Downhill oesophageal varices are venous submucosal dilatations developing in the upper oesophagus, draining upper body venous flow "downwards" and usually bypassing superior vena cava obstruction. Extrinsic compression from a thyroid goiter is a rare cause with only 18 cases reported in the literature. We report the case of an 84 year old woman with a long history of multinodular goiter admitted for the exploration of severe iron-deficiency anemia. She had no history of hematemesis or melena. The endoscopic exam found grade II upper oesophageal varices with no sign of active bleeding, as well as a non hemorrhagic gastric ulcer. No other obvious explanation for anemia could be found. Goiter investigation included a cervical and thoracic CT scan which evidenced a voluminous thyroid goiter with massive endothoracic extension, causing oesophageal compression. The optimal treatment was considered to be radioiodine therapy followed by surgery. Downhill oesophageal varices are a rare clinical entity seen in patients with goiter. We propose a clinical observation of this pathology in a patient explored for chronic anemia.
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