Clinical presentation: A 38-year-old woman was referred for aspiration cytology. The patient had recurrent hyperthyroidism and surgery was planned. Before the operation multiple nodules were found on ultrasound.

Palpation. Both lobes were enlarged. No nodule could be palpated.

Laboratory tests: TSH 0.01 mIU/L, FT4 20.7 pM/L, FT3 10.7 pM/L on daily 20 mg methimazole.

Ultrasonography. The thyroid was composed of echonormal and hypoechogenic areas. The echogenicity index was around 40%. None of the discrete areas fit to a nodule in a pathological sense. The vascularization was increased.

A total thyroidectomy was performed. Histopathology resulted in diffuse goiter corresponding to Graves' disease.

Comment. This is one of the most typical patterns of a diffuse autoimmune thyroid disease. If we held this pattern as nodular than almost 100% of diffuse thyroids would be described as nodular.