Thyroid Enlargement and Difficulty Swallowing (Dysphagia)
Thyroid enlargement can cause difficulty swallowing, or dysphagia, as a result of the thyroid gland directly compressing the swallowing organs. The thyroid gland, which is usually about the size of a quarter, can become enlarged as a symptom of various thyroid disorders, as well as other medical conditions. While not all patients with enlarged thyroid glands (also called goiters) experience compressive symptoms, studies have shown that up to 33% of those with benign goiters do report difficulty swallowing and shortness of breath.
Conditions associated with enlarged thyroid include:
- Graves’ disease: This autoimmune disorder is characterized by overproduction of thyroid hormones, which typically results in thyroid enlargement.
- Thyroiditis: This condition involves swelling or inflammation of the thyroid and is categorized by several types depending on the cause.
- Hashimoto’s disease: When the immune system attacks the thyroid gland, it becomes damaged and swollen and can no longer produce sufficient hormones.
- Thyroid nodules: Small growths, typically benign, can develop on the thyroid causing it to become enlarged.
- Hyperthyroidism (overactive thyroid) or hypothyroidism (underactive thyroid): Overproduction or underproduction of thyroid hormones can result in an enlarged thyroid.
- Iodine deficiency: Inadequate iodine intake can prevent the thyroid gland from producing necessary hormones. As the pituitary gland stimulates the thyroid to increase production, the thyroid can become enlarged.
- Pregnancy: Sometimes the increased production of hormones during pregnancy can cause swelling of the thyroid gland.
Thyroid cancer and other medical conditions can also contribute to or cause thyroid enlargement.
How Thyroid Enlargement Can Affect Swallowing
Swallowing is a complex process which involves the brain, several muscles, nerves and valves, and the esophagus working together in 3 phases. In phase I, the food (or liquid) is held in the mouth by the tongue and palate. During phase II, the brain’s decision to swallow triggers a series of reflexes, simultaneously sending the food into the pharynx, opening a muscular valve to allow food into the esophagus, and closing the trachea to keep food from going into the airways. In phase III, the food enters into the esophagus which contracts, opening a valve and propelling the food into the stomach.
When the thyroid gland becomes significantly enlarged, the goiter can begin to compress the esophagus (and other nearby structures, such as the trachea), leading to dysphagia, as well as breathing difficulties in some cases. Patients with compressing symptoms often feel a sensation of food stuck in the throat or choking. Studies involving patients with compressing symptoms showed that nodule size and lobe size directly affected the ability to swallow.
Symptoms of Dysphagia
Dysphagia means that you have difficulty swallowing. These swallowing problems can range from mild to severe. When thyroid enlargement is the cause, dysphagia can worsen if nodules continue to grow or your thyroid condition progresses.
Depending on severity, symptoms can also include:
- Pain with swallowing (odynophagia)
- Neck pressure
- Globus sensation (feeling of a lump in the throat)
- Hoarseness or voice problems
- Frequent heartburn
- Gagging when swallowing
- Unexplained weight loss
- Recurring pneumonia (from food entering lungs)
- Acid reflux
- Avoiding large foods or cutting food into small pieces to swallow
Diagnosing and Treating Dysphagia
Because dysphagia can be caused by various medical conditions, it is important to get a proper diagnosis on the cause of your swallowing difficulty. If the thyroid gland is enlarged enough to cause compressing symptoms, your doctor may be able to identify the goiter by palpating the neck area during swallowing.
Other diagnostic tests to determine if an enlarged thyroid is the cause of dysphagia may include:
- Hormone test
- Antibody test
- Thyroid scan
Diagnosing swallowing problems may also include:
- Endoscopy: Thin, flexible tube equipped with a tiny camera is inserted into the esophagus to visualize the inside of the esophagus and pharynx for evaluation.
- Cineradiography: Barium is swallowed and then viewed on an x-ray to study its movement through the esophagus.
- Manometry: Strength and timing of esophageal contractions and valve relaxation are measured.
If it is determined that an enlarged thyroid is causing dysphagia, treatment typically involves partial or total removal of the thyroid gland (thyroidectomy). Multiple studies show results of 85% of thyroid patients with compressive symptoms experiencing relief of those symptoms after undergoing thyroid surgery. In cases of thyroid inflammation, your doctor may prescribe medication to reduce thyroid swelling and swallowing problems. Treatment will often depend on severity of the dysphagia.
Other causes of dysphagia can include:
- Certain medications
- Vocal cord problems
- Neurological disorders
- Esophageal diseases
- Muscular dystrophies
If you are experiencing dysphagia (swallowing problems), feel that your enlarged thyroid is causing other compressing symptoms, or if you have other ear, nose, or throat concerns, please contact our office for an appointment.
Schedule an appointment with one of our physicians at Fort Worth ENT & Sinus by completing an online appointment request or phone 817-332-8848.