Clinical data: a 31-year-old woman was referred for an evaluation of 'lump in the throat' feeling.

Palpation: both thyroids were firm.

Result of blood tests: euthyroidism with TSH-level 2.08 mIU/L, FT4 12.1 pM/L.

Ultrasonography: the thyroid was intact except for a few small minimally hypoechogenic areas in the left lobe.

Aspiration cytology was performed from both thyroids and resulted in Hashimoto's thyroiditis

We performed anti-TPO determination which yielded normal level, 8 U/mL.

We suggested regular follow-up, i.e. TSH determination every year, in the event of pregnancy at once. 21 months later the patient became pregnant. On the 6th weeks of gestation the TSH rose to 7.01 mIU/L. Replacement therapy was started.

Comments.

1. The palpation of the thyroid may have an important role. This was the only clinical sign of thyroid abnormality.

2. The finding of an intact thyroid on ultrasonography in the case of lymphocytic thyroiditis is a very rare situation.

3. The cytology has role not only in nodular thyroid disease but even in the diagnosis of lymphocytic thyroiditis.

4. The correct interpretation of intranuclear holes is essential. See comments to cytological images.