VASCULAR COMPLICATIONS IN LYMPHOCYTIC THYROIDITIS – SONOGRAPHIC FINDINGS

Abstract

Objective: Alert to the ultrasonographic findings of cervical vascular involvement in the context of lymphocytic thyroiditis, since it is a rare situation. Design and method: CASE DESCRIPTION: Male patient, 87 years old, caucasian, diagnosed with lymphocytic thyroiditis since 2004, euthyroid, stable until 2019, presenting an enlarged thyroid volume on that date. He has a history of ischemic stroke in 2003. In 2019, he underwent a thyroid ultrasound where the hypothesis of intraluminal thrombus of the right internal carotid artery was raised. The evaluation with cervical vascular ultrasonography revealed an iso-hypoechogenic, heterogeneous image, lining the arterial wall, in the proximal segment of the internal carotid arteries, without hemodynamic repercussions, compatible with a probable inflammatory/fibrous infiltrate, in the context of lymphocytic thyroiditis. Computed Tomography scan of the thyroid and soft tissue confirmed the progression of the adjacent soft tissue infiltrate. Results: DISCUSSION: Taking into account the size of the inflammatory changes and the fact that the patient remains euthyroid, it is important to question about a the possibility of an evolution/adjustment of the disease previously diagnosed in 2004 to a new one: Riedel's thyroiditis, also known as an invasive fibrous or sclerosing thyroiditis. Riedel's thyroiditis is a pathological condition with an unknown etiology that causes a fibro-inflammatory infiltrative stated in the 2019 examination. Considering the low prevalence of the pathology, it is important to alert sonographers to the possible vascular complications observed in a supposed Riedel's thyroiditis, in order to make a reliable evaluation and diagnosis of the cervical vascular ultrasonographic findings. Conclusions: Regarding the monitoring of lymphocytic thyroiditis, it is just as important to do a periodic evaluation of the dimensions, characteristics of the gland and analytical evaluation of the thyroid function, as it is to monitor the infiltrate of adjacent tissues, namely vascular, to prevent possible serious complications.