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July 03, 2023 9 min read

Have you ever experienced muscle weakness while taking levothyroxine? As a group that has dealt with hypothyroidism and its treatment, we understand the frustration of feeling weak and powerless even with medication. Levothyroxine is a commonly prescribed drug to treat an underactive thyroid gland. However, just like any medication, it can have side effects affecting our daily lives. In this article, we will explore whether or not levothyroxine can cause muscle weakness and what you can do to manage it.

Can hypothyroidism cause muscle pain?

Before we talk about levothyroxine causing muscle weakness, let's start with a fundamental understanding of hypothyroidism. This condition occurs when one's thyroid gland does not produce enough thyroid hormones. One primary effect of this insufficiency? Impaired muscle function. This can present itself in several ways - muscle cramps, general muscle weakness, and even some instances of muscle injury.

Let's take a closer look at what's called "hypothyroid myopathy." These two words paired together might sound fancy, but they just mean muscle disease associated with hypothyroidism. Muscle symptoms can vary widely among people with hypothyroid myopathy, which can make it a tricky condition to diagnose. Some people experience mild muscle stiffness, while others deal with severe cramping as part of their hypothyroid myopathy. Muscle weakness, particularly proximal muscle weakness, can also be a symptom. The 'classic' hypothyroid myopathy presents weakness and atrophy (shrinking) of the muscles closest to the middle of the body, like your thighs or shoulders.

Uncommonly, hypothyroidism might pave the way to extreme muscle symptoms. A case in point is Hoffman's syndrome - an unusual condition where muscles become enlarged, a condition referred to as muscle hypertrophy. This can manifest in substantial muscle stiffness, weakness, and even pain.

If you've been feeling unusually weak lately or dealing with recurring muscle cramps, you might be asking yourself: 'Can hypothyroidism cause muscle pain?' The answer, in short, is yes. Hypothyroidism has been known to cause what's called myalgia, or muscle pain, due to increased sensitivity to pain resulting from the reduction of thyroid hormone in the body.

Regular muscle function is integral for mobility, strength, and overall quality of life, making these thyroid-related muscle symptoms worth paying attention to. So, if you're dealing with continuous muscle cramps, weakness, or injury that isn't linked to an obvious cause, talk to your doctor about the possibility of hypothyroidism.

What is levothyroxine?

Levothyroxine is a medication commonly used to treat hypothyroidism, which affects approximately 5% of the US population. This prescription drug is a synthetic form of the thyroid hormone thyroxine (T4) that helps regulate metabolism and energy levels in the body.

You may be curious about how this medication, the levothyroxine oral tablet, regulates your thyroid hormone levels and improves your overall health. Well, it's quite simple, actually.

Levothyroxine works by increasing the amount of thyroxine in your bloodstream, signaling your pituitary gland to decrease its thyroid-stimulating hormone (TSH) production. TSH normally stimulates the thyroid gland to produce more thyroid hormones; however, when there are enough thyroid hormones in your bloodstream, TSH production decreases, and so does thyroid hormone production. This feedback loop helps regulate your thyroid hormone levels and improve symptoms associated with hypothyroidism, such as fatigue, weight gain, depression, and muscle weakness.

But while levothyroxine can replace missing thyroid hormones and relieve symptoms, in rare cases, it might cause or exacerbate muscle weakness.

Why do I feel muscle weakness all the time, even with levothyroxine?

Muscle weakness is not a common side effect of levothyroxine, but it can occur in some people. Many factors can contribute to this, including getting the wrong medication dosage, difficulty converting T4 to T3 hormones, other health conditions that affect muscles, lifestyle factors like diet and exercise habits, and issues with how well the body absorbs levothyroxine. We'll explore these possibilities to help you understand why you might be experiencing ongoing muscle weakness despite treatment.

1. Wrong dosage

If you take too high of a levothyroxine dosage, your muscles may feel like they're constantly working out. This is because taking too much levothyroxine can lead to an overactive thyroid (hyperthyroidism), which in turn may cause myopathy. Hyperthyroid myopathy causes muscle weakness, making it hard for you to rise from a chair, climb stairs, or hold objects.

How can you tell if your dose is too high? Here are three signs to look out for:

  • Rapid heartbeat: If you notice that your heart is racing or beating faster than usual, it could be a sign that your body is getting too much levothyroxine.

  • Insomnia: Taking too much levothyroxine can also make sleeping difficult at night.

  • Increased appetite: Overdosing on levothyroxine can cause an increase in appetite and weight loss, even if you're eating more than usual.

Conversely, it's also possible that you might be taking too little levothyroxine. As explained before, hypothyroidism can cause muscle symptoms. If you're taking levothyroxine, but your dosage is too low, your hypothyroidism won't be treated properly, meaning you'll still experience hypothyroidism-induced myopathy.

2. T4 to T3 conversion

Converting T4 to T3 is like turning a key in a car's engine, providing the fuel for optimal thyroid function. This process is critical because T3 is the active hormone that regulates our body's metabolism, energy levels, and muscle strength. However, it's important to understand that levothyroxine only contains synthetic T4.

While the body can naturally convert some of the synthetic T4 into T3, not everyone can do so efficiently. Those who struggle with converting T4 to T3 may experience symptoms such as muscle weakness. This is because the body receives a lot of T4 that can't be converted to T3, so it doesn't effectively trigger the 'engine.' This is akin to having a lot of unburned fuel in a car; the key is there, but the engine isn't efficiently running.

When T3, the active hormone that dictates our metabolism, energy levels, and muscle strength, remains insufficient due to inefficient conversion, muscle weakness can be an unfortunate repercussion. Fundamentally, the body is receiving a high dose of synthetic T4 from levothyroxine, but the lack of conversion into usable T3 results in a surplus of 'fuel,' which isn't effectively powering the 'engine.'

Remember that everyone's body works differently, and some people might not struggle with this conversion. However, if you are experiencing persistent muscle weakness or other symptoms of hypothyroidism despite taking your levothyroxine as prescribed, it might be worth considering other alternatives.

3. Other health conditions

While a thyroid disorder like hypothyroidism certainly can be a contributing factor to muscle weakness, it's important to know that it's not always the culprit. Other health conditions may play a part in fueling your muscle symptoms.

Conditions such as diabetes, inflammatory diseases like lupus or rheumatoid arthritis, certain types of infections, and even problems with the electrolyte balance in your body can all lead to muscle weakness. Moreover, neurological disorders such as multiple sclerosis or certain muscular disorders could be at play.

4. Lifestyle factors

Keep in mind that lifestyle habits can also play a role. Lack of sleep, nutrition, and hydration, overexertion through exercise, stress, and even certain medications can contribute to muscle function impairment.

5. Levothyroxine absorption

Improving the absorption of levothyroxine can be crucial in preventing muscle weakness. It's important to note that levothyroxine is a synthetic hormone replacement therapy that needs to be absorbed properly for it to work effectively. Absorption can occur due to poor diet, drug interactions, and digestive problems.

Taking levothyroxine on an empty stomach with water at least 30 minutes before eating breakfast or any other medication is recommended to ensure proper absorption. It's also essential to avoid foods high in fiber or calcium supplements within four hours of taking the medication since they can interfere with absorption. Additionally, ensuring adequate hydration levels and avoiding alcohol consumption before and after taking the medication can help improve its effectiveness.

How can you manage or reduce muscle weakness while taking levothyroxine?

There are several ways you can manage or reduce muscle weakness while taking levothyroxine. Here are some of the ways you can do it:

1. Talk to your doctor

Remember, it's okay not to have all the answers, especially when it comes to understanding complex conditions like hypothyroidism and its ripple effects on your body. That's where medical professionals step in to provide their expertise.

If you feel something is not right, talk to your doctor. They can help you find the best tactics to manage hypothyroidism.

2. Monitoring and adjusting medication dosage

To ensure optimal treatment, it's important to regularly monitor and adjust the levothyroxine dosage if muscle weakness persists. This is because muscle weakness can be a symptom of an incorrect dosage or too much medication. Here are four steps to effectively monitor and adjust your levothyroxine dosage:

  • Schedule regular appointments with your doctor: Your doctor will assess your symptoms, order blood tests, and recommend changes in medication as needed.

  • Keep track of your symptoms: Take note of any muscle weakness or other side effects you experience while taking levothyroxine. Share this information with your healthcare provider during appointments.

  • Be consistent with taking your medication: Taking levothyroxine simultaneously every day can help stabilize hormone levels in the body, reducing the risk of muscle weakness.

  • Follow up after any medication adjustments: It may take some time for changes in dosage to take effect, so follow up with your healthcare provider after any adjustments have been made to determine their effectiveness.

  • Consider combination therapy or natural desiccated thyroid (NDT).

Exploring combined therapeutic approaches or natural desiccated thyroid (NDT) could be the key to managing hypothyroidism effectively and meeting treatment goals. For some individuals, taking levothyroxine alone might not fully alleviate their symptoms. In such cases, combined therapy, which involves the simultaneous use of liothyronine (synthetic T3) and levothyroxine, could offer a more comprehensive approach. Yet, the necessity of taking two separate medications can be an inconvenience for some, and others might not respond favorably to synthetic drugs.

Natural desiccated thyroid (NDT) is another alternative when levothyroxine alone isn't enough. It's also a great option for those who are looking for a more holistic approach to hypothyroidism treatment. NDT is made from dried pig thyroid gland tissue containing T3 and T4 hormones. Unlike synthetic levothyroxine, which only provides the T4 hormone, NDT delivers a more balanced ratio of T3 and T4 hormones found in natural human thyroid glands. Some studies show that much more (257% to be exact) people who tried NDT and levothyroxine preferred NDT.

The most common NDT medications in the US are Armour Thyroid and NP Thyroid. You can also buy desiccated thyroid online, without a prescription, such as VitaliThy. This NDT supplement contains both T4 and T3, just like Armour Thyroid and NP Thyroid. Plus, it's free from lactose, gluten, fish, shellfish, and eggs, as well as artificial colors and flavors.

3. Maintaining healthy lifestyle

You can improve your overall well-being and manage hypothyroidism by maintaining a healthy lifestyle. Regular physical activity is essential to maintain muscle strength and flexibility. Even light exercises such as walking or yoga can go a long way in preventing muscle weakness caused by levothyroxine. Eating a nutritious diet rich in protein, calcium, and vitamin D can also help strengthen muscles and bones. So make sure to include lean meats, dairy products, leafy greens, and nuts in your daily meals. By making these small changes to your lifestyle, you can effectively manage the symptoms of hypothyroidism while avoiding the side effects of medication like levothyroxine-induced muscle weakness.

4. Take levothyroxine correctly

If you want to avoid feeling like a zombie, taking your levothyroxine medication correctly is important. Here are three tips to help you take your medication correctly:

  • Establish a consistent routine: It's helpful to take your medication simultaneously every day, so set the alarm or incorporate it into your daily routine. This will ensure you don't miss a dose and maintain stable hormone levels.

  • Take on an empty stomach: Levothyroxine should be taken on an empty stomach before breakfast, preferably in the morning. This ensures optimal medication absorption and avoids any interference from food or other medications.

  • Avoid certain substances: Certain substances, such as calcium supplements, iron supplements, and antacids, can interfere with the absorption of levothyroxine in the body. So avoid taking these substances within four hours of taking levothyroxine.

Conclusion: muscle weakness is a side effect of levothyroxine

While levothyroxine is necessary for those with a thyroid disease like hypothyroidism, it can come with side effects such as muscle weakness. However, it's essential to note that muscle pain and weakness can also be a symptom of an underactive thyroid. Therefore, it's crucial to consult with your doctor if you're experiencing muscle weakness or any other adverse side effects.

If you've diligently tweaked your levothyroxine dosage, ensured proper intake, and yet still experience bouts of muscle weakness, you may want to contemplate transitioning to natural desiccated thyroid (NDT).

NDT is a type of thyroid hormone replacement therapy that is derived from the dried thyroid glands of pigs. This naturally derived medication contains both T4 and T3 hormones, much like a human thyroid gland would produce.

Some people with hypothyroidism find that they respond better to NDT compared to synthetic forms of thyroid medication. The presence of both T4 and T3 might provide more comprehensive management of thyroid symptoms, muscle weakness included. One great option if you want to make the switch is VitaliThy, a natural desiccated thyroid you can buy online.

Wojciech Majda
Wojciech Majda

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