Clinical data: A 56-year-old woman was referred for evaluation. She has been treated for hypothyroidism for more than 10 years. Two months before the present examination, symptoms of thyroid associated orbitopathy (tearing, photosensitivity and exophthalmos in one side) have occurred. The patient did not have double vision. A week after the onset of eye complaints, COVID-19 infection was diagnosed. At that time, TSH was 0.01 on daily 100 microgram levothyroxine. The dose was reduced to daily 25 microgram by the GP.

Palpation: The right lobe was palpable but no nodule was found.

Laboratory evaluation: TSH-level 0.61 mIU/L on daily 25 microgram levothyroxine. TSAb 31 U/L (normal values below 1.5).  

Ultrasonography revealed hypoechogenic inhomogeneous thyroid. There were numerous less hypoechoic discrete areas corresponding to those parts of the gland which were not or less influenced by the underlying thyroiditis. There was a nodule-like lesion in the ventrolateral part of the left lobe.

Comments.

1. It was not evident whether the discrete lesion in the left lobe would be a true nodule or not. In such cases, the term nodule-like or discrete lesion is clearly preferred over nodule.

2. We cannot rule out that the infection diagnosed one week after the symptoms existed before the onset of symptoms and was responsible for the ophthalmopathy.