Abstract
Dysphagia is a common problem in elderly patients and a rare manifestation of Graves' disease. We report a case of an 82-year-old male who presented with a 4-week history of dysphagia and weight loss. Workup for his dysphagia with upper endoscopy, MRI brain, electromyography, acetyl-cholinesterase receptor antibodies, and voltage-gated calcium channel antibodies were negative. Modified Barium swallow test showed oropharyngeal dysphagia. Thyroid function tests that revealed hyperthyroidism and antibodies to TSH-receptor were positive. Based on the above findings, we considered Graves' disease as the most likely diagnosis. Patient was treated with methimazole and beta-blockers and subsequently his dysphagia resolved. This paper highlights the importance to clinicians of considering thyrotoxicosis as possible diagnosis in an elderly patient presenting with unexplained dysphagia.
Highlights
In the elderly, the prevalence of hyperthyroidism is 0.2–2% which is similar to general population and often present with a subtle and unusual clinical pattern
Thyrotoxicosis can cause bulbar muscle wasting, weakness, and resultant pharyngeal or esophageal dysmotility, and the patient may present with dysphagia [2]
When thyrotoxicosis causes bulbar muscle wasting and resultant oropharyngeal or esophageal dysmotility, the patient may present with dysphagia, dysarthria, and dysphonia [6]
Summary
The prevalence of hyperthyroidism is 0.2–2% which is similar to general population and often present with a subtle and unusual clinical pattern. Thyrotoxicosis can cause bulbar muscle wasting, weakness, and resultant pharyngeal or esophageal dysmotility, and the patient may present with dysphagia [2]
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