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Intermittent throat tightness in a 37-year-old woman
1Department of Internal Medicine, Madigan Army Medical Center, Tacoma, Washington.
Annals of Allergy
|August 1, 1993
Summary
Thyroid goiter can cause throat tightness and difficulty swallowing (dysphagia). Early diagnosis and thyroid hormone suppression treatment effectively resolved these symptoms in a patient presenting with these complaints.
Area of Science:
- Otolaryngology
- Endocrinology
- Allergy Immunology
Background:
- Intermittent throat tightness and dysphagia present diagnostic challenges, with potential causes including allergic, neuromuscular, or mechanical/structural disorders.
- Dysphagia is broadly categorized as oropharyngeal or esophageal, often localized by patient-reported sensation, with this patient pointing to the throat area.
Observation:
- Referral to Allergy Service considered laryngeal angioedema due to dysphagia, hoarseness, and throat tightness.
- A palpable thyroid gland prompted further investigation, revealing potential extrinsic compression.
- Diagnostic studies for oropharyngeal dysphagia include barium swallow, rhinopharyngoscopy, and upper endoscopy.
Findings:
- Thyroid disease, particularly thyroiditis, is associated with a high incidence of tracheal or esophageal compression and obstruction.
- Patient's scan and uptake were consistent with thyroiditis, though multinodular goiter can present similarly.
- A goiter, not fully appreciated on physical exam, was identified as the cause of extrinsic compression leading to the patient's symptoms.
Implications:
- Extrinsic compression from thyroid masses should be considered in the differential diagnosis of laryngeal angioedema and throat-related symptoms.
- Thyroid hormone suppression therapy can effectively manage dysphagia and throat tightness caused by goiter.
- This case highlights the importance of thorough evaluation for thyroid pathology in patients with unexplained throat symptoms.
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