First examination (first row):

Clinical presentation: a 41-year-old woman was referred for an evaluation of typical complaints suggesting hyperthyroidism.

Palpation: no abnormality.

Functional state: hyperthyroidism with TSH 0.001 mIU/L, FT4 41.9 pM/L.

Ultrasonography: the thyroid was moderately hypoechogenic without any nodule. The vascularization was increased.

Clinical diagnosis: hyperthyroidism caused by Graves-Basedow's disease.

We administered daily 20 mg methimazole to the patient.

Second examination one year later (second row):

Clinical presentation: the patient was treated with hyperthyroidism for a year. She had no complaints.

Palpation: no abnormality.

Functional state: euthyroidism on daily 10 mg methimazole and 50 microgram levothyroxine with TSH-level 2.08 mIU/L, FT4 13.9 pM/L.

Ultrasonography: the echo structure and the vascularization of the thyroid had normalized.

The methimazole was discontinued.

Third examination two years after the first (third row):

Clinical presentation: the patient was well till the previous month. Then she lost 2 kg in weight, fatigue, nervousness developed.

Palpation: no abnormality.

Functional state: hyperthyroidism with TSH-level 0.01 mIU/L, FT4 49.9 pM/L, TSH-receptor antibody test positive.

Ultrasonography: the thyroid became minimally hypoechogenic, and the vascularization was increased again.

Suggestion: daily 20 mg methimazole and radioiodine therapy.