Unfortunately, I'm not an expert in reading ultrasound reports... is this the entire report? Usually, at the end, there's a paragraph or sentence that give the "findings" or "recommendations", which is what the radiologist thinks should be done for follow up...
The large lesion may be of concern, as it could be nodule and possibly should have a biopsy to make sure it's not cancerous. However, it should be noted that less than 5% of all nodules (if that's what this is) turn out to thyroid cancer, which is the easiest of all cancers to treat, as the thyroid is removed and the cancer with it.
The thyroid is enlarged, which means a goiter - very common with thyroiditis, such as Hashimoto's Thyroiditis...
What symptoms are present? Has blood work been done to test actual thyroid function? There should have been Free T3, Free T4 and TSH at the very least. In addition, hopefully, the doctor would have ordered thyroid antibody tests to determine whether there is an autoimmune thyroid condition such as Hashimoto's or Graves Disease, depending on symptoms presented.
If you can give further information, regarding symptoms and blood work, I will be happy to help you as much as I can. When providing results for blood tests, please be sure to include reference ranges, since those vary lab to lab and have to come from one's own lab report.