Incidental Detection of Takayasu Arteritis During Thyroid Ultrasonography in a Young Woman: A Case Report

Abstract

Background: Takayasu arteritis (TA) is a rare chronic large-vessel vasculitis predominantly involving the aorta and its major branches. Early diagnosis can be challenging because of its nonspecific clinical presentation. High-resolution ultrasonography (HRUS), particularly of the carotid arteries, can detect characteristic vascular wall abnormalities and may facilitate early diagnosis.
Case Report: A 22-year-old woman presented with vertigo, generalized weakness, and several episodes of syncope. Brain computed
tomography and routine laboratory investigations were unremarkable, except for a mildly elevated erythrocyte sedimentation rate (ESR) of 20 mm in the first hour. One month later, she underwent thyroid evaluation for mild neck swelling. Thyroid function tests were normal, although the thyrotropin receptor antibody (TRAb) level was mildly elevated (2.77 IU/mL). HRUS of the neck demonstrated mild thyromegaly with slightly heterogeneous parenchymal echotexture and marked circumferential wall thickening of both common carotid arteries, with a maximum anteroposterior thickness of 13.8 mm. The intima-media thickness of the internal and external carotid arteries, radial arteries, and abdominal aorta was normal. Clinical assessment revealed non-recordable blood pressure in the left brachial artery and a markedly diminished left radial pulse. An elevated C-reactive protein level and CT angiography demonstrating narrowing of the distal ulnar arteries and the mid-to-distal segments of both radial arteries supported the diagnosis of TA. The patient was treated with corticosteroids, methotrexate, and folic acid, with subsequent clinical improvement and normalization of CRP.
Conclusion: This case highlights the diagnostic value of HRUS in the incidental detection of TA during routine thyroid ultrasonography. Careful assessment of extrathyroidal vascular structures and recognition of characteristic arterial wall thickening may provide an important early clue to TA. Maintaining vigilance during routine ultrasonographic examinations can facilitate timely diagnosis, appropriate referral, and treatment before the development of major vascular complications.

BJusg. vol. 27, no. 1, June 2026, Page: 55-59