Editor’s Note
When it comes to joint soreness, which department do you think of first? Rheumatology? Orthopaedics? Anyway, I won’t go to the endocrinology department first, and I won’t think of what’s relationship with thyroid gland. However, in fact, thyroid gland has a lot to do with arthralgia. Please listen to Dr. Zhou Qiao of rheumatology department for everyone.
In the rheumatology clinic, whenever there is arthralgia, muscle pain, myasthenia patients, in the routine examination of rheumatology, will be tested for thyroid function at the same time. Because whether it is hyperthyroidism or hypothyroidism, there may be some symptoms of joints and muscles.
Hypothyroidism and Joint and Muscle Diseases
Many hypothyroidism patients (about 30-80%) may develop neuromuscular and articular skeletal symptoms during the course of the disease, such as joint and muscle pain, stiffness, weakness, etc. The symptoms depend on the severity of hypothyroidism. As hypothyroidism is controlled, these symptoms will gradually improve.
In addition, 15 ~ 30% of patients may have [carpal tunnel syndrome].
Editor’s Note
Carpal tunnel syndrome refers to the [median nerve] that controls the thumb, index finger, middle finger and part of ring finger. When passing through the [carpal tunnel] structure at the wrist, it suffers compression, which will lead to numbness, pain and other symptoms of fingers. Early fingers will suffer numbness and tingling from time to time, which is obvious at night. In the medium term, there will be persistent pain and numbness, obstacles and numbness in subtle movements such as buttoning and holding cups, and the pain may also extend to elbows or shoulders. In the later period, thumb muscle atrophy, difficulty in stretching and loss of hand sensation will occur.
There are also some extremely rare cases in which hypothyroidism patients will be accompanied by [hypothyroidism myopathy], which is manifested as proximal myasthenia (proximal muscle mainly refers to the muscles of thigh and upper arm) with elevated muscle enzyme (muscle enzyme level can be tested by blood drawing).
Hyperthyroidism and Joint and Muscle Diseases
Hyperthyroidism can lead to osteoporosis and fracture, which is a common cause of limb pain in hyperthyroidism patients. Osteoporosis is especially common in [iatrogenic hyperthyroidism].
Editor’s Note
Iatrogenic hyperthyroidism refers to hyperthyroidism caused by certain drugs or examinations, such as amiodarone for arrhythmia and iodine-containing contrast agent used in enhanced CT, which may cause hyperthyroidism.
Like hypothyroidism, hyperthyroidism also causes proximal myasthenia, which is more common in hypothyroidism patients. However, myasthenia symptoms can be quickly relieved after hyperthyroidism is corrected.
Hyperthyroidism patients are also prone to adhesive shoulder arthritis, often with shoulder joint inability to move as the first manifestation.
Hyperthyroidism Drugs and Joint and Muscle Diseases
Drugs for thyroid diseases may also cause symptoms of joint muscles.
For example, propylthiouracil, which is commonly used in the treatment of hyperthyroidism, can induce [ANCA (antineutrophil cytoplasmic antibody)-related vasculitis], mainly manifested as fever, muscle and joint pain, and may also lead to lung and kidney damage. The drug may also cause muscle damage, manifested as muscle soreness of limbs, accompanied by elevated muscle enzymes.
Another drug for hyperthyroidism, methimazole, may also cause arthralgia, which is usually temporary and can be improved without stopping the drug. However, if joint muscle pain accompanied by fever, hematuria, hemoptysis, etc. occurs during the medication period, it is necessary to see a doctor in time.
Thyroid Diseases and Autoimmune Diseases
Graves’ disease (the most common cause of hyperthyroidism) and Hashimoto’s thyroiditis (the most common cause of hypothyroidism) are two common thyroid diseases that belong to autoimmune thyroid diseases. Essentially, autoantibodies produced in the body mistakenly attack the normal tissue of thyroid gland.
Autoimmune thyroid disease belongs to the large category of autoimmune diseases. If a person has an autoimmune disease, he will often suffer from other autoimmune diseases one after another. Therefore, patients with autoimmune thyroid disease often suffer from rheumatoid arthritis, systemic lupus erythematosus, Sjogren’s syndrome and so on.
If patients with hyperthyroidism and hypothyroidism suffer from dry mouth, dry eyes, oral ulcer, muscle and joint soreness, skin allergy to light and other symptoms, it is possible that other autoimmune diseases have occurred and further treatment is required in rheumatology department.
Conclusion
The human body is a complex system, Many diseases do not exist in isolation. If pain and weakness in joints and muscles occur, In addition to considering the general rheumatology diseases, we should also be alert to whether it is caused by thyroid diseases, and we should leave a mind to check thyroid function. If hyperthyroidism and hypothyroidism patients have joint and muscle soreness, we should also be alert to whether other autoimmune diseases have occurred together, and we should find a rheumatologist as soon as possible.