Dysphagia and Odynophagia in a Woman With Hypothyroidism

Xiang Liu, MD; John W. Birk, MD


May 03, 2023


Thyroid disease is unlikely to be the cause of this patient's symptoms because her thyroid hormone levels show that her hypothyroidism is well controlled. The lack of severe iron deficiency anemia makes Plummer-Vinson syndrome unlikely.

Esophagrams are frequently obtained for evaluation of dysphagia, but these tests are neither sensitive nor specific in diagnosing most esophageal disorders. Mild esophageal thickening on CT is also nonspecific and should be interpreted cautiously. Although esophagrams and CT are helpful in cases of high-grade obstruction and assessment of some anatomic causes of dysphagia, alarm esophageal symptoms such as dysphagia and odynophagia, with or without weight loss, warrant an endoscopic evaluation for a more definitive diagnosis.

Nevertheless, the patient's clinical history can be very helpful in the diagnosis of esophageal diseases. Liquid dysphagia is commonly observed in achalasia, but odynophagia is not a typical feature. Endoscopic findings in achalasia can often be normal; however, suggestive features include a dilated esophagus and hypertonic lower esophageal sphincter. Esophageal manometry is used to diagnose achalasia or other esophageal motility disorders.

Severe reflux esophagitis can present with both dysphagia and odynophagia, but patients often report a prior history of acid reflux, regurgitation, or repeated emesis. Inflammation from reflux disease as well as associated ulceration and stricture is usually found in the distal esophagus.

Scleroderma may also be considered in women of this age group, especially if other manifestations of CREST syndrome are present. Scleroderma is often associated with absent contractility or ineffective esophageal motility disorder, which requires manometry for differentiation.

Other conditions, such as corrosive or radiation-induced esophagitis or stricture, may also be considered depending on the clinical context.


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