First examination (first row of images):

Clinical data: A 40-year-old woman was referred for evaluation of a relapsing hyperthyroidism. She has been treated for Graves' disease 3-times in the past 12 years.

Palpation: Both lobes were palpable and not firm.

Laboratory tests: TSH 0.001 mIU/L, FT4 49.3 pM/L.

Ultrasonography. The thyroid was diffusely hypoechoic and enlarged. There were no discrete lesions within. The vascularity was increased.

Suggestion: daily 20 mg methimazole.

Second examination 6 weeks later (second row of images):

Clinical data: The patient's complaints disappeared.

Palpation: no abnormality.

Laboratory tests: TSH 5.04 mIU/L, FT4 8.47 pM/L.

Ultrasonography. The thyroid has decreased in size and the vascularity became average.

Suggestion: radioiodine therapy.

Third examination 6 month after the first visit (third row of images):

Clinical data: The patient received radioisotope treatment for 4 months. Three months ago, the first check-up showed hypothyroidism (TSH 12.1 mIU/L), and since then she has been taking 50 microgram of levothyroxine daily.

Palpation: no abnormality.

Laboratory tests: TSH 6.61 mIU/L.

Ultrasonography. The thyroid became smaller and presented scanty vascularity.

Suggestion: to increase the dose of levothyroxine to 75 microgram daily.