Clinical presentation: A 33-year-old man requested a second opinion. He has been treated for recurrent hyperthyroidism for more than 6 years. The last relapse occurred 6 weeks ago.

Palpation. Both lobes were enlarged, no nodule could be palpated.

Laboratory tests: TSH 0.001 mIU/L, FT4 6.8 pM/L, FT3 4.99 pM/L on daily 60 mg propylthiouracil.

Ultrasonography. The thyroid was hypoechogenic and presented increased vascularization. There were no discrete lesions in the thyroid.

Total thyroidectomy was performed. Histopathology disclosed diffuse goiter.