Three years prior to present examination (first row of images)

Clinical data: a 36-year-old woman referred for evaluation of nodular goiter. On evaluation of progressive difficulties in swallowing, palsy of the left recurrent nerve and a nodular goiter was discovered.

Palpation: no abnormality.

Functional state: euthyroidism with TSH 2.87 mIU/L.

Ultrasonography. The thyroid was echonormal and contained small hypoechogenic areas. The echogenicity index was around 20%. There was an echonormal nodule presenting hypoechogenic parts in the right lobe. Th presence of halo sign and perinodular blood flow was doubtful, while the intranodular bloood flow was increased.

Cytology of the echonormal nodule resulted in benign report.

On further examinations a viral infection was suspected as a cause for the complaints of the patient. Three months after the beginning of dysphagia, the complaints of the patient have resolved including recurrent nerve palsy.

Present examination (second row of images)

Clinical data: hypothyroidism has developed one year after the preious examination and the patient was treated with levo-tiroxin. She was referred for ultrasound follow-up examianation.

Palpation: a firm, enlarged thyroid. The presence of nodule was equivocal.

Functional state: euthyroidism on daily 100 microgram levo-tiroxin (TSH 0.47 mIU/L).

 

The nodule in question is located in the dorsal part of the right thyroid.