Clinical presentation: A 32-year-old woman was referred for evaluation of 'lump in the throat' feeling.

Palpation: The thyroid was not palpable.

Hormonal investigation: subclinical hypothyroidism (TSH 7.02 mIU/L, FT4 11.8 pM/L, aTPO 0.5 U/mL).

Ultrasonography revealed a minimally hypoechogenic, inhomogeneous thyroid having several tiny and one relatively larger hypoechogenic area in the left lobe.

Follow-up: Instead of immediate replacement therapy we initiated a repeat TSH-test in 3 months which resulted in 4.93 mIU/L. Suggestion: TSH in every 6 to 12 months, if TSH exceeded 5 mIU/L on two successive occasions, replacement therapy would be indicated.