Looking Beyond What You See: A Rare Cause of Dysphagia

Abstract

Hypothyroidism is a common endocrine condition with typical symptoms such as cold intolerance, weight gain, fatigue, constipation, and coarse skin, as well as less common symptoms such as depression, difficulty in concentration, and hair thinning. It is usually diagnosed by combining clinical features and applying clinical judgment; however, the wide spectrum of presenting symptoms can sometimes lead to a diagnostic dilemma. Dysphagia secondary to hypothyroidism is a rarely reported symptom in the literature and is believed to be associated with a hormonal effect on esophageal and gastric motility with neuromuscular incoordination; however, the underlying mechanism remains unknown. The most common cause of hypothyroidism is Hashimoto's disease, which can rarely manifest as heartburn, possibly due to esophageal dysmotility. Herein, we describe an unusual presentation of severe hypothyroidism with dysphagia, for which we could not identify any obstructive cause despite extensive investigations This condition was resolved successfully with levothyroxine treatment. Through this report, we aimed to communicate to the audience the important learning message that hypothyroidism may cause symptoms of dysphagia and to inform practitioners regarding this possibility, which should be considered after ruling out any obstructive pathology.

Choked: A Case Report of Oculopharyngeal Muscular Dystrophy Mimicking Hypothyroidism From the Philippines

“…These are usually in conjunction with systemic hypothyroidism symptoms such as weight gain, cold intolerance, and dry skin [11,12]. These neuromuscular manifestations of hypothyroidism respond significantly to thyroid replacement therapy [10][11][12][13][14]. Our patient had persistent, bilateral, and symmetric ptosis with dysphagia and choking that did not improve with Levothyroxine therapy.…”

“…We described a hypothyroid female patient with OPMD, misidentified as having a neuromuscular manifestation of hypothyroidism. Both OPMD and hypothyroidism can manifest with ptosis and dysphagia, although in hypothyroidism, the said symptoms are usually milder and unusual [10][11][12][13][14]. Ptosis in hypothyroidism has been described to be bilateral, intermittent, and can be asymmetric [10,11], while dysphagia was associated with choking and dysphonia [12][13][14].…”

“…Both OPMD and hypothyroidism can manifest with ptosis and dysphagia, although in hypothyroidism, the said symptoms are usually milder and unusual [10][11][12][13][14]. Ptosis in hypothyroidism has been described to be bilateral, intermittent, and can be asymmetric [10,11], while dysphagia was associated with choking and dysphonia [12][13][14]. The more common neuromuscular manifestations of hypothyroidism include myalgias, elevated creatine kinase levels, and proximal myopathy commonly affecting the shoulder and hip girdle muscles.…”

“…The more common neuromuscular manifestations of hypothyroidism include myalgias, elevated creatine kinase levels, and proximal myopathy commonly affecting the shoulder and hip girdle muscles. These are usually in conjunction with systemic hypothyroidism symptoms such as weight gain, cold intolerance, and dry skin [11,12]. These neuromuscular manifestations of hypothyroidism respond significantly to thyroid replacement therapy [10][11][12][13][14].…”

“…Ptosis has been associated with hypothyroidism, although rare and often mild [10,11]. Dysphagia is another infrequent symptom of hypothyroidism but has been reported in severe cases with frequent choking [12,13].…”