Clinical presentation: A 35-year-old woman was referred for evaluation of a suspected hypothyroidism detected by a routine blood test.

Palpation: no abnormality.

Hormonal investigation: euthyroidism (TSH 3.39 mIU/L, aTPO 214 U/mL).

Ultrasonography revealed a minimally-moderately hypoechogenic thyroid which presented more hypoechogenic areas. None of the latter fit to a nodule in a pathological sense. The thyroid contained abundant connective tissue.

Suggestion daily 50 microgram levothyroxine.

Comments.

1. In our practice we administer replacement therapy for euthyroid women in childbearing age if the TSH exceeds 3 mIU/L and either the ultrasound or the aTPO level suggest an underlying autoimmune thyroiditis.

2. The large hypoechogenic area was irregular in shape which strongly argued against a true nodule.