Marc Darrow, MD.JD
Many people with a diagnosis of hypothyroidism will suffer from joint pain. Hypothyroidism is a medical condition where the thyroid gland does not produce enough thyroid hormone for normal body function. Their joint pain comes from under-active (hypo) thyroid gland causing excessive protein deposits in joint tissue. The knees, ankles, feet, and hands the most common pain site in hypothyroidism. However, underlying autoimmune disorders such as rheumatoid arthritis may also be causing issues. This is especially suspected if thyroid medication is given without relief of the person’s joint pain.
Hyperthyroidism, (you produce too much thyroid hormone) can also cause degenerative joint disease.
Thyroid and TMJ
The joint pain, thyroid, autoimmune disease connection is suggested suggested by researchers in a 2018 paper. (1) They suggest that autoimmune thyroid disease also known as Hashimoto thyroiditis, can cause significantly elevated prevalence of temporomandibular disorders (jaw related pain) and have a high prevalence among women in addition to being associated with fibromyalgia and widespread chronic pain. The researchers add that patients with temporomandibular disorders who do not respond to therapy should be referred for thyroid diagnostic workup.
Vitamin D, TMJ and joint pain, and Thyroid
A February 2023 study (2) reviewed the role of vitamin D3 in bone metabolism, temporomandibular joint osteoarthritis, and autoimmune thyroid diseases. The researchers wrote: Vitamin D3 plays a significant role in human health and deficiency may lead to a Thyroid imbalance and may be considered by some researchers as one of the possible backgrounds of autoimmune thyroid diseases, Hashimoto’s thyroiditis or Graves’ disease. Further, the researchers noted, vitamin D3 may also play an important role in the development and progression of degenerative joint diseases, including temporomandibular joint osteoarthritis.
Thyroid and shoulder problems
A 2016 paper suggested (3) that “the association between thyroid disorders and musculoskeletal diseases has long been suspected, but it is still debated whether they have a role in the pathogenesis of shoulder diseases. In vivo and in vitro studies describe the role of thyroid hormones in bone, cartilage and tendon biology. Retrospective studies and case reports suggest that thyroid diseases should be considered as risk factors and hold prognostic value in some of the most common causes of shoulder pain.”
More recently, an August 2020 paper (4) sought to clarify the association of thyroid disorders and primary frozen shoulder. The researchers did this by comparing 166 patients with frozen shoulder with 251 control subjects without shoulder disease and with 129 patients with diagnosis of rotator cuff tears.
The researchers suggested:
“When comparing the frozen shoulder group with the control and rotator cuff groups, there is a specific association between the presence of thyroid disorders and frozen shoulder. By calculating relative risk, it is possible to state that an individual with (thyroid disease) has 2.69 more chance of developing frozen shoulder. Also, there was an association with gender, since women with frozen shoulder exceeded significantly the risk.”
Thyroid and degenerative disc disease
A May 2023 study (7) analyze whether serum thyroid hormones, parathormone, calcium, and vitamin D levels were associated with lumbar intervertebral disc degeneration, Modic changes (signaling degenerative disc disease), and fatty infiltration in the paraspinal muscles.
The authors reviewed the medical records of patients who visited internal medicine outpatient clinics with suspect of endocrine disorders and chronic low back pain.
- Patients with higher serum free thyroxine levels (overactive thyroid) were more likely to have severe lumbar intervertebral disc degeneration.
- Higher parathormone levels (known to lead to bone thinning) were observed in patients with severe intervertebral disc degeneration at L4-L5 level.
- Patients with lower serum vitamin D and calcium levels had more Modic changes and fattier paraspinal muscles at upper lumbar levels.
Thyroid and knee osteoarthritis
Researchers presenting at the 45th Annual Meeting of the European Thyroid Association ETA 2023 “indicated that higher free thyroxine levels may increase the risk of knee osteoarthritis, particularly in individuals with extra joint-loading, such as obesity and weight-bearing physical activity.”(9)
A November 2024 study (13) looked at thyroid-stimulating hormone (TSH) and free thyroxine (FT4) levels in people with hand, hip, or knee osteoarthritis.
- Among 9054 participants (average age 65 years, 56.3% women), higher free thyroxine concentrations were associated with an increased risk of prevalent knee osteoarthritis and more severe knee osteoarthritis. There was a positive association between free thyroxine and overall progression of knee osteoarthritis.
Thyroid and rheumatoid arthritis
The connection between rheumatoid arthritis and autoimmune thyroid disease is controversial. A June 2020 study (10) explains the controversy “The association of the two conditions (rheumatoid arthritis and autoimmune thyroid disease) has been recognized (a) long-time ago and the prevalence of autoimmune thyroid disease in patients with rheumatoid arthritis and vice versa is well assessed. . . The association between rheumatoid arthritis and thyroid disorders is well-known since more than a century, but many aspects remain to be clarified. Questions about genetic and epigenetic basis of this association and prognostic role of one disease on the other are still unresolved. The evaluation of thyroid autoimmunity and functional status is might be screening in rheumatoid arthritis patients. The correction of a condition of hypothyroidism improves rheumatoid arthritis activity, being able to enhance the quality of life of RA patients.”
A paper from 2016 (5) wrote of the rheumatic clinical manifestations in hypothyroidism. They include: polyarthralgias (joint pain without degenerative disease in many cases), lack of recent skill of fine movements of the hands, carpal tunnel syndrome or tarsal tunnel syndrome, osteoarthritis or acute type (gout, chondrocalcinosis), adhesive capsulitis (frozen shoulder syndrome), generalized muscular stiffness, hypothyroid myopathy (muscle disorders), secondary osteoarthritis, Dupuytren’s contracture, “trigger finger” (also called as stenosing tenosynovitis or trigger thumb) etc.
Researchers found (6) that the incidence of hypothyroidism was 1.74-fold higher in the rheumatoid arthritis patients than in people who did not have rheumatoid arthritis. Women had an incidence 3.6-time higher than men. It was not the hypothyroidism that caused the rheumatoid arthritis but rather the rheumatoid arthritis that caused the hyothyroidism. This is noted by the researchers suggestion: “rheumatoid arthritis patients should be closely monitored to prevent the development of hypothyroidism.
An October 2023 study (11) suggested a potentially causal effect (one is happening because of the other and how severe the symptoms are are based on the impact of one to the other condition) of genetically predicted rheumatoid arthritis on autoimmune hyperthyroidism and a bidirectional causal relationship (each causes an impact on the other condition) between rheumatoid arthritis and autoimmune hypothyroidism was also observed with complementary genetic approaches (how each condition impacts each other), which supports the importance and necessity of thyroid function screening and monitoring in rheumatoid arthritis patient management in clinical practice.”
Thyroid and cartilage breakdown
A July 2022 study (8) wrote: “Thyroid hormones play an instrumental role in chondrogenic differentiation and matrix maturation” (the way we make cartilage). This study then investigated the correlation between thyroid status and osteoarthritis and found free triiodothyronine (FT3), free thyroxine (FT4), and thyroid stimulating hormone (TSH) are strongly associated with the prevalence of osteoarthritis which “illustrates the complex correlation between the thyroid system and chondrogenic differentiation.”
Symptoms Beyond Joint Pain That Maybe Caused By Hypothyroidism
Maybe typical for patients with hypothyroidism and joint pain are the following conditions:
- Weight gain, even with extreme dieting because of slow metabolism.
- Loss of energy, excessive fatigue.
- Possible fibromyalgia.
- Memory and mood disorders
- Cold sensitivity
- Menstrual problems
- Constipation
- Generalized hair loss
Summary
In the publication STATPEARLS Hypothyroidism (12) The authors write: “Hypothyroidism affects multiple organ systems across all age groups and affects patient well-being and ability to function on a daily basis. This disorder is best managed by the primary care physician or endocrinologist. Treatment is with levothyroxine monotherapy.”
References
1 Grozdinska A, Hofmann E, Schmid M, Hirschfelder U. Prevalence of temporomandibular disorders in patients with Hashimoto thyroiditis. Journal of Orofacial Orthopedics/Fortschritte der Kieferorthopädie. 2018 Jul;79(4):277-88.
2 Szulc M, Świątkowska-Stodulska R, Pawłowska E, Derwich M. Vitamin D3 Metabolism and Its Role in Temporomandibular Joint Osteoarthritis and Autoimmune Thyroid Diseases. International Journal of Molecular Sciences. 2023 Feb 17;24(4):4080.
3 Vicenti G, Moretti L, De Giorgi S, Caruso I, La Malfa M, Carrozzo M, Solarino G, Moretti B. Thyroid and shoulder diseases: the bases of a linked channel. Journal of biological regulators and homeostatic agents. 2016 Jul 1;30(3):867-70.
4 Cohen C, Tortato S, Silva OB, Leal MF, Ejnisman B, Faloppa F. Association between frozen shoulder and thyroid diseases: strengthening the evidences. Revista Brasileira de Ortopedia. 2020 Sep 30;55:483-9.
5 Iuliana RA, Groppa L, Lorina VU. Musculoskeletal impairment in prymary hypothyroidism. The Medical-Surgical Journal. 2016 Jun 30;120(2):244-51.
6 Huang CM, Sung FC, Chen HJ, Lin CC, Lin CL, Huang PH. Hypothyroidism risk associated with rheumatoid arthritis: A population-based retrospective cohort study. Medicine. 2022 Jan 7;101(1).
7 Ekşi MŞ, Orhun Ö, Demir YN, Kara M, Berikol G, Özcan-Ekşi EE. Are serum thyroid hormone, parathormone, calcium, and vitamin D levels associated with lumbar spine degeneration? A cross-sectional observational clinical study. European Spine Journal. 2023 May;32(5):1561-74.
8 Chen S, Sun X, Zhou G, Jin J, Li Z. Association between sensitivity to thyroid hormone indices and the risk of osteoarthritis: an NHANES study. European Journal of Medical Research. 2022 Dec;27(1):1-8.
9 Xu Y, Szilagyi I, Boer C, Sedaghati-Khayat B, Edward VW, Chaker L. Association between thyroid function and osteoarthritis: a population-based cohort study. InEndocrine Abstracts 2023 Aug 24 (Vol. 92). Bioscientifica.
10 Conigliaro P, D’Antonio A, Pinto S, Chimenti MS, Triggianese P, Rotondi M, Perricone R. Autoimmune thyroid disorders and rheumatoid arthritis: A bidirectional interplay. Autoimmunity reviews. 2020 Jun;19(6):102529.
11 Liu X, Yuan J, Wang X, Tang M, Meng X, Zhang L, Wang S, Zhang H. Association between rheumatoid arthritis and autoimmune thyroid disease: evidence from complementary genetic methods. Endocrine. 2023 Oct 26:1-8.
12 Patil N, Rehman A, Jialal I. Hypothyroidism. [Updated 2023 Aug 8]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-.
13 Xu Y, Szilagyi IA, Boer CG, Sedaghati-Khayat B, Visser WE, van Meurs JB, Chaker L. Association between thyroid function and osteoarthritis: A population-based cohort study. Osteoarthritis and Cartilage. 2024 Nov 12.