Clinical presentation: A 31-year-old woman was referred for evaluation of a suspected hypothyroidism. She had 3 stillbirths in the previous 2 years.

Palpation: no abnormality.

Hormonal investigation: euthyroidism (TSH 3.21 mIU/L, aTPO 971 U/mL).

Ultrasonography. The right lobe was moderately hypoechogenic while the left was echonormal. Both contained more hypoechogenic areas. None of these fit to a nodule in a pathological sense.

Suggestion daily 50 microgram levo-tiroxin.

Comment. In our practice we administer replacement therapy for euthyroid women in childbearing age if the TSH exceeds 3 mIU/L and either the ultrasound or the aTPO level suggest an underlying autoimmune thyroiditis.