Clinical presentation: A 71-year-old woman was referred for follow-up evaluation of hypothyroidism which has been known and treated for more than 20 years.

Palpation. No abnormality.

Laboratory tests: TSH 1.27 mIU/L. The aTPO level was 829 U/mL at the time of diagnosis of hypothyroidism.

Ultrasound. The thyroid was atrophic. Basically, the thyroid was moderately hypoechogenic and had more and less hypoechogenic areas. None of the areas corresponds to a pathological nodule.

Ultrasonography. The thyroid was atrophic and composed of hypoechogenic areas. None of these areas corresponded to nodule in pathological sense.