Clinical presentation: An 81-yr-old woman was referred for aspiration cytology of a nodular goiter which was detected on evaluation of weight loss.

Palpation: The right lobe was suspicious having a firm nodule.

Laboratory test: TSH 2.37 mIU/L.

Ultrasonography. The thyroid was echonormal. There was a hypoechoic lesion in the upper while a heterogeneous, dominantly hypoechoic nodule in the lower part of the right lobe. The nodule margins were a bit undulated.

Cytology of the larger, heterogeneous nodule resulted in Hashimoto's thyroiditis.

Comments. Both the upper (smaller) and the lower (larger) lesions belong to EU-TIRADS 4 category.