When hypothyroidism is painful: Musculoskeletal manifestations

When hypothyroidism is painful: Musculoskeletal manifestations

Pain.
I can’t bear it.
Help!
Doctors tell me it’s not my thyroid.
They say there is nothing more they can do.
Some say it’s all in my head.

Scope of this pain issue

Musculoskeletal disorders are conditions affecting the bones, muscles, and connective tissues. The most common symptom of most musculoskeletal disorders is pain.

According to the 2016 Global Burden of Diseases, Injuries, and Risk Factors Study, the most common leading cause of disability for men was low back pain “resulting in the highest age-standardised rates of years lived with disability (YLDs) in 133 of 195 countries and territories, including every country in the high-income regions, central and eastern Europe, central Asia, Andean and Tropical Latin America, and eastern and central sub-Saharan Africa, as well as most countries in southeast Asia, north Africa and the Middle East, and western sub-Saharan Africa. Low back pain was the leading cause of age-standardised YLD rates for women in 104 of the 195 countries and territories.” Neck pain and other musculoskeletal disorders ranked in the top ten of more than half of the countries and territories.[1]

Half of all American adults (126.6 million of U.S. adults over the age of 18) reported being diagnosed with musculoskeletal conditions in 2012 according to the Executive Summary of The Burden of Musculoskeletal Diseases in the United States: Prevalence, Societal and Economic Cost” by the USA Bone & Joint Initiative.[2]

Musculoskeletal manifestions in hypothyroidism

“Thyroid hormones play an important role in the development, maturation and maintenance of morpho-functional integrity of locomotor system structures,” wrote a researcher in the Romanian Journal of Rheumatology.[3] The relationship between hypothyroidism and musculoskeletal conditions has appeared in the scientific literature since the 1800s.[4]

Shoulder pain and its relationship with thyroid disorders has been suspected since the late 1920s. More recently, the implication of thyroid disease in rotator cuff tendon tears has been studied.[5]

The neck stiffness and joint pain associated with hypothyroidism have been known for centuries.[6]

In 2016, 52 rheumatoid arthritis patients underwent thyroid function testing and 20 of the 52 patients (38.4%) had hypothyroidism.[7]

Carpal tunnel syndrome was discovered in 32.5% of patients with untreated primary hypothyroidism. Women were more vulnerable to develop carpal tunnel syndrome.[8,9]

Adhesive capsulitis (frozen shoulder), Dupuytren’s contracture, trigger finger, and limited joint mobility are common in patients with hypothyroidism as well.[9]

The prevalence of fibromyalgia is approximately 2-7% in the general global population but as high as 30-40% in the population with the thyroid autoimmune disease Hashimto’s thyroiditis.[10]

Based on a study which analyzed data from individuals who participated in health screening programs at Chang Gung Memorial Hospital in northern Taiwan (2000–2010), both hypothyroidism and hyperthyroidism were significantly associated with gout.[11]

Tendinitis is another common painful presenting complaint in hypothyroidism. The Journal of Medical Case Reports includes the unusual (or maybe not so unusual) case of spontanous rupture of the long head of the biceps tendon in a 48-year-old woman with severe hypothyroidism.[12]

In a 2013 study published in the Indian Journal of Rheumatology, the following disorders were found to be significant in 120 patients with primary hypothyroidism[13]:

body ache and myalgia (83.33%)
muscle cramps and stiffness (83.33%)
osteoarthritis (66.7%)
mild inflammatory arthritis involving hand joints (50%)
low back pain (50%)
arthralgia (25%)
adhesive capsulitis (20.8%)
limited joint mobility (16.67%)
rheumatoid arthritis (16.67%)
myopathy (8.33%)
systemic lupus erythematosus (8.33%)
carpal tunnel syndrome (6.6%)
fibromyalgia (5%)
trigger finger (4.1%)
Dupuytren’s contracture (3.33%)
Raynaud’s phenomenon (1.66%)
mixed connective tissue disease (1.66%)
tarsal tunnel syndrome (1.6%)

Conclusion

The relationship between hypothyroidism and musculoskeletal disorders is significant. Comprehensive thyroid testing including thyroid antibodies should be part of the workup of a patient presenting with musculoskeletal conditions. Musculoskeletal manifestations can serve as early signs of undiagnosed hypothyroidism and warning signs of hypothyroidism that is not optimally treated.

Psssst! Your pain is NOT in your head.

References:

1. GBD 2016 Disease and Injury Incidence and Prevalence Collaborators. Global, regional, and national incidence, prevalence, and years lived with disability for 328 diseases and injuries for 195 countries, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016. The Lancet. 16 September 2017;390(10100):1211-1259.

2. Bone and Joint Initiative USA. The Impact of Musculoskeletal Disorders on Americans – Opportunities for Action. boneandjointburden.org

3. Parasca, I. Manifestari reumatologice in bolile tiroidei. EMCB. 01.07.2008.

4. Radu, I., et al. Musculoskeletal Impairment in Primary Hypothyroidism. Rev Med Chir Soc Med Nat Iasi. 2016;120(2):244-251.

5. Oliva, F., et al. Thyroid hormones enhance growth and counteract apoptosis in human tenocytes isolated from rotator cuff tendons. Cell Death Dis. 313;4(7):705.

6. Doyle, L. Myxoedema: some early reports and contributions by British authors, 1873-1898. J R Soc Med. 1991;84(2):103-106.

7. Joshi, R., et al. Prevalence of hypothyroidism in rheumatoid arthritis and its correlation with disease activity. Sage Journals. 20 Jan 2016;47(1):2017.

8. Eslamian, F., et al. Electrophysiologic Changes in Patients with Untreated Primary Hypothyroidism. Journal of Clinical Neurophysiology. June 2011;28(3):323-328.

9. Cakir, M., et al. Musculoskeletal manifestations in patients with thyroid disease. Clinical Endocrinology. Sep 2003;59(2):162-7.

10. Haliloglu S, et al. Clinical Rheumatology. July 2017;36(7):1617-1621.

11. See, L.C., et al. Hyperthyroid and hypothyroid status was strongly association with Gout and Weakly Associated with Hyperuricaemia. PLoS One. 2014;9(12):e114579.

12. Pantazis, K., et al. Spontaneous rupture of the long head of the biceps tendon in a woman with hypothyroidism: a case report. Journal of Medical Case Reports. 2016;10:2.

13. Alakes, K.K., et al. Rheumatic manifestations in primary hypothyroidism. Indian Journal of Rheumatology. March 2013;8(1):8-13.

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About Dana Trentini

Dana Trentini M.A., Ed.M., founded Hypothyroid Mom October 2012 in memory of the unborn baby she lost to hypothyroidism. This is for informational purposes only and should not be considered a substitute for consulting your physician regarding medical advice pertaining to your health. Hypothyroid Mom includes affiliate links including the Amazon Services LLC Associates Program.

Comments

  1. Georgia Mosebach says

    I have had hypothyroidism for 30 years since the birth of my son. After hair thining and trouble losing the baby weight, blood test revealed I needed the synthroid meds to replace my thyroid hormones. All went well, lost the weight, felt a lot better and hair loss stopped. Until 5 years ago, I started gaining weight and feeling tired so I started drinking coffee, several cups in the morning. My hair was thinning again, I had four trigger finger surgeries and two Morton neuroma surgeries. Recently I read if you drink coffee with Thyroid meds it will not work. Well the proff is in the coffee. I do not drink it within 30 minutes before or after meds and I am less tired, losing weight and hair is not as thin. Hope this life experience helps others in need.

  2. Constance Weinberger says

    Twenty five years ago I was treated for psychiatric illnesses I was diagnosed as morbidly obese, bipolar, ADHD, severely depressed and suffering from PTSD. The medications I was given to treat my symptoms made me extremely ill. I have been completely off medications for over 20 years now and have done everything to clean up my diet which has done wonders; no sugar, no flour (no gluten), and I am intolerant of all grains so I eat no bread or cereals. Today I am emotionally stable and spiritually well . I still suffer from weight issues and extreme food sensitivities like bloating, hives, and poor digestion but it presses me on to take care in my diet; I eat good fats, small amounts of meat, mostly greens for vegetables and only berries for fruit (I can’t digest anything else). The worst of the symptoms still is the chronic fatigue, and the severe insomnia. I still suffer from many symptoms but every doctor I have seen in the last 10 years just tells me that there is nothing wrong with me because my blood tests are fine. I am still far from fine but I am not without hope.
    Thank God for your web site and Dr’s that are well informed that have written books about adrenal fatigue and hypothyroidism (there are some fantastic Dr’s out there); I have hope for that reason and continue to educate myself.
    I shall also let food be my medicine. The journey though it be long is toward healing; we can all help to encourage one another to never give up hope. Today I am free from mental illness, I am 50 lbs lighter and my diet is amazing. I have God to thank for my life and the strength to press on even when things were at there worst. Never give up, never give up, never ever give up hope. (Winston Churchill)

  3. Beverly Cass says

    I was treated with radiation 19 years ago. I had a cancerous tumor T the back of my tongue. After 35 treatments to head & neck it was about a few months later i started losing my hair. I was told my thyroid was damaged even though they had it blocked. I have been o synthroid 100mg ever since. I have most of the symptoms of hypothyroidism especially muscle pain & soreness all over. If I take Tylenol it helps. My annual blood tests are coming back ok as the Dr says. I have had 4 family doctors since i had my treatment. They checked my T3 & T4 & said it was ok “for me”.

  4. Liesel Blakeborough says

    I experienced a thyroid storm last June and was first diagnosed hyperthyroid. Months later, I am now hypothyroid, and this article listed exactly what I am feeling. I have been very sick, very scared and very confused by all of this without much help from my doctor’s. Thank you for sharing all of this.

  5. Dawn Leslie says

    I was diagnosed with fibyrmialgia then hypothroidism RHEUMATOID ARTHRITIS lupus Raunauds hypoglycemia

  6. Mary Jane Purcell says

    I have had this problem for years.I have been told it’s Fybro & Arthritis

  7. This article is amazing as I also discovered that hypothyroidism that I have had for over 20 years could also have been the start of ME and antagonism of brain tissue injury causing epilepsy requiring me to have neurosurgery. Amazing how much you can discover in one week. But also gives complete inner peace 👍🏻😁

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