First examination (first row of images):

Clinical presentation: A 39-yr-old woman was referred for evaluation of a newly diagnosed hypothyroidism. She was treated for Graves' hyperthyroidism for 11 and for 7 years. Since than, the thyroid function has been normal.

Palpation: Both lobes were enlarged and nodular on palpation.

Laboratory tests: TSH 10,3 mIU/L, FT4 8.63 pM/L.

Ultrasonography. The thyroid was composed of hypoechoic and isoechoic islets divided by hypoechoic bands. The presentation corresponded to micronodular pattern.

Suggestion: daily 75 microgram levothyroxine. The is 3 months, ultrasound in three years.

Second examination seven years later (second row of images):

Clinical presentation: The patient requested the evaluation because of complaints suggesting hypothyroidism.

Palpation: unchanged.

Laboratory tests: TSH 6.81 mIU/L on daily 50 microgram levothyroxine.

Ultrasonography. The pattern and the thyroid volume were essentially the same as 7 years ago.

Suggestion: daily 75 microgram levothyroxine. TSH in 6 months, ultrasound in three years.

Comments.

1. The micronodular pattern is usually stable. The thyroid is more often enlarged than in other forms of hypothyroidism.

2. As in most cases of micronodular presentation, the presence of true nodule or nodules cannot be ruled out or justified.