Clinical presentation: A 39-year-old woman was referred for aspiration cytology of a recurrent nodular goiter. She has been underwent a left lobectomy for 4 years because of a large cystic nodule. Histopathology disclosed Hashimoto's thyroiditis and no nodules in a pathological sense. Two years later thyroid associated orbitopathy has developed which caused diplopia and continuous conjunctivitis despite various treatments including large dose steroid therapy. The ophthalmologist suggested removal of the right thyroid.

Palpation: The right lobe was firm and had an uneven surface.

Functional state: TSH 0.39 mIU/L on daily 87.5 microgram levothyroxine. TSAb was 2.9 U/L (normal value < 1.5).

Ultrasonography. The thyroid was moderately hypoechogenic and inhomogeneous. There were multiple discrete lesions which were partly echonormal, partly minimally hypoechogenic. None of them fit to a nodule in a pathological sense. There was no parenchyma in the left thyroid bed.

Cytology of a hypoechogenic lesion in the lower-dorsal part of the right lobe resulted in benign Hashimoto's thyroiditis.

Histopathology: Hashimoto's thyroiditis without any nodules.

 

 

 

 

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