Clinical presentation: A 61-year-old woman was referred for evaluation of a newly diagnosed hypothyroidism. We met the patient first 15 years ago when Hashimoto's thyroiditis was diagnosed both on ultrasound presentation and elevated aTPO level (1524 U/mL). She underwent yearly TSH test which became abnormally elevated at the last two occasions.

Palpation. No abnormality.

Laboratory test: TSH 9.01 mIU/L.

Ultrasonography. The thyroid was moderately hypoechogenic and presented several more hypoechogenic areas. There were no nodules of pathological sense.

Diagnosis: Primary hypothyroidism caused by Hashimoto's thyroiditis. Daily 50 microgram levothyroxine was adjusted.

Comment. It is worth to compare the presentation of the thyroid with that of the former patient who is the daughter of this woman.