Dysphagia in a Patient with Thyrotoxicosis and Iron Deficiency Anemia: A Case Report

Abstract

Dysphagia is mostly caused by the pathologies in the esophagus itself and nearly all of them can be simply detected with the esophagogastroduodenoscopy or barium swallowing. But herein we reported the dysphagia found concurrently in the patient with thyrotoxicosis and iron deficiency anemia without the lesion in the esophagus. She was a 45-year-old Thai patient who had progressive dysphagia and weight loss for one month. The physical examination found nothing except for the pallor. The blood tests: Hb 5.7 g%, WBC 6,100/mm³, platelet 596,000/mm³, MCV 49.8 fl, MCH 14.3 pg, RDW 27.8 %, ferritin 2.1 ng/ml, serum iron 1 mcg/dl, TIBC 579 mcg/dl, FT₃ 8.4 pg/ml, FT₄ 3.1 ng/dl, TSH 0.003 uIU/ml. The gastroscopy and the barium swallowing showed no abnormality. The dysphagia in this case was presumably associated with the thyrotoxicosis and iron deficiency anemia. She was treated with propranolol, methimazole and FBC. The dysphagia was gradually improvedand completely recovered. Five months later, Hb 11.8 g%, WBC 7,000/mm³, platelet 399,000/mm³, MCV 74.2 fl, MCH 23.2 pg, RDW 17.1 %, FT₃ 2.1 pg/ml, FT₄ 0.2 ng/dl, and TSH 96.9 uIU/ml. The dysphagia in this patient waspreferably associated with the thyrotoxicosis rather than the iron deficiency anemia because in case of dysphagia due to the iron deficiency anemia, it was always found associated with the esophageal web.