Myopathic dysphagia caused by thyrotoxicosis: a case report and review of the literature

Author:

Alwithenani Raad1234ORCID,Andrade Danielle M5,Zhang Lingxin67,Gomez-Hernandez Karen E1

Affiliation:

1. Department of Medicine, Division of Endocrinology and Metabolism, University of Toronto, Toronto, Ontario, Canada

2. College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia

3. King Abdullah International Medical Research Center, Jeddah, Saudi Arabia

4. Department of Medicine, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Jeddah, Saudi Arabia

5. Department of Medicine, Division of Neurology, University of Toronto, Toronto, Ontario, Canada

6. Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Canada

7. Department of Pathology and Laboratory Medicine, Mount Sinai Hospital, Toronto, Ontario, Canada

Abstract

Summary Myopathy caused by thyrotoxicosis is not uncommon. Skeletal muscles are commonly involved, but dysphagia is a rare manifestation of thyrotoxicosis. We aim to raise awareness of dysphagia caused by hyperthyroidism and review similar cases in the literature. We present a case of severe dysphagia caused by hyperthyroidism. We also summarize similar case reports in the literature. Our patient is a 77-year-old man who presented with thyrotoxicosis related to Graves’ disease (GD), dysphagia to both liquid and solid food, and weight loss. Further investigations revealed severe esophageal dysphagia and a high risk for aspiration. He required the placement of a G-tube for feeding. After 8 weeks of methimazole treatment, his thyroid function normalized and his dysphagia improved significantly, leading to the removal of the feeding G-tube. We summarize 19 case reports published in the literature of hyperthyroidism leading to dysphagia. Patients with thyrotoxicosis and dysphagia are at higher risk for aspiration pneumonia and thyroid storm. Based on previous case reports, on average, approximately 3 weeks of treatment with anti-thyroidal drugs and beta-blockers is needed before patients can eat normally. We report a case of dysphagia associated with GD, which is rare and needs prompt recognition to restore euthyroid status. Dysphagia generally resolved with normalization of thyroid function. Learning points Myopathy caused by thyrotoxicosis is not uncommon. Skeletal muscles are commonly involved, but dysphagia is a rare manifestation of thyrotoxicosis. Dysphagia due to hyperthyroidism resolves with normalization of thyroid function. Early recognition of dysphagia related to hyperthyroidism and early initiation of therapy may help reverse the dysphagia and prevent complications.

Publisher

Bioscientifica

Subject

Endocrinology, Diabetes and Metabolism,Internal Medicine

Reference14 articles.

1. Thyrotoxicosis complicated with dysphagia;Okada,2009

2. Hyperthyroidism presenting as dysphagia;Noto,2000

3. Dysphagia as a manifestation of thyrotoxicosis: report of three cases and literature review;Chiu,2004

4. Acute bulbar muscle dysfunction and hyperthyroidism. A study of four cases and review of the literature;Kammer,1974

5. Thyrotoxic myopathy presenting as dysphagia;Marks,1980

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