Ultrasonic follow-up of a methotrexate-treated patient with Riedel's thyroiditis

Abstract

A 48-year-old woman was admitted to our hospital because of neck tightness, cough, hoarseness, and nocturnal dyspnea. Physical examination revealed left neck swelling, but her thyroid gland was small on ultrasound examination. A clear demarcation of the thyroid gland depicting fibrotic invasion was difficult to find and positron emission tomography/computed tomography suggested chronic thyroiditis (Figure 1a–e). The parathyroid hormone and calcium levels were within normal limits. Biopsy revealed some fibrocytes and lymphocytes but no signs of malignancy. The patient was finally diagnosed with Riedel's thyroiditis. She was treated with prednisone and methotrexate. Cervical ultrasonography performed throughout follow-up showed no significant change in the thyroid volume; however, the compressive symptoms disappeared and hoarseness was relieved. The hypoechoic areas surrounding the carotid arteries gradually decreased after treatment (Figure 1f–h). No further changes were obvious beyond 1 year.

Xinlong Shi analyzed the data and prepared the first draft of the manuscript. Xinlong Shi and Yu Xia participated in the conception and design of the study, Xinlong Shi constructively revised the manuscript; Yu Xia participated in and supervised the study throughout, and he shared corresponding authorship. All authors commented on previous versions of the manuscript and approved the final version.

The authors declare no conflicts of interest.

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