Clinical presentation: A 32-year-old woman was referred for evaluation of a recurrent hyperthyroidism. She has been treated for recurrent hyperthyroidism for three years. Her thyroid associated orbitopathy has got worse over the years and diplopia has developed.

Palpation. Both lobes were enlarged.

Laboratory test: TSH 9.72 mIU/L, FT4 13.8 pM/L, FT3 4.99 pM/L on daily 20 mg propylthiouracil.

Ultrasonography. The thyroid was minimally hypoechogenic and presented more hypoechogenic discrete areas. The vascularization was average.

Total thyroidectomy was performed. Histopathology disclosed diffuse goiter.