Clinical presentation: A 40-year-old woman requested a second opinion. She has been treated for hypothyroidism for 2 years.

Palpation: The thyroid was moderately firm without any palpable nodule.

Laboratory test: TSH 4.55 mIU/L on daily 50 microgram levothyroxine.

Ultrasonography. The thyroid was moderately hypoechogenic and inhomogeneous. There were several more hypoechogenic areas in both lobes. None of these fit to a nodule in pathological sense.

Diagnosis: hypothyroidism caused by Hashimoto's thyroiditis.

Suggestion: continuation with the replacement therapy. TSH-determination in a year's time.