Clinical presentation: An 89-year-old woman was referred for evaluation of a recurrent hyperthyroidism. She was first treated with methimazole more than 10 years ago. Scintigraphy excluded the presence of autonomously functioning nodule. The patient refused to undergo surgery. The hyperthyroidism was recurred 13 months before present investigation and caused congestive heart failure. The cardiac problems of the patient have significantly ameliorated parallel with the normalization of thyroid function.

Palpation: Both lobes were nodular on palpation.

Functional state: euthyroidism on daily 5 mg methimazole (TSH 4.37 mIU/L, FT4 10.3 pM/L).

Ultrasonography. Both lobes were composed of a large nodular area surrounded with minimally hypoechogenic non-nodular rim. There was a hypoechogenic nodule presenting fibrotic changes and a combined perinodular and intranodular vascularization.

Cytology was performed form the nodule in the right lobe and resulted in benign lesion.

Suggestion: lifelong thyrostatic therapy with checking of thyroid function every 3 months.