Clinical presentation. A 28-year-old woman has been treated for recurrent hyperthyroidism for several years. She was referred for aspiration cytology of a thyroid nodule detected on ultrasound performed because of a planned surgery. The colleague described a nodule having microcalcifications in the lower part of the left lobe.

Palpation: no abnormality.

Laboratory tests: TSH 0.01 mIU/L, FT4 31,5 pM/L on daily 20 mg methimazole.

Ultrasonography. The thyroid was echonormal and contained multiple hypoechogenic areas. The echogenicity index was around 20%. None of the discrete lesions fit to nodule in pathological sense. The vascularization was increased.

Cytology of the hypoechogenic lesion in the left lobe resulted in benign hormonal atypia.

Histopathology disclosed a diffuse goiter corresponding to Graves' disease.

Comments. There were two issues in the ultrasound interpretation of the colleague. First, the thyroid did not contain any nodules. The discrete hypoechogenic areas in this case are typical presentations of a diffuse Graves' disease. Second, the echogenic figures did not belong to the echogenic punctate granule (microcalcification) subgroup because not only echogenic granules but also echogenic lines were present within the lesion.

 

 

 

 

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