An Unexpected Twist Behind Dysphagia in a Patient With a Goiter.

Dysphagia lusoria is a rare cause of dysphagia resulting from extrinsic esophageal compression by an aberrant right subclavian artery (ARSA). Its coexistence with thyroid pathology may obscure the diagnosis and delay appropriate management. We report a case of a 29-year-old female who presented with a multinodular goiter and dysphagia disproportionate to the size of the thyroid swelling. Clinical evaluation, thyroid ultrasonography, and fine-needle aspiration cytology confirmed a benign euthyroid multinodular goiter. Owing to persistent dysphagia, further evaluation was undertaken. A barium swallow demonstrated extrinsic compression of the esophagus, while computed tomography aortogram confirmed an ARSA coursing posterior to the esophagus, establishing the diagnosis of dysphagia lusoria. The patient underwent total thyroidectomy for the multinodular goiter; however, her dysphagia persisted postoperatively. She was subsequently referred to the cardiothoracic vascular surgery team for definitive surgical management of the ARSA. This case highlights the importance of considering vascular anomalies in patients with dysphagia that is disproportionate to the degree of thyroid enlargement. Early recognition through appropriate imaging and a multidisciplinary approach are essential for accurate diagnosis, avoidance of unnecessary interventions, and optimal patient outcomes.