Clinical presentation: A 30-year-old woman was referred for evaluation of a relapsing hyperthyroidism. She was first treated for hyperthyroidism 2 years ago.

Palpation: no abnormality.

Laboratory tests: TSH 0.001 mIU/L, FT4 77.9 pM/L, TSAb > 40 U/L.

Ultrasonography. The thyroid was hypoechogenic without any discrete lesions of clinical significance. The thyroid presented hyperechogenic lines. The vascularization was extremely increased.

Definitive therapy was advised. The patient decided to undergo total thyroidectomy because she could not manage the two weeks absence from his 4-yr-old child required after a radioiodine therapy. Histopathology: Diffuse goiter corresponding to Graves' diseases.