Hypothyroidism and Musculoskeletal Considerations

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Do you suffer from muscle pain or general aches and pains without knowing why? It could be hypothyroidism, which can manifest itself as symptoms affecting the musculoskeletal system. This, in turn, can limit your success in exercising – but it doesn’t have to.

Hypothyroidism is a condition caused by a structural or functional derangement that interferes with the production of adequate levels of the thyroid hormone, and it occurs more often in women. There are two types of hypothyroidism, primary and secondary, with a variety of symptoms that may be confused for other conditions. Muscle and joint pain or soreness is a common one that isn’t frequently described, but often causes discomfort.

Common hypothyroidism symptoms include:

  • Fatigue
  • Weakness
  • Weight gain or increased difficulty losing weight
  • Coarse, dry hair
  • Dry, rough pale skin
  • Hair loss
  • Cold intolerance (you can’t tolerate cold temperatures like those around you)
  • Muscle cramps and frequent muscle aches
  • Constipation
  • Depression
  • Irritability
  • Memory loss
  • Abnormal menstrual cycles
  • Decreased libido

Hypothyroidism Diagnosis

Laboratory evaluation plays a crucial role is the diagnosis of hypothyroidism. Measurement of serum TSH level is the most sensitive screening test for this disorder. Serum T4 levels should also be checked along with TSH to confirm the diagnosis.  Ask you medical doctor for more information regarding testing.

Musculoskeletal Considerations

Patients with hypothyroidism frequently develop moderate muscle pain or nerve. These muscle pains include aches, muscle stiffness, muscle fatigability, muscle weakness, muscular cramps, and elevated levels of muscle enzymes, which are prevalent in approximately 20% to 80% of hypothyroid patients. The prevalence of a nerve problem or neuropathy in patients varies between 10% and 70%. Hypothyroid patients often complain of joint and muscular pains, and may even suffer from joint-swelling involving the knees or small joints.

In a study by Duyff et al (2000), it was found that 79% of hypothyroid patients had neuromuscular complaints, 38% had clinical muscle weakness in one or more muscle groups, 42% had signs of sensorimotor axonal neuropathy, and 29% had carpal tunnel syndrome. Electrodiagnostic exams performed in this study revealed patients with hypothyroidism may have a decreased reaction time in terms of muscle activation.

In a study by Cakir et al (2003), they evaluated the prevalence of the following musculoskeletal symptoms in various thyroid diseases: adhesive capsulitis, Dupuytren’s contracture, trigger finger, limited joint mobility and carpal tunnel syndrome (CTS). It was found that Dupuytren’s contracture and limited joint mobility are most common in hypothyroid patients. Trigger finger occurred in 10% of patients with subclinical hypothyroidism. Adhesive capsulitis was highest in patients with hyperthyroidism.

In rare occasions, rhabdomyolysis may be seen in patients with hypothyroidism. It is mainly seen in collagen diseases, ingestion of massive amounts of alcohol other agents, infection, trauma, or congenital deficiency of muscular enzymes. This condition is the breakdown of muscle tissue called myolysis. Myolysis in hypothyroidism is caused by changes in muscle fibres from fast twitch (type II) fibers to slow twitch (type I) fibers, deposition of glycosaminoglycans, poor contractility of active-myosin units, low myosin ATPase activity and low ATP turnover in skeletal muscle. Laboratory investigation will reveal a moderate rise in plasma creatine phosphokinase. Patients generally suffer from muscle weakness and tenderness, and markedly raised muscle enzymes.

It is important to realize that there are many symptoms of hypothyroidism. Joint and muscle pain has been reported by many patients. Muscle fatigue, stiffness, and cramps and joint soreness should not be ignored. Ensure that your medical doctor assesses your condition to prescribe appropriate medical management if you have hypothyroidism, or believe you need to be screened for it. Once diagnosed and treated with medication, manual therapists such as chiropractors can help with pain management of  muscle and joint pain symptoms associated with hypothyroidism. This can be achieved through exercise, joint mobilization, soft tissue therapy and acupuncture.


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