Presentation
A patient with a medical history of hypothyroidism and multi-nodular goiter presented for evaluation. A thyroid ultrasound revealed a heterogeneous gland with multiple nodules. Notably, a prominent nodule was identified in the left mid/lower pole. Fine needle aspiration (FNA) of this nodule demonstrated benign thyroid tissue, consistent with goiter and Hashimoto's lymphocytic thyroiditis.
Patient Data
The left thyroid lobe is diffusely heterogeneous with multiple nodules.
Mid/lower left pole solid or almost completely solid, hyperechoic thyroid nodule with mild vascularity and no calcifications measuring approximately 2.9 x 1.9 x 2.7 cm.
Case Discussion
The patient, with a known history of hypothyroidism, presented with a prominent nodule located in the mid/lower pole of the left thyroid. Fine needle aspiration revealed benign thyroid tissue with polymorphous lymphocytes, consistent with Hashimoto's thyroiditis. This nodule, referred to as a 'White-Knight' nodule, is well-defined, isovascular or avascular, and lacks calcifications—typical findings associated with Hashimoto's thyroiditis.
Hashimoto's thyroiditis most often manifests as a diffusely enlarged thyroid with a coarsened, hypoechoic texture on ultrasound. In some cases, patients with Hashimoto's thyroiditis may develop nodular changes, with hyperechoic nodules that are generally regenerative and benign 1.
Contributor and mentor: Dr Ravikumar Hanumaiah
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