Clinical presentation: A 55-year-old woman was referred for follow-up investigation. She has been treated for hypothyroidism for five years.

Palpation: Both lobes were moderately firm and uneven.

Hormonal investigation: euthyroidism on daily 75 microgram levothyroxine (TSH 1.28 mIU/L). The aTPO level was 296 U/mL 7 years ago.

Ultrasonography revealed minimally-moderately hypoechogenic thyroid presenting more hypoechogenic areas. These corresponded to more active foci of Hashimoto's thyroiditis and not to nodules in a pathological sense.

Suggestion: to continue with the same dose of replacement therapy.