Right lobe, transverse scan

Right lobe, longitudinal scan

Right lobe, color Doppler mode

Right lobe, microflow imaging

Left lobe, transverse scan

Left lobe, longitudinal scan

Left lobe, color Doppler mode

Summary of ultrasound and laboratory data:

Date of examination	Volume of the thyroid lobes (mL)		Echogenicity index (%)	Therapy before	Results of laboratory investigations			TSAb (U/L) (normal value < 1.5)	Therapy after
	Right lobe	Left lobe			TSH (mIU/L)	FT4 (pM/L)	FT3 (pM/L)
7 months after delivery	8.3	6.6	70%	Nothing	0.01	17.7	7.16	1.5	Nothing
9 months after delivery	12.9	12.4	25%	Nothing	< 0.001	51.6	6.90	6.0	20 mg methimazole
11 months after delivery	19.5	15.9	80%	20 mg methimazole	33.7	3.83	-	-	10 mg methimazole
14 months after delivery	11.9	8.7	20%	10 mg methimazole	5.91	12.5	-	-	5 mg methimazole
20 months after delivery	12.8	11.8	15%	5 mg methimazole	2.08	12.6	-	0.1	Nothing

First examination - additional clinical data: A 27-year-old woman was referred for evaluation. She gave birth seven months ago. In the following months, she experienced significant weight loss, sweating, and a high heart rate. Symptoms significantly diminished by the time of the first study.

Second examination - additional clinical data: The patient's previous symptoms recurred two weeks before the study.

Comments.

1. Based on the clinical symptoms, it is assumed that the patient already had spontaneously improving hyperthyroidism in the months after delivery.

2. Neither clinical nor hormonal course is characteristic of post partum thyroiditis but is of Graves' disease.

3. This is the typical course of a Graves' hyperthyroidism which does not relapse within a year. As the hormone result improves, both the size of the initially enlarged goiter and the degree of hypoechogenicity decrease.