Uneven echogenicity of the thyroid gland suggests the presence of thyroid autoimmune diseases such as thyroid nodules, thyroid adenomas or Hashimoto’s thyroiditis. If the thyroid echogenicity is uneven, we need to check thyroid function and thyroid-related antibodies to see if there are any abnormalities in thyroid function or thyroid antibodies, and if both of these are normal, then regular follow-up is all that is needed, i.e. regular follow-up thyroid ultrasound. If thyroid function is normal, but simple thyroid antibodies are elevated, such as elevated thyroid peroxidase antibodies and thyroglobulin antibodies, this suggests the presence of Hashimoto’s thyroiditis. For Hashimoto’s thyroiditis with normal thyroid function, no treatment is needed, only regular review. Hashimoto’s thyroiditis combined with hypothyroidism requires thyroid hormone supplementation.