Clinical presentation: A 35-year-old woman was referred for evaluation of a suspected hypothyroidism detected by a routine blood test.

Palpation: no abnormality.

Hormonal investigation: euthyroidism (TSH 3.39 mIU/L, aTPO 214 U/mL).

Ultrasonography revealed a minimally-moderately hypoechogenic thyroid which presented more hypoechogenic areas. None of the latter fit to a nodule in a pathological sense. The thyroid contained abundant connective tissue.

Suggestion daily 50 microgram levo-tiroxin.

Comments.

1. 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.

2. The large hypoechogenic area was irregular in shape which strongly argued against a true nodule.