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Evaluation of thyroid ultrasound and 99mTc-pertechnetate scintigraphy side by side frequently produces ambiguous results regarding the correct assignment of anatomy and functionality of a nodule. We describe the usefulness of 99mTc-pertechnetate-SPECT/US-fusion imaging. A 75-year-old woman was referred for exclusion of cold nodules. After conventional diagnostics (in vitro thyroid parameters, B mode–US, planar 99mTc-pertechnetate-thyroid scintigraphy), a SPECT was performed using a conventional gamma camera. The SPECT data set was transferred to an ultrasound device (LOGIQ E9), and sensor-navigated 3D ultrasound was performed. Both data sets (SPECT/US) were fused in real time, revealing the exact functional state of multiple nodules.