Dysphagia and Odynophagia in a Woman With Hypothyroidism

Xiang Liu, MD; John W. Birk, MD


May 03, 2023

Physical Examination and Workup

On presentation, the patient is afebrile. Her heart rate is 70 beats/min, and her blood pressure is 120/70 mm Hg. The results of the physical examination are normal. Her abdomen is soft and nontender, and no skin or mucosal lesions are evident.

The laboratory workup is notable for these values:

  • Hemoglobin: 14 g/dL (reference range, 13.2-17.1 g/dL)

  • Mean corpuscular volume: 90 fL (reference range, 80-100 fL)

  • Thyroid-stimulating hormone: normal

  • Free thyroxine: normal

A CT of the abdomen and pelvis with intravenous and oral contrast reveals mild distal esophageal wall thickening. No mass or lymphadenopathy is identified.

A barium esophagram shows a small caliber esophagus with no obvious stricture.

The patient subsequently undergoes esophagogastroduodenoscopy (EGD), which reveals friable, inflamed, and glistening mucosa; reticulated streaks; and ulcerations and stenosis involving primarily the middle and upper thirds of the esophagus (Figures 1 and 2). The stomach and duodenum appear normal. Given the evidence of stenosis, her esophagus is dilated with a balloon dilator for symptomatic relief.

Figure 1.

Figure 2.


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