Clinical presentation: A 55-year-old woman was referred for follow-up of hypothyroidism which has been treated for more than 15 years. Recently she has undergone ultrasound examination. On ultrasound report multiple hypoechogenic nodules were described.

Palpation. No abnormality.

Laboratory test: TSH 7.15 mIU/L on daily 100 microgram levothyroxine.

Ultrasonography. The thyroid was atrophic. There were multiple moderately hypoechogenic discrete areas within a near echonormal background. There were no nodules of pathological sense.

Suggestion: to increase the dose of levothyroxine to daily 125 micrograms.