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May 09, 2023 8 min read

Did you know that an underactive thyroid can cause muscle issues, also known as myopathy? While these muscle symptoms are generally mild and can be managed by treating the underlying thyroid disorder, there are rare instances when myopathy can be quite severe and significantly impact daily life.

What is hypothyroidism?

The thyroid is a small butterfly-shaped gland in your neck, just below Adam's apple. It plays a crucial role in the body's metabolism by producing hormones regulating energy use. These thyroid hormones, known as triiodothyronine (T3) and thyroxine (T4), are released into the bloodstream and affect the function of almost every organ in the body.

The pituitary gland controls your thyroid gland, located at the base of the brain. The pituitary gland produces thyroid-stimulating hormone (TSH), which signals the thyroid to produce and release T3 and T4 hormones.

When your thyroid function properly, it produces the right amount of hormones to keep your body running smoothly. However, if the thyroid produces too little hormone (underactive thyroid or hypothyroidism), it can cause a range of problems. People with hypothyroidism will exhibit various signs and symptoms, such as fatigue, anxiety, muscle weakness, weight gain, and cold intolerance. Additionally, hypothyroidism leads to serious health problems, such as heart disease, high cholesterol, and nerve damage if left untreated.

The most common cause of hypothyroidism is an autoimmune disease called Hashimoto's thyroiditis. In this condition, your immune system attacks the thyroid gland, damaging the gland and reducing its ability to produce thyroid hormone. Other causes of hypothyroidism include surgical removal of the thyroid gland, radiation therapy to the neck area, congenital hypothyroidism (a condition present at birth), and certain medications such as lithium and amiodarone. Iodine deficiency can also cause hypothyroidism, which is rare in developed countries where iodine is added to salt and other food products.

A woman looking tired due to hypothyroidism

What is myopathy?

Let's delve into the basics of myopathy before we connect it to hypothyroidism.

Myopathy, in simple terms, refers to a muscle disorder that affects the function, structure, or metabolism of muscle fibers. This can result in muscle weakness, pain, and sometimes muscle wasting, depending on the severity and type of myopathy. There are various types of myopathies, which can be inherited, acquired, or even caused by endocrine disorders, such as thyroid diseases.

Myopathy caused by hypothyroidism is known as hypothyroid myopathy. Conversely, overactive thyroid (a condition where the thyroid gland produces too much hormone) can also cause myopathy. When this occurs, it's called hyperthyroid myopathy.

What is hypothyroid myopathy?

Hypothyroidism-induced myopathy is a muscle disease that occurs due to thyroid dysfunction or low levels of thyroid hormone in your body. Living with hypothyroid myopathy can be tough, as it often leads to weakness all over the body. This condition affects the muscles and causes weakness, pain, cramping, and stiffness. You may also suffer from swelling of the small joints in the hands. You might feel it the most in your thigh and shoulder muscles, making simple tasks like climbing stairs or combing your hair a bit of a struggle.

What are the types of hypothyroid myopathy?

Hypothyroid myopathy can manifest in different ways, including:

1. Generalized muscle weakness

As one of the most common types of hypothyroid myopathy, muscle weakness is characterized by weakness in the proximal muscles (those closest to the body's core), such as the shoulders, hips, and thighs.

2. Muscle cramps and stiffness

Some individuals with hypothyroidism may experience muscle cramps and stiffness, primarily in the lower limbs.

3. Hoffman's syndrome

In a few rare cases, hypothyroidism can cause more intense muscle symptoms. One example is Hoffman's syndrome, where muscles become larger (muscle hypertrophy). This can cause painful spasms and proximal muscle weakness. In other words, it may make your muscles feel really stiff, weak, and painful. This form of hypothyroid myopathy is usually seen in primary hypothyroidism and rarely with secondary hypothyroidism. The cause of muscle pseudohypertrophy in Hoffmann's syndrome is complex and largely unclear.

4. Kocher-Debre-Semelaigne syndrome

This is a rare form of hypothyroid myopathy that affects children and is characterized by muscle weakness, stiffness, and hypertrophy, along with delayed growth and development.

5. Rhabdomyolysis

Rhabdomyolysis is a serious and potentially life-threatening complication of severe and untreated hypothyroid myopathy. This condition occurs when muscle tissue breaks down rapidly and releases its contents into the bloodstream. The released muscle cell contents can damage the kidneys and cause kidney failure, leading to a build-up of toxins in the body.

There are various causes behind this condition, but it may occur if you have hypothyroidism and do intense exercise or take cholesterol-lowering medications called statins. Although these situations are rare, it's good to know about them and talk to your doctor if you have any concerns.

A woman jogging, looking like she have muscle pain due to hypothyroidism

How does hypothyroidism lead to muscle pain or myopathy?

While it's clear that hypothyroidism affects the body's metabolism, why and how it specifically causes muscle pain isn't known. However, some experts believe that the following factors contribute to muscle pain or myopathy:

1. Slowed metabolism and reduced energy production

When the body's metabolism slows down due to decreased thyroid hormone levels, the energy production in muscle cells is also reduced. This can lead to muscle weakness, fatigue, and pain.

2. Thyroxine (T4) deficiency

Thyroid hormones, including T4, play a crucial role in maintaining normal muscle function, including muscle contraction and relaxation. A decrease in thyroid hormone levels can lead to impaired muscle function, causing muscle stiffness, cramps, and pain. Moreover, not having enough thyroid hormone can cause abnormal oxidative metabolism, which ultimately leads to muscle injury.

3. Accumulation of glycosaminoglycans

Hypothyroidism can cause an increase in the production of glycosaminoglycans, which are long-chain sugar molecules found in connective tissues. These molecules attract water and can cause swelling and stiffness in muscles and joints, leading to pain.

4. Altered muscle metabolism

Hypothyroidism can also cause changes in muscle metabolism, including a decrease in muscle protein synthesis and an increase in muscle protein breakdown. This can lead to muscle weakness, atrophy (muscle wasting), and pain.

5. Decreased blood flow to muscles

Low thyroid hormone levels can cause blood vessels to constrict, reducing blood flow to muscles. This can lead to muscle cramps, pain, and fatigue.

6. Effects on pain perception

Hypothyroidism has been found to increase the sensitivity of pain receptors, making individuals more susceptible to muscle pain.

7. Inflammation

In some cases, hypothyroidism can lead to inflammation in the muscles, causing pain and tenderness.

Diagnosis of Hypothyroidism-Related Muscle Pain

Hypothyroidism-related muscle complaints and pain can be difficult to diagnose since they may be a symptom of other conditions.

Figuring out if you have hypothyroid myopathy involves looking at your symptoms, doing a physical examination, and running some diagnostic tests. One such test is a blood test that measures creatinine kinase, which can help your healthcare provider in making a diagnosis. In some cases, your healthcare provider may recommend additional tests, such as electromyography. This test involves using needles to measure the electrical signals in your muscles and nerve cells while they are active and at rest.

For more severe cases or when the diagnosis remains unclear based on less invasive testing, a muscle biopsy may be necessary. This procedure involves the removal of a small sample of muscle tissue through a minor surgical procedure for microscopic examination. Rest assured, this procedure is safe and performed only when necessary to obtain a clear diagnosis and determine appropriate treatment options.

A woman looking happy while taking natural desiccated thyroid (NDT)

Ways to Decrease Joint Pain From Hypothyroidism

If you leave it untreated, joint discomfort caused by hypothyroidism could become severe. However, these activities can help you to relieve joint pain and tension.

1. Try low-impact aerobics

Low-impact aerobics can be an effective way to ease joint and muscle pain. Low-impact exercises include activities like walking, cycling, swimming, and water aerobics. These exercises are less stressful on the joints and muscles, making them a great option for you suffering from hypothyroidism-related pain.

2. Consider strength training

Starting a weightlifting routine can help strengthen your muscles and alleviate joint and muscle pain. It's essential to start with low weights and gradually increase the intensity to avoid causing injury or exacerbating pain. Work with a certified personal trainer or physical therapist to develop a customized weightlifting program that meets your needs and fitness level. Remember to always use proper form and technique during weightlifting exercises to avoid injury. Additionally, it's also important to rest and allow your muscles time to recover after each workout.

3. Get a good night's sleep

Getting enough sleep is crucial for rejuvenating your joints and muscles. When you sleep, your body repairs and rebuilds damaged tissue, including your joints and muscles. Aim to get at least 7-8 hours of sleep per night to help your body recover and decrease inflammation.

4. Maintain a healthy diet

Maintaining a healthy diet is crucial in managing joint pain related to hypothyroidism. A well-balanced diet rich in nutrients and incorporating foods high in vitamin C, Vitamin E, and carotenoid sources.

5. Practice yoga

Yoga is a popular mind-body practice that can be helpful for you to ease your joint and muscle pain. Yoga movement involves a combination of physical postures, breathing exercises, and meditation or relaxation techniques. Most importantly, yoga can improve strength, flexibility, balance, and overall physical function while reducing stress and improving your mental health.

6. Stay positive

Maintaining a positive mindset and staying motivated can also significantly impact managing bodily pain from hypothyroidism. Additionally, seeking support from friends, family, or a support group can provide encouragement and motivation on the journey toward a better health condition.

7. Meditate to reduce stress

Sometimes stress can worsen hypothyroidism. One effective way to reduce stress is through meditation. Meditation can help calm the mind and body, promoting relaxation and reducing the production of stress hormones.

8. Treat your hypothyroidism

Taking thyroid hormone replacement therapy to improve your thyroid hormone levels will ease hypothyroid myopathy. As thyroid hormone levels return to normal with treatment, muscle pain and other symptoms of hypothyroidism should improve. For example, your doctor may prescribe you levothyroxine (synthetic T4). This is the standard treatment for hypothyroidism, so your doctor will likely prescribe you it when you just got diagnosed with hypothyroidism.

If you don't feel better with levothyroxine or you prefer a more natural approach, you can consider natural desiccated thyroid (NDT). Made of dried pig thyroid glands, NDT contains both T4 and T3. That's why more people feel better with it compared to levothyroxine. NDT is available in both prescription medication and supplement forms. You can buy desiccated thyroid online in supplement form, such as VitaliThy. It contains Thyroid (USP) just like Armour Thyroid and NP Thyroid but is registered as a supplement due to the difference in law between the US and Vietnam.

9. Pain management medications

In addition to thyroid hormone replacement therapy, pain management drugs like nonsteroidal anti-inflammatory drugs (NSAIDs). In some cases, additional treatment may be needed to address specific muscle problems, such as physical therapy for muscle weakness.

Conclusion: Hypothyroidism and Muscle Pain

A thyroid disease like hypothyroidism can cause muscle pain (myopathy) due to various factors, including slowed metabolism, impaired muscle function, accumulation of glycosaminoglycans, altered muscle metabolism, decreased blood flow, increased pain perception, and inflammation. Understanding these factors can help individuals with hypothyroidism and their healthcare providers identify and manage muscle pain more effectively. With proper diagnosis and treatment, most individuals with hypothyroid myopathy can experience significant improvements in muscle pain and overall quality of life.

Wojciech Majda
Wojciech Majda

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