Clinical presentation: A 45-year-old woman was referred for follow-up investigation. She was treated with daily 200 microgram levothyroxine but the TSH-level was high.

Palpation: no abnormality.

Laboratory test: TSH 6.51 mIU/L.

Ultrasonography revealed an atrophic thyroid. The lobes were echonormal and had numerous small discrete hypoechogenic areas. The left thyroid bed contained a thickened fiber of the sternocleidomastoid muscle.

We suggested to increase the dose of levothyroxine to daily 300 microgram.

Comment. It is worth analyzing the presentation of the left lobe in video.