Clinical presentation: A 35-year-old woman was referred for evaluation of a recurrent hyperthyroidism. The patient had the first hyperthyroidism 12 years ago when she had got thyrostatics for two years. Her complaints have recurred two months prior the present examination. In contrast with the first attack of hyperthyroidism, at this time eye complaints have also appeared.

Palpation: no abnormality. Both lobes were a bit tender. There were no palpable nodules.

Laboratory investigations: TSH 0.001 mIU/L, FT4 44.3 pM/L, TSAb 7.0 U/L (normal value < 1.5).

Ultrasonography. The thyroid was echonormal and presented numerous more hypoechogenic areas. None of them fit to a nodule in pathological sense. The vascularization was moderately increased.

Summary of follow-up. The patient was treated by methimazole. Five weeks after inititation of methimazole therapy, the FT4 level became normal. Despite steroid therapy her eye symptoms have not relieved. Therefore surgery was advised.

Histopathology: Diffuse goiter. Chronic lymphocytic thyroiditis.

 

 

 

 

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