The report also indicats:
There is evidence of enlarged thyriod gland right lobe measures 18*15 mm left lobe measures 20* 19 mm
The gland shows focal hypo echoic focus with mild increased vascularity.
I have Hashimoto's and had my thyroid removed in two surgeries last year.
I had two thyroid ultrasounds before my surgeries, and they didn't show any swollen lymph nodes on the ultrasound (I had a multinodular goiter with lots and lots of nodules, so maybe they just didn't pick up on all the lymph nodes).
During the first surgery, which removed just my right thyroid lobe, 3 swollen lymph nodes were removed, all of them were non-cancerous (my thyroid nodule that was suspicious, along with 2 other nodules were cancerous, but had not spread past the thyroid).
During the second surgery, which removed my remaining thyroid tissue, 3 lymph nodes were stuck to the side of the thyroid and were removed when the thyroid was removed, and 8 more swollen lymph nodes were removed in a clump from the "central compartment" of my neck. All 11 of those lymph nodes were non-cancerous.
Swollen lymph nodes can be caused by the immune system's attack on the thyroid with Hashimoto's. In my case, I didn't realize I had a thyroid problem until it was a really big problem for me (multinodular goiter with some nodules that had to come out because they were cancer, but hadn't spread outside the thyroid). I'm not sure if everyone with Hashimoto's has lots of swollen lymph nodes, but in my case I did.
Other things can cause swollen lymph nodes as well, but since you have Hashimoto's, I would think that the most likely cause would be the autoimmune attack on the thyroid.
As for the thyroid itself, depending on the size of the "focal hypoechoic focus with mild increased vascularity", the doctor may recommend a fine needle biopsy. Usually biopsies are done on thyroid nodules 2 cm or larger. Hypoechoic nodules have a slightly higher risk so they may recommend a biopsy if it is 1-1.5 cm or larger, but since no sizes are noted it is difficult to tell. Nodules smaller than 1 cm are usually not biopsied, just monitored by ultrasound to see if they increase in size.
What should you do? I hope that you are less worried about the lymph nodes as they can often be swollen due to the autoimmune attack with Hashimoto's. If there is still a lot of pain in the thyroid, that is something that you need to talk to your doctor about.