Initial examination (1st and 2nd rows of images):

Clinical presentation: a 29-year-old woman was referred for an evaluation of hyperthyroidism. She lost 3 kg in weight and had palpitation.

Palpation: both thyroids were firm but not tender.

Functional state: hyperthyroidism with TSH-level 0.01 mIU/L, FT4 39.1 pM/L.

Ultrasonography: there were two hypoechogenic lesions with blurred borders in both lobes. The vascularization was average.

Cytological and final diagnosis: subacute, granulomatous de Quervain's thyroiditis.

Suggestion: steroid therapy and beta-blocking agent.

Examination 3 months later (3rd row of images):

Clinical presentation: the patient had no complaints.

Palpation: no abnormality.

Functional state: euthyroidism with TSH-level 3.99 mIU/L, FT4 12.8 pM/L.

Ultrasonography: the extent of hypoechogenic areas decreased.

Comment: de Quervain's thyroiditis without neck complaints is a relatively rare situation. The sonographic picture was very specific. It is mandatory to perform ultrasound examination in a hyperthyroid patient without thyroid-associated ophthalmopathy.