Clinical data: a 25-year-old woman with signs of hyperthyroidism referred for a thyroid investigation.

Functional state: moderate degree of hyperthyroidism (TSH-level 0.001 mIU/L, FT4 32.1 pM/L, FT3 9.01 pM/L).

Ultrasonography: echonomal thyroid with an echogenicity index of 30%. The vascularization was not increased.

Clinical diagnosis: in the absence of increased vascularity we presumed a clinically subacute, pathologically lymphocytic thyroiditis with hashitoxicosis. 

Suggestion: follow-up with only symptomatic treatment and no thyrostatic drug.

Follow-up results:

6 weeks later. The patient had no clinical signs of thyroid dysfunction. Anti-TPO level 301 IU/ml, anti-TSH-receptor antibody test normal, TSH 0.01 mIU/L, FT4 11,4 pM/L, FT3 5,02 pM/L. The sonographic picture did not changed.

1 year later. Euthyroidism (TSH 3.72 mIU/L, FT4 11.2 pM/L).

2 years later. Hypothyroidism (TSH 8.01 mIU/L, FT4 8.37 pM/L).