while a hard, smaller lesion in the lower part.

Functional state : euthyroidism (TSH 1.05 mIU/L).

Ultrasonography. The right thyroid was intact. There was a mixed nodule in the upper part of the left lobe. There was another nodule in the middle-lower part of the left lobe. The latter presented the so-called eggshell calcification. Both nodules displayed a type 1 vascular pattern.

Cytology was performed from the nodule with eggshell calcification. Cytological diagnosis : benign, colloid goiter with oxyphilic metaplasia.

A nodule with eggshell calcification is unsuitable for ethanol sclerotherapy because we cannot see anything behind the coarse calcification. Surgery was advised and a left lobectomy was performed.

Histopathology disclosed benign hyperplastic nodules with degenerative changes.

Comment. Most if not all mixed nodules evolve from a solid nodule. The solid part of a mixed nodule is presented as an increment in all of the cases.