Clinical presentation: A 67-year-old woman was referred for evaluation of a newly discovered hypothyroidism. She has been known harboring a nodule for almost 20 years. We aspirated her lesion 7 years ago, thereafter an acute inflammation had developed (see case 2 of rare forms of thyroiditis). In the upcoming years she had no complaints.

Palpation. No abnormality.

Laboratory tests: TSH 6.76 mIU/L, aTPO 92 U/mL.

Ultrasonography.  The thyroid has decreased in size compared with the former examination. The dimensions of the lesion in the left lobe were 13x11x18 mm and 4x3x6 mm, first and present examination, respectively.

Suggestion: daily 50 microgram levothyroxine.