First examination (first row of images):

Clinical presentation: A 49-year-old woman was referred for evaluation of a hyperthyroidism. The patient had had typical complaints for 2 months.

Palpation: no abnormality.

Laboratory tests: TSH 0.001 mIU/L, FT4 53.7 pM/L.

Ultrasonography. The thyroid was hypoechogenic and presented echogenic lines corresponding to proliferation of connective tissue. The vascularization was significantly increased.

Suggestion: daily 30 mg methimazole and check of the thyroid function in 5 weeks.

Follow-up examination 2 months after the previous visit (second row of images):

Clinical presentation: The hyperthyroid symptoms have resolved, the patient has gained her weight back.

Palpation: The thyroid became enlarged.

Laboratory tests: TSH 0.03 mIU/L, FT4 4.4 pM/L.

Ultrasonography. The thyroid became enlarged and more hypoechogenic while the vascularization did extremely increased.

Suggestion: to stop thyrostatic therapy for 5 days, then follow with daily 10 mg.

Summary of the follow-up. 6 months later the hyperthyroidism had relapsed and definitive therapy was suggested. The patient refused radioiodine treatment and chose surgery.

Histopathology: Diffuse goiter corresponding to Graves' disease. Focal lymphocytic thyroiditis.