TPO and hyperthyroidism: It is crucial to remember that even though it is uncommon, the coexistence of achalasia and hyperthyroidism needs to be carefully taken into account.5 In a prior study,7 out of 30 achalasia cardia patients had thyroid disease (four had hypothyroidism, two had hyperthyroidism, and one had just a thyroid nodule in the euthyroid condition).9 In the second case, the patient presented with hyperthyroidism as well and her anti-TPO level was also elevated.