Clinical data: A 40-year-old man was referred for evaluation of hypothyroidism detected on screening.

Palpation: no abnormality.

Laboratory tests: TSH 4.25 mIU/L, aTPO 574 U/mL.

Ultrasonography. The thyroid was minimally/moderately hypoechoic. There were no discrete lesions within the lobes.

We suggested TSH in a year.

Comments. It is well-known that hypoechogenicity is the hallmark of an autoimmune thyroiditis. Nevertheless, a thyroid without any discrete lesion is rather the exception in this disease.