Understanding Hypothyroidism and Chronic Pain
Chronic pain is way too common these days. And as someone with chronic pain myself, I really get how much it impacts the quality of life. Recently I realized that I've been overlooking a potential cause of widespread body pain: the thyroid. An underactive thyroid can actually trigger lots of pain and stiffness, aches, and muscle pain.
Hypothyroidism means your thyroid gland does not make enough thyroid hormone. Low levels of this important hormone lead to joint pain, sore muscles, muscle weakness, and cramps. The unfortunate thing is hypothyroidism symptoms look a lot like fibromyalgia, autoimmune diseases like rheumatoid arthritis, or severe vitamin D deficiency. That makes it easy to miss.
Given how common thyroid issues are, especially for women, I want to make sure my patients get checked for this treatable cause of pain. Getting on the right thyroid medication could provide tremendous relief for many folks. I will start screening for it more often when unexplained muscle or joint pains come up. Controlling thyroid levels stops the metabolism issues that create pain and weakness in the first place.
My goal is simply to help anyone with undiagnosed hypothyroidism get to the bottom of their suffering. I aim to rule out this sneaky contributor to widespread body agony that masquerades as other diseases. Relieving your pain is my top priority as your doctor. Understanding all the potential causes is the first step.
What is Hypothyroidism?
Hypothyroidism means your thyroid gland in the neck does not make enough thyroid hormone. The thyroid is a small gland that secretes hormones that impact your whole body. When levels of this important hormone run low, it slows your metabolism and causes problems across different systems. Thyroid hormone helps control growth, fixes damaged tissues, and keeps metabolism running smoothly. Without enough, you may notice symptoms like unusual tiredness, weight gain, feeling cold, constipation, dry skin and many more issues.
Causes of Hypothyroidism
Several diseases and conditions cause hypothyroidism:
Hashimoto's thyroiditis – An autoimmune disorder where the immune system attacks the thyroid gland
Treatment for hyperthyroidism like radioactive iodine and surgery
Radiation therapy of head and neck cancers
An iodine-deficient diet, often in developing countries
Low selenium levels have been associated with thyroid diseases like Hashimoto's disease and Grave's disease. Selenium deficiency may make an autoimmune thyroid condition worse.
Medications like lithium, anti-seizure drugs, amiodarone, and interferon alpha
Congenital enzyme issues
Aging – As we age, thyroid function naturally declines
In the U.S., autoimmunity and prior treatment of hyperthyroidism are common causes. Women have hypothyroidism 5 to 8 times more often than men.
Hypothyroidism and Chronic Joint Pain
Nearly 79% of people with hypothyroidism experience muscle and joint discomforts like aches, stiffness, cramps, and weakness. For some, these pains become so severe that normal physical activities are limited.
The root cause is deficient thyroid hormones resulting in a slower metabolism and reduced energy production inside muscle cells. Lack of thyroid hormone also increases inflammation, which can worsen muscle weakness. The large shoulder and hip muscles seem especially impacted. Tasks like climbing stairs and getting up from chairs become challenging.
A rare but dangerous complication is rhabdomyolysis, a form of extreme muscle breakdown. The destroyed muscle fibers release myoglobin protein into the bloodstream, which can poison the kidneys. Known triggers for hypothyroid rhabdomyolysis include trauma, intense exercise, statin medications, and electrolyte imbalances. Seeking prompt emergency care is vital since kidney failure can occur.
In summary, the majority of hypothyroid patients battle nagging muscle discomfort and weakness. But in severe cases, extremes like rhabdomyolysis mean the condition can become life-threatening without proper treatment. Monitoring for worsening pain and rapid medical attention for related emergencies like dark urine is essential.
How Hypothyroid Pain Mimics Fibromyalgia
The muscle aches and fatigue of hypothyroidism can resemble the symptoms of fibromyalgia, a chronic pain condition caused by nervous system abnormalities. Like fibromyalgia, hypothyroidism can also lead to issues like depression and poor sleep. This makes distinguishing between the two tricky, and misdiagnosis sometimes occurs.
There are a few key differences to help tell them apart:
Fibromyalgia usually involves more sleep problems and mood instability.
Hypothyroidism tends to cause more weight gain, dry skin/hair, and feeling cold.
Most importantly, lab testing reveals thyroid hormone abnormalities with hypothyroidism.
Some patients suffer from both fibromyalgia AND low thyroid function simultaneously. In those complex cases, treating one condition alone may not resolve all overarching pains. The good news is that family history and blood work can usually differentiate the root causes. An accurate diagnosis guides appropriate treatment for resolving chronic widespread pain - whether from thyroid disease, fibromyalgia, or both together.
Signs and Symptoms
Weakness, often in large muscles
Weight gain, puffy face
Forgetfulness, slower thinking
Dry skin and hair
An uncommon manifestation of severe hypothyroidism is called Hoffman syndrome. This involves enlarged, swollen muscles rather than the weakness and atrophy expected. The puffy appearance comes from abnormal buildups of connective tissues and fluids between muscle fibers. Hoffmann syndrome also causes muscle stiffness, cramps, and feelings of heaviness along with the telltale signs of hypothyroidism like fatigue and weight gain. Blood work confirms the thyroid deficiency. Many cases emerge in adults after years of subtle, undiagnosed thyroid problems. Treating the hormonal shortage reverses most Hoffman syndrome signs apart from some residual muscle enlargement. Recognizing this variant presentation reminds practitioners that hypothyroidism symptoms span quite a spectrum - from painful weakness to puffy pseudo-hypertrophy. Catching unusual variants allows proper diagnosis and management.
Doctors diagnose hypothyroidism with blood tests. TSH for thyroid-stimulating hormone is the usual first test. Normal TSH falls around 0.5 to 5 mIU/L, often lower for rigorous range standards. TSH over 5 mIU/L confirms hypothyroidism. Some in the functional medicine field have the upper limit of TSH at 2.5 mIU/L. A free T4 level below the normal range of 0.8-1.8 ng/dL provides added confirmation.
Creatine kinase (CK) blood levels may be elevated, indicating muscle inflammation, but do not definitively diagnose hypothyroid myopathy. Still, CK over 1000 IU/L warrants assessing thyroid function. Electromyography (EMG) can show abnormal electrical activity in weakened muscles.
Daily oral thyroid hormone tablets treat hypothyroidism. Levothyroxine is a typical preparation. The average starting replacement dose is around 1.6 mcg per kg of body weight. Doses often need adjustment based on lingering symptoms and follow-up blood tests.
Armour Thyroid is another option. It is a natural thyroid hormone replacement medication used to treat hypothyroidism. It contains both T3 (triiodothyronine) and T4 (thyroxine) derived from purified porcine thyroid glands. Armour
Some individuals report preference for natural desiccated thyroid preparations in terms of better symptom improvement. Armour Thyroid can have more interactions with certain foods, medications, and medical conditions. The added T3 hormone gives little room for errors in precise dosing as well. Hence close monitoring and cautious adjustment is imperative, guided by frequent lab testing and clinical evaluation.
With adequate replacement, muscle and joint discomfort gradually resolve over weeks to months in most cases. But some residual pain persists long-term for many. Physical therapy helps rebuild strength and function.
Thyroid and Chronic Pain
If you or a loved one suffer from unexplained widespread muscle aches and pain or exhausting fatigue, I urge you to consider screening for hypothyroidism. This common but sneaky thyroid disorder causes much misery that is sadly overlooked and undertreated. I see it masquerading as everything from fibromyalgia to arthritis to chronic fatigue syndrome way too often. It breaks my heart knowing proper thyroid hormone replacement could restore quality of life for so many people incorrectly labeled with other conditions.
Nogueira, R. V., Lima, R., Parente, C., Liberal, P., & Santos, L. (2023). Hypothyroidism: A Peculiar Presentation. Cureus, 10(7759). https://doi.org/10.7759/cureus.49819
About the author: Dr. Harold Pierre is a board-certified anesthesiologist and addiction medicine specialist with over 20 years of experience. He is certified by the American Board of Anesthesiology and the American Board of Preventive Medicine.
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