Sudden Significant Swallowing Problems (Dysphagia)

Since the summer of 2024, I have had occasional trouble with swallowing.  Originally, the problem occurred sometimes when I swallowed supplements.  Typically, I have always been able to swallow any kind of pill or capsule with no trouble at all and could typically swallow three to five at once without difficulty.  

I remember at least one instance in June or July 2024 where a maca root capsule became stuck in my throat.  I finally coughed it up after around half an hour.  Beginning in the fall of 2025, I began to have more frequent problems with swallowing, including with food getting stuck in my throat.  This happened with dry foods like bread and crackers.  

The problems became even more frequent in December and January.  I had a bad virus in December that inflamed my thyroid (see post).  I didn't know if my goiter was a contributing factor to the swallowing problem or if worsening Sjögren's was more to blame.

I was concerned that the problem had reached the point to where I would need medical intervention.  As the problem continued to worsen, I began swallowing lots of air, which caused additional problems.  As the problem progressed, I tried to find answers.  

I used my browser's search history to obtain dates and see what my concerns were.  

Jan 13 trouble swallowing
Jan 15 trouble swallowing
Jan 16 swallow therapy
Jan 18 stress swallowing problems
Jan 18 swallowing techniques
Jan 18 how not to swallow
Jan 18 swallowing air while drinking

In January, I thought that stress was the main problem.

Feb 27 swallowing problems after covid
Feb 27 stress swallowing

In February, I thought that stress and the virus from December were the cause.

Mar 18 swallowing too much air
Mar 18 swallowing too much air when taking vitamins
Mar 20 what does difficulty swallowing feel like with Sjogren's
Mar 20 how to swallow properly
Mar 20 how to correct swallowing problems
Mar 20 swallowing exercises for Sjogren's
Mar 21 why do some people have trouble swallowing after a virus
Mar 26 how to avoid swallowing air
Mar 26 how to avoid swallowing air when taking vitamins
Mar 27 taking vitamins indigestion trouble swallowing
Mar 27 esophageal swelling immediately after swallowing vitamin
Mar 30 can heartburn narrow the esophagus to where swallowing is difficult

In March, I briefly tried swallowing exercises, which I quickly abandoned.  I've been able to swallow fine my entire life, and this problem spiraled out of control in the last six months.  I decided that the strength of my esophageal muscles or my technique wasn't likely the cause of the issue.

I also felt that something was off in my throat.  It was like my esophagus had a pocket somewhere in the vicinity of my thyroid where stuff was getting stuck.  Something was structurally wrong, and no amount of exercise would solve that problem.

I began to suspect that heartburn had something to do with it.  If so, then it was caused by my vitamins, which were getting stuck in my throat at times.  I did learn that pill esophagitis is an actual condition caused by pills getting stuck in the throat.  The throat becomes irritated.

Two things happened at the beginning of April.  I had a filling repaired on April 2, and that was the day that I searched for information about esophageal swelling caused by dental problems.  I searched for that information before my appointment that day, since I recalled having an improvement in autoimmune symptoms after a filling repair in August 2024 (see post).  I learned that dental problems could possibly cause some swelling in the throat.  I don't think that was the problem, however.

In early April, I quit taking supplements that were harder to swallow or more likely to get stuck: probiotics, a multivitamin, B-complex, and maca root.  I continued taking omega-3 oils and sea buckthorn, since they help my dryness.

My swallowing problems have lessened.  I feel like the main culprit might have been the maca root, which was the supplement that gave me problems in the summer of 2024.  I will never take it again.  Eventually, I will resume some of the others, but I'm keeping off of them right now to give my throat a chance to settle down more.

I have been under intense stress this year, and people can develop swallowing problems due to stress.  Viruses can cause swallowing problems as well.  It could be that I had some irritation caused by maca root which worsened considerably after my virus and was also compounded by my high stress level.

I am still having some minor trouble swallowing.  It's definitely much less of a problem than it was during the last few months.  I am hopeful that I will continue to improve.

Intense Stress Worsens My Autoimmune Condition

As I wrote in "Teaching Heightens the Risk for Autoimmunity," the 2024-2025 school year broke me.  I had an unusually high workload which caused high stress.  Additionally, I got Covid for the second time in December 2024.  I have not been the same since that time.

I believe that I have long Covid and that the main manifestation is that it greatly worsened my dry eyes.  Another unpleasant impact is that I now frequently smell menthol.  The menthol odor is a phantom smell.  It's like I have Vicks or a similar product inside my nostrils.  When I smell the phantom menthol odor, my eyes burn as if menthol is in them.  It's quite annoying.

I have seen an ophthalmologist for my eyes since February 2025.  The measures taken so far have not helped.  I have now been referred to a dry eye specialist.

The current school year has been just as intensely stressful as the previous school year, except for a different reason.  What happened early in the year was honestly the most stressed I have ever been in all of the years I have been teaching.  I was not in good shape when the school year began, and the intense stress just continued to pile on.

People who are autoimmune are told to manage their stress levels.  I do what I can, but I can't control the demands that my job places on me.  I can't control how other people behave.  If I could retire right now, then I would.  I must work three more years before I will receive full benefits.  

Two consecutive school years of intense stress along with a Covid infection have worsened my autoimmune condition.  I feel like I've been on a steep decline.

I wish I could say what happened at the start of the year.  I will say that I finally got permission to do something in a certain way that resulted in some of the pressure being reduced.  It didn't save me from what was still a massive amount of work.  The workload has quite honestly been extreme this year.  During the fall, I frequently stayed at the school working until 6 to 7 PM each day and left with my work unfinished.  That took quite a toll on my body.  By December, I reached a point where I was able to leave before 6 PM most days, but the work load was still quite high.

In October, I tried Evoxac, which had a negative impact on my thyroid levels (see post).  My dry eye worsened again due to Evoxac.  I quit Evoxac at the end of October.  My eyes slowly began to improve.  My tiredness improved somewhat.

I then caught a bad virus, which I had from November 29 to about December 18. The virus was so bad that I tested myself for Covid three different times, and each time I tested negative.  I caught another virus which cleared by December 22. The left lobe of my thyroid became quite swollen. 

I decided to begin taking selenium to see if that would reduce the swelling in my thyroid.  I found a selenium supplement on Amazon that had 100mcg instead of 200mcg.  I wanted to be cautious and not risk overdoing it, even though 200mcg selenium is recommended for improvement in thyroid function.  I have taken 100mcg selenium daily since December 27.

I had a thyroid appointment scheduled for December 30.  I got my labs done.  

TSH = 4.99959 (range 0.35-4.94).  In June 2025, it was 2.1297. 
T3 Free = 2.18 (range 1.71-3.71).  In June 2025, it was 2.53.
T4 Free = 0.94 (range 0.7-1.48).  In June 2025, it was 0.97.

It was clear that the Evoxac followed by two viruses had unseated my thyroid levels.  My appointment for December 30 was cancelled by the clinic and rescheduled for April 15.  I was not pleased at the long delay, but I also knew that my dose would not be adjusted immediately after an illness.  I did not contact my provider with any details, since I knew that I had to wait it out.

I had hyperthyroid symptoms briefly around January 4 to 20.  This is typical after a viral infection.  The thyroid becomes swollen due to inflammation, causing it to release its store of thyroid hormone.  The secretion of extra hormone causes hyperthyroid symptoms.

During this time period, my swallowing problems worsened.  I'd had more trouble swallowing since the summer of 2024, and it greatly worsened during this time.  I will go into detail about the swallowing problem in a separate post.

By January 23, the swelling in my thyroid had decreased to what is typical for me.  I began to have hypothyroid symptoms.  Around February 3, I began to have more pronounced hypothyroid symptoms, which worsened into the middle of February.

I decided to get my labs done again on February 12.

TSH = 3.8043 (range 0.35 to 4.94)
T3 Free = 2.27 (range 1.71 to 3.71)
T4 Free = 0.95 (range 0.7 to 1.48)

The test results didn't match how I felt at that time.  I realized years ago that how I feel at any given time is tied to what my levels were approximately 14 days before.  This delay is caused by the pituitary-thyroid feedback loop.

My TSH and T3 Free had improved.  What struck me was that my T4 Free had only gone up slightly.  It was also not that great back in June 2025.  I had a suspicion that I might need a dose increase.  My provider told me that I needed to wait longer.  I wasn't thrilled about the idea, but I knew that April 15 wasn't that far in the future.

My condition began to improve.  I could tell that I stabilized at around March 20, but I didn't feel that great.  I tested again right before my April 15 appointment.

TSH 3.5777 (range 0.35 to 4.94),
T3 Free = 2.22 (range 1.71 to 3.71)
T4 Free = 0.96 (range 0.7 to 1.48)

Selenium supplementation is supposed to improve thyroid function, and there are multiple studies showing that it does.  I wondered what, if anything, the selenium had done.  

I pulled up my lab history and looked at the graphs.  I chose July 2023 to the present, for three reasons.  My thyroid medication was adjusted to 81.5mcg in July 2023, and I have been on that dosage ever since.  The graphs show the fluctuation of my thyroid levels while on a consistent dose.  My second Covid infection was in December 2024, and I have been in worse overall health since that time.  Finally, I felt really good when my labs were done in late December 2024, and I wanted to compare that data point to the entire time I've been on 81.5mcg of Tirosint. 

In late December 2024, I did not believe that my recent Covid infection had any impact on my thyroid levels.  I now realize that it must have.  I suspect that my thyroid was slightly more swollen at the time that my December 2024 labs were done.  My thyroid had probably released a small amount of extra hormone, which caused me to feel optimal.  As time passed, my levels have very slowly fallen off.  That's what I see in all three of these graphs. 

For TSH, lower is better so long as it's not near the bottom of the range.  I believe I'm optimal with a TSH of around 2.  My TSH was slightly less than 2 in late December 2024, which is the lowest value in the below graph.

Click or tap on the graphs in order to see them at a higher resolution.

Notice in this next graph that my highest T3 Free level of the last three years was in late December 2024.

The same is true in the T4 Free graph.  My best T4 Free level was in late December 2024.

This corroborates my belief that I was optimal in late December 2024.  I remember telling my provider that I felt like I was at my best at that time.  How I felt during that time caused me not to think that the Covid infection impacted my thyroid.

I am now convinced that my December 2024 Covid infection impacted both my thyroid and my eyes.  The worsening of my dry eyes may be in part due to thyroid hormone levels that have not been optimal.

At my April 15 appointment, I requested that my Tirosint be increased from 81.5mcg to 88mcg.  My request was granted.  I asked about my selenium supplementation of 100mcg daily.  It was suggested to continue with 100mcg daily for at least four to six weeks after beginning the higher dose of Tirosint.  After that time has passed, I can raise the selenium to 200mcg daily if I feel I need a further boost in thyroid levels.  That is my current plan.

I am hopeful that taking a higher dose of Tirosint will result in my dry eyes improving slightly in the next couple months.  Even if my eyes don't improve, I should feel better and have fewer symptoms.

Teaching Heightens the Risk for Autoimmunity

Those of us with high-stress jobs have a greater risk of developing autoimmunity.  A 2001 mortality study investigated whether an association exists between teaching and death caused by autoimmune diseases.

Excess autoimmune disease mortality among school teachers

The study concluded that evidence had been found of "excess mortality from autoimmune diseases among teachers" and that "teachers experience an occupational exposure that increases risk of autoimmune diseases."

I first began noticing what I now realize were autoimmune symptoms in the first few years that I taught.  The job immediately began wearing me down.  In some ways, it has gotten easier.  Once I quit looking like I was in my 20s, which unfortunately didn't happen until I was around 38, students began respecting me at a much higher level.  It's crazy how much more respect students have when their teachers look more like their parents.

In other ways, teaching has become infinitely harder.  If I still had the lack of respect that I once did and had to deal with the additional modern demands of the job, I wouldn't be able to do it at all.  As it is, I'm finding it terribly difficult to keep going.

I teach at the high school level, and my job has become so all-consuming that I don't have much left for anything else.  I have managed to continue selling books on eBay and Etsy, but I haven't been able to do anything else in addition to that.  I am not reading and am not keeping up with most other things.

I can't get into the specifics of my situation, but I can tell you about the overarching problems.

Young people have an extremely short attention span.  That is, we all have a shorter attention span than we once did, due to social media and smart phones.  Teenagers know no other world.  All of my students were born after the first iPhone was released.

Students have changed profoundly since the pandemic.  We are still trying to claw our way out of that.

Students are blatantly cheating on everything with AI.  We can't prevent it.  When I confront a student who clearly cheated on a test by using AI, they tell me that the work is how their tutor showed them.  They don't understand how obvious it is that the work is AI and that no tutor would ever work a math problem the way that AI does.  The students would be better off admitting it, but no, they think they can deceive me.  What they get is a teacher who makes sure they are never able to use AI on a test again.  

Test days used to be great days when I could get a lot of grading done.  Test days are now extremely stressful, and I get nothing done.  Anyone who has managed to use AI on a past test is watched carefully, and I must be constantly vigilant to make sure students don't trick me.  For instance, a student might write problems down on a slip of paper, sneak it into their pocket, and then ask to go to the restroom.  If I don't ask for their phone, then the student might access AI with their phone while in the restroom and then write down all the correct answers for the test.

We are supposed to do everything on Chromebooks, but students don't learn well without paper and pencil.  Besides that, they cheat with AI on all digital work.

I have continued to use paper and pencil all along, despite the intense pressure to quit consuming paper.  It appears that people are finally realizing that doing everything on a screen has set us back greatly.  Technology is great, but it should be supplementary to learning that is done primarily with paper and pencil.

Most young people now have poor reading comprehension.  Even many young people who love to read have poor reading comprehension.  I have seen it firsthand in online discussion groups where youth can only read books at a surface level.  They have no idea of any nuance that is obvious to those of us who learned how to read long before social media existed.

We have a very severe teacher shortage in Oklahoma that is continuing to worsen.  This has been caused by all of the above plus the way we are treated by Oklahoma politicians.  You'd have to live here to understand how bad it truly is.  

Our Oklahoma Superintendent of Public Education from early 2023 to late 2025 treated teachers as if they were political activists whose sole purpose was indoctrinating children.  He called teachers unions "terrorist organizations."  He suspended teaching certificates of teachers who made statements on their social media that he didn't like.  He tried to take away the accreditation of school districts if he didn't like something they were doing.  If he were still the superintendent, I would not have included this paragraph as it would have been too dangerous.

Our state legislature continues to push out laws that make it worse.  One of their recent ideas was to use $25 million from the Oklahoma public teachers' retirement account to fund tax credits for private schools.  It probably sounds like I'm making this up.  

And there's a bunch of other stuff that they've done or attempted to do.  We feel like we are constantly under attack.

The severe Oklahoma teacher shortage has caused people to be hired to teach subjects for which they aren't certified.  For instance, a social studies teacher would be hired to teach math.  Yes, I'm serious.

When students have a teacher who isn't qualified, then they might not learn as well.  When the students go to the next course, the next teacher must teach them everything they didn't learn the year before plus all the new content.  That's a tall order.  

We keep being told to change what we're doing to some other method.  We get yanked one way, and then we're yanked back the other way.

Back about 15 years ago, a veteran teacher remarked that she had noticed that education goes in a circle.  She said that we continue to try new things and end up right back where we started, doing the same things over and over again.  I didn't have quite enough experience at that time to see it, but now I do.  Educators are constantly being forced to change to some great new idea, which is just a rehashing of some previous great new idea that didn't work any better than anything else ever has.  After a cycle of around 15 to 20 years, we end up right back where we started.  And the cycle continues.

The 2024-2025 school year broke me.  I would have retired in May 2025 if I had qualified.  This year is the very first year that I do qualify to take early retirement with reduced benefits.  It does please me to know that my retirement window has now opened.  I will have to work for three more years to qualify for full retirement benefits.  I am counting down by months and weeks.  Currently, I am at three years and one month.  Soon, I will be able to say "fewer than three years."  

Bad Reaction to Evoxac—Worsened Dry Eye and Decreased Thyroid Levels

My overall dryness has been worse since I had Covid for the second time in December 2024.  Early last year, I was prescribed pilocarpine and had a terrible allergic reaction.  

When I had a rheumatology appointment in October, I requested to try something other than pilocarpine.  I was prescribed Evoxac.  I was excited, since I've heard that it's great.

Evoxac definitely helped the dryness in my mouth.  The problem was that it made my dry eyes worse and caused me to have blurry vision in the evening.  I have had problems with my eyes since early 2025.  I had seen some improvement in the early fall, and Evoxac pretty much wrecked my eyes again.

I have always struggled with my electrolyte levels.  Two different blood pressure medications failed last year because they either dangerously lowered my electrolytes or threw off my levels.  I simply cannot get my blood sodium level above the lower boundary of the normal range.  One blood pressure medication caused my blood sodium level to fall close to a level that would have required hospitalization.

I believe Evoxac impacted my electrolytes.  I've noticed that I get insomnia whenever my electrolytes are off, and I did get insomnia soon after starting Evoxac.

On top of all the other side effects, I am pretty sure that Evoxac impacted my thyroid levels.  I can't have that.

I searched thoroughly online for confirmation that I wasn't the only person who's ever had these reactions to Evoxac.  It seems to be a miracle drug for just about everyone.  I created this blog because my condition just doesn't follow the same pattern as everyone else.  It's baffling.

I scoured the internet for information to substantiate what I believed was happening to me, and I found just about nothing.  This has happened so many times...

I finally turned to AI to see if I could get any confirmation.  Here, I include excerpts from some of my chats with Chat GPT.  These chats occurred over around a two-week-long period, as I tried to figure out why I was having so much trouble with a drug that helps so many people.

I would like for you to search for any adverse thyroid impacts caused by Evoxac.  I would also like you to search online for any anecdotal reports of thyroid levels that could be tied to Evoxac.

I could not find credible clinical case reports, label warnings, or pharmacovigilance signals that link Evoxac (cevimeline) to causing thyroid dysfunction or to interfering with levothyroxine absorption.

Are there any reports of Evoxac making the eyes dry or making them burn?

Yes—there are reports and side-effect listings showing that Evoxac (generic Cevimeline) can cause dry or burning eyes, or other ocular symptoms, though the data suggest these are less common compared to the beneficial effect of increased tears.

ChatGPT also stated:

While the original intent of the drug is to increase secretions (including for eyes) in conditions like Sjögren's syndrome (which cause dry eyes and dry mouth), the side-effect listings show that in some people, the effect may be paradoxical (or perhaps related to other ocular irritation) resulting in "dry, burning, itching" eyes.

Naturally, I would be one of those people.

I'm wondering if—since Evoxac helps the body secrete more moisture—that going off it could impact electrolyte levels and then as a result cause symptoms like a temporary headache.

Evoxac (cevimeline) does alter fluid balance slightly by stimulating glands throughout the body.

ChatGPT also said:

There's no evidence in studies or adverse event databases that stopping Evoxac causes measurable electrolyte disturbances (like hyponatremia or hypokalemia).

Huh.  That's what it thinks.  It should be noted that I didn't think much of ChatGPT's responses.  AI is unreliable, and ChatGPT acts just like a gaslighting doctor who doesn't believe that a patient is having certain side effects.  It was a few days after this exchange that I decided to corner it.

Evoxac is a cholinergic agonist.  What about this?  See link.

https://www.sciencedirect.com/science/article/abs/pii/0196978185901573

The link I gave ChatGPT goes to "Cholinergic and VIPergic effects on thyroid hormone secretion in the mouse."  The study concludes "that basal thyroid hormone secretion is inhibited by both cholinergic activation and blockade."  Since Evoxac is cholinergic, I felt I had my smoking gun.

ChatGPT, behaving in an incredibly dense fashion, continued its spiel about electrolytes, completely ignoring that the link is to a page about thyroid function being impacted by cholinergic agonists.  I continued in my quest to pin down ChatGPT.

I am referring to this excerpt:

"It is concluded that basal thyroid hormone secretion is inhibited by both cholinergic activation and blockade.  Furthermore, TSH-induced thyroid hormone secretion is more sensitive to inhibition with cholinergic stimulation than is VIP-induced thyroid hormone secretion."

And it seems like Evoxac can impact thyroid levels in some fashion.   Isn't that what this means?

Come on, ChatGPT, you can do it...

• Both stimulating and blocking cholinergic receptors can reduce baseline thyroid hormone release (T3/T4).
• When thyroid cells are stimulated by TSH (the pituitary signal to make thyroid hormones), adding cholinergic activation further inhibits that secretion—meaning acetylcholine-like drugs (such as muscarinic agonists) could dampen thyroid output.
• The inhibition didn’t apply equally to all hormonal stimuli: thyroid stimulation via VIP (vasoactive intestinal peptide) was less affected than TSH.

So yes—mechanistically, cholinergic stimulation can suppress thyroid hormone release under some conditions.

ChatGPT added:

In theory, Evoxac could exert a mild inhibitory effect on thyroid hormone secretion, at least transiently or in sensitive individuals.

That’s not necessarily the same as causing hypothyroidism—but if you already have borderline thyroid function or are on levothyroxine, this kind of interference could slightly alter your TSH–T4 feedback balance.

Precisely.  I quit Evoxac five days ago because it messed up the fluid balance in my body.  My eyes became much more dry with Evoxac.  They are now getting better.  Additionally, my thyroid due to Hashimoto's is extremely sensitive to any medication changes of any kind.  Since there is evidence that Evoxac could impact thyroid levels, I believe that happened to me during the two weeks that I took Evoxac.  I have mild symptoms of thyroid imbalance.   It will take my body a couple weeks to return to baseline.

As I recall, it took around six weeks for my eyes to recover from the Evoxac.  As far as my thyroid levels, I then caught a horrible virus and have still not recovered my thyroid levels as of late April 2026.  But I digress.  That debacle will be addressed in another post.

Anyway, I figured that I had one-upped ChatGPT with my final prompts.  Evoxac was terrible for my body, and I never want to try it again.  It really did help with dry mouth, and I noticed how my mouth was more dry as the medication wore off.  The benefit was not worth the negative symptoms.  I will just continue dealing with my dryness, hoping that one of the new Sjögren's drugs is approved in the next year.  With my luck, I'll be allergic to it.  Still, I can hope.