First examination (first row of images):

Clinical presentation: A 31-year-old woman was referred for evaluation of hypothyroidism detected on evaluation of tinnitus.

Palpation: The thyroid was not palpable.

Hormonal investigation: TSH 8.06 mIU/L, FT4 12,2 pM/L, aTPO 381 U/mL.

Ultrasonography revealed a minimally-moderately hypoechogenic thyroid showing fibrotic changes and tiny hypoechogenic areas. The vascularization was decreased.

Diagnosis: Subclinical hypothyroidism. Autoimmune thyroiditis.

Suggestion: daily 50 microgram levothyroxine.

Second examination 3 years later (second row of images):

Clinical presentation: The patient had no complaints.

Palpation: The thyroid was not palpable.

Hormonal investigation: TSH 3.82 mIU/L.

Ultrasonography remained unchanged.

Suggestion: to continue with daily 50 microgram levothyroxine.