Thyroid Disease: Coping With Muscle and Joint Pain

pain, muscle and joint pain, thyroid disease
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Hypothyroidism and hyperthyroidism can cause a variety of muscle or joint-related symptoms. Both hypothyroidism and hyperthyroidism are known to cause what are called myopathies—the medical term for diseases that affect your skeletal muscles.

Skeletal muscles are the muscles connected to your bones. An example of skeletal muscles are your biceps in the upper arm or the quadriceps in your thighs.

Myopathies most often are seen in what are known as the proximal muscles.

These are the muscles that are closest to the center of the body, such as the thigh or shoulder.

In myopathies caused by inflammation or metabolic conditions—such as autoimmune thyroid disease—white blood cells may attack parts of your muscle and the surrounding blood vessels. Abnormal levels of certain biochemical substances may also end up accumulating in your muscles, leading to weakness or pain.

Different thyroid conditions can also be associated with particular types of muscle and joint problems.

Muscle and Joint Pain With Hypothyroidism

Hypothyroidism can result in a variety of muscle and joint-related symptoms. Most commonly, these symptoms are fluid retention, which results in the swelling of muscles, or swollen muscles that are pressing on your nerves. Some of the problems seen include:

  • general muscular weakness and pain, including cramps and muscle stiffness
  • general joint pain, achiness, and stiffness, known as "arthropathy"
  • tendonitis in your arms and/or legs
  • carpal tunnel syndrome, which involves pain, tingling, weakness, achiness, or numbness in your wrists, fingers, or forearms. It is due to swelling of membranes that compress a nerve in your forearm
  • tarsal tunnel syndrome, which is similar to carpal tunnel syndrome, and causes pain, tingling, burning, and other discomfort in the arch of your foot, the bottom of your foot, and can potentially extend into your toes
  • frozen shoulder, also known as adhesive capsulitis, which causes pain, limited movement, and stiffness in your shoulder

Muscle and Joint Pain With Graves' Disease/Hyperthyroidism

In hyperthyroidism and Graves' disease, you may experience muscle weakness and fatigue, known as hyperthyroid myopathy. Pain in muscles is not as common in hyperthyroidism.

Some people with hyperthyroidism actually lose muscle tone and strength, a process that can be referred to as "muscle wasting." Some common complaints include:

  • difficulty climbing stairs
  • difficulty holding or gripping objects with your hands
  • difficulty reaching your arms above the head

In some cases, the muscles affected can include those that help you swallow, so you may have some hoarseness or difficulty swallowing.

When the Pain Doesn't Go Away

Typically, the worst of these symptoms and conditions usually resolve for the most part with proper treatment of your thyroid condition. When muscle and joint pain does not go away with proper thyroid treatment, however, it's time to ask several questions:

1) If you are hypothyroid, are you getting sufficient and proper treatment? In other words, is your treatment "optimized" or are you undertreated? Resolving insufficient thyroid hormone replacement, or meeting a need for additional T3, may be required to resolve your muscle and joint pain.

Talk to your doctor if you feel your hypothyroidism is unrelieved by your medication.

2) If you are receiving optimal thyroid treatment, and still suffering joint and muscle problems, should you get a referral to a rheumatologist for further evaluation and possible treatment? A trained rheumatologist can provide a more thorough evaluation for arthritis and fibromyalgia. Rheumatologists are experts in joint and muscle problems, and treat arthritis, some autoimmune conditions, various musculoskeletal pain disorders, fibromyalgia and tendonitis. To find a rheumatologist in your area, check the American College of Rheumatology's Doctor Directory.

3) Have you been evaluated for fibromyalgia? Interestingly, on the subject of fibromyalgia, some practitioners actually believe that fibromyalgia is a symptom of or manifestation of hypothyroidism. Fibromyalgia is a syndrome that features specific tender points in the body, with widespread weakness and fatigue.

4) Should you look into alternative therapies? Some patients with chronic joint and muscle pain related to their thyroid conditions have had success with therapies, such as massage, acupuncture, and myofascial therapy. In terms of supplements, researchers at the National Institutes of Health's National Institute of Arthritis and Musculoskeletal and Skin Diseases have found that glucosamine and chondroitin "may have some efficacy against the symptoms of [osteoarthritis]."

Sources: 

Braverman, L, Cooper D. Werner & Ingbar's The Thyroid, 10th Edition. WLL/Wolters Kluwer; 2012.

Suresh E, Wimalaratna S. "Proximal myopathy: diagnostic approach and initial management."  Postgrad Med J. 2013 Aug;89(1054):470-7. doi: 10.1136/postgradmedj-2013-131752. 

Villar J, et. al. "Myopathy in patients with Hashimoto's disease." Invest Clin. 2015 Mar;56(1):33-46.

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