Clinical presentation: A 71-year-old woman was referred for evaluation of a newly discovered hypothyroidism. She has been treated twice for Graves' disease, last time 4 years ago. Scintigraphy disclosed diffusely increased uptake at the beginning of both time of hyperthyroidism. In the upcoming years the TSH remained normal without thyrostatic medication.

Palpation: Both lobes were firm. There was a firmer nodule in the lateral part of the left lobe.

Laboratory tests: TSH 11.6 mIU/L, FT4 11.6 pM/L, aTPO 308 U/mL.

Ultrasound. The thyroid was moderately hypoechogenic and presented several small hypoechogenic areas. There was one larger hypoechogenic lesion in the isthmic part of the right lobe while two other similar lesions were found in the left lobe. Compared to the previous ultrasound description 6 years earlier, neither the pattern nor the size of the lesions has changed.

Suggestion: daily 50 microgram levothyroxine.

Comment. It is difficult to decide whether the discrete areas are true nodules or not. We described them as nodule-like lesions on ultrasound report.