From the Guidelines
Hypothyroidism can cause dysphagia through thyroid enlargement (goiter) compressing the esophagus, or through neuromuscular dysfunction affecting swallowing, and patients with both conditions require comprehensive evaluation and treatment. When monitoring for hypothyroidism and dysphagia, watch for key symptoms that may indicate these conditions. For hypothyroidism, look for fatigue, cold intolerance, weight gain, dry skin, hair loss, constipation, depression, slowed heart rate, and hoarseness. Laboratory tests showing elevated TSH and low free T4 levels confirm the diagnosis. Treatment typically involves levothyroxine (starting at 25-50 mcg daily for older adults or those with cardiac issues, or 1.6 mcg/kg/day for others), with dose adjustments based on TSH levels checked every 6-8 weeks until stabilized 1.
For dysphagia, be alert for coughing or choking while eating, food sticking sensation, regurgitation, unexplained weight loss, drooling, and voice changes. According to the study by Vergis et al 2, witnessed aspiration and sedative medications are the most important risk factors for pneumonia in patients with dysphagia. Patients with dysphagia may benefit from dietary modifications, such as eating several small meals a day, and enriching their meals with high-calorie foods, as well as postural maneuvers like the chin-tuck posture to protect the airway during swallowing 1.
It is essential to note that aspiration can occur without coughing, and patients with dysphagia are at increased risk of aspiration pneumonia, which can have significant morbidity and mortality rates 2. Therefore, comprehensive evaluation, including thyroid function tests, barium swallow studies, and possibly endoscopy, is crucial for patients with both hypothyroidism and dysphagia. Treatment should address both the thyroid dysfunction and swallowing difficulties, which may include speech therapy and dietary modifications alongside thyroid hormone replacement.
Some key considerations for managing dysphagia in patients with hypothyroidism include:
- Adapting the texture of solid and liquids to facilitate swallowing and avoid aspiration
- Using postural maneuvers, such as the chin-tuck posture, to protect the airway during swallowing
- Eating several small meals a day to reduce fatigue and improve swallowing
- Enriching meals with high-calorie foods to prevent weight loss and malnutrition
- Considering speech therapy and dietary modifications to improve swallowing and reduce the risk of aspiration pneumonia.
From the Research
Clinical Manifestations of Hypothyroidism
The clinical manifestations of hypothyroidism associated with dysphagia are not explicitly mentioned in the provided studies. However, the studies discuss the symptoms and management of hypothyroidism in general.
- Common symptoms of hypothyroidism include: + Cold intolerance + Fatigue + Weight gain + Dry skin + Constipation + Voice changes + Menstrual cycle abnormalities 3, 4
- The diagnosis of hypothyroidism relies on blood levels of thyroid-stimulating hormone (TSH) and free thyroxine 3, 4
- Management of hypothyroidism usually involves monotherapy with levothyroxine taken on an empty stomach 3
Dysphagia in Hypothyroidism
There is no direct evidence in the provided studies that links hypothyroidism with dysphagia. However, some studies mention that patients with hypothyroidism may experience persistent symptoms despite optimized TSH levels, and that these symptoms may be related to other conditions unrelated to the thyroid 5, 6.