What does Hashimotos do to your muscles?

Understanding Muscle Pain and Weakness in Thyroid Disease

Ana Maria Kausel, MD, is double board-certified in internal medicine and endocrinology/diabetes and metabolism. She works in private practice and is affiliated with Mount Sinai St. Luke’s/Mount Sinai West.

Muscle disease, or myopathy, may occur because you have an underactive thyroid (hypothyroidism) or an overactive thyroid (hyperthyroidism). Muscle problems related to these medical conditions are usually mild. Treatment of your thyroid disorder can help ease the symptoms.

However, in some rare cases, myopathy related to thyroid disease can be severe and debilitating.

By gaining a better understanding of the muscle symptoms of thyroid disease, you’ll be able to manage your discomfort or weakness.

This article will talk about thyroid disease and how it can cause pain and weakness. It will discuss thyroid muscle disease symptoms and how a healthcare provider diagnoses and treats the disease.

• Weakness in muscles close to the center of the body (thighs, shoulders)
• Elevated creatinine
• Cramping
• Rarely, enlarged muscles (Hoffman’s syndrome)
• Rarely, breakdown of muscle tissue (rhabdomyolysis)

• Muscle weakness
• Creatinine levels tend to be normal
• Cramping (uncommon)
• Rarely, issues with the muscles involved in swallowing and breathing (rare)

Hypothyroid Myopathy

Muscle weakness, aches, and cramping are common in people with hypothyroidism.

Symptoms

People with hypothyroid myopathy can experience weakness throughout the body, and it is typically most severe in the muscles of the thighs or shoulders. This can lead to problems climbing stairs or combing your hair.

High Creatinine Kinase Levels

In addition to muscle symptoms, you may have a high creatinine kinase level, which is measured with a blood test. Creatinine kinase is a muscle enzyme that is released into the blood when there is a muscle injury. But your creatinine kinase level is not necessarily linked to the severity of your muscle pain.

Rarely, hypothyroidism can cause severe muscle symptoms. One example is Hoffman’s syndrome. This is when a person develops muscle hypertrophy (enlarged muscles). It can lead to significant muscle stiffness, weakness, and pain.

Rhabdomyolysis, a condition where muscle breaks down rapidly, is a rare complication of hypothyroidism. It’s often triggered by the combination of being hypothyroid and doing strenuous exercise. It may also occur when people take a statin, which is a cholesterol-lowering medication.

Causes

The exact cause of hypothyroidism-induced myopathy isn’t known, but some experts believe that the thyroxine (T4) deficiency seen in hypothyroidism leads to muscle injury and impaired muscle function.

Diagnosis

Hypothyroid myopathy is diagnosed based on symptoms, physical examination, and diagnostic tests. You may have a blood test to measure creatinine kinase.

Your healthcare provider may recommend other tests, such as electromyography. This is a test that uses needles to measure the electrical signals in your muscles and nerve cells while they’re active and at rest.

With a muscle biopsy, a small sample of muscle is removed with a minor surgical procedure for microscopic examination. This procedure is safe. You may have a biopsy if your symptoms are severe and your diagnosis is not clear based on less invasive testing.

Treatment

Treatment with the thyroid hormone replacement medication Synthroid (levothyroxine) can usually improve symptoms. It may take weeks for cramps and stiffness to improve. It usually takes several months for muscle weakness to improve.

Hyperthyroid Myopathy

Hyperthyroidism can also cause muscle weakness and sometimes cramping, but the symptoms tend to differ from myopathy related to hypothyroidism.

Symptoms

Muscle weakness in the shoulders and hips is the main symptom in people with hyperthyroidism. While muscle cramps and aches may occur, they are not as common as they are with myopathy that’s related to hypothyroidism.

Muscle weakness from hyperthyroid myopathy causes difficulty climbing stairs, rising from a chair, holding or gripping objects, and trouble reaching arms above the head.

People with hyperthyroid myopathy may experience weakness in the throat, face, and respiratory muscles. Rarely, the weakness can involve the muscles that help you swallow and breathe.

Causes

The causes of myopathy with hyperthyroidism are not well understood. It’s been suggested that high thyroid hormone levels may lead to increased breakdown of muscle protein, as well as greater muscle energy use.

Diagnosis

As with myopathy in hypothyroidism, your healthcare provider will ask you about your muscle symptoms and perform a physical examination.

They may also order blood tests, such as thyroid function panel. The blood creatinine kinase level is generally normal with hyperthyroid myopathy. Your healthcare provider may recommend electromyography.

Thyroid Disease Doctor Discussion Guide

Get our printable guide for your next doctor’s appointment to help you ask the right questions

Treatment

Treatment of your hyperthyroidism will generally cure hyperthyroid myopathy. However, it can take time to improve—possibly up to several months—even after the thyroid is functioning normally again.

Summary

When you have thyroid disease, you might experience muscle weakness and pain, especially if your thyroid hormone levels are not where they should be. Hypothyroid myopathy tends to cause muscle weakness in the larger muscles of the body, typically the shoulders and thighs. Hyperthyroid myopathy causes muscle weakness throughout the body that may rarely affect the muscles that control swallowing and breathing.

Both types of myopathy improve with treatment of the underlying thyroid disease, but it can take time for symptoms to get better.

A Word From Verywell

Muscle complaints are common in thyroid disease. They can usually be soothed when your thyroid starts to function normally again. Coping strategies for easing muscle pain, regardless of the cause, may be useful in the meantime. Things like drinking enough fluids, a massage, warm baths, and gentle exercise are good ways to help with the pain. Taking magnesium supplements can also soothe muscle cramps.

Still, it’s important to see your healthcare provider if you notice new or significant muscle pain or weakness. While your thyroid may be the cause of your pain and weakness, there are other health conditions that can cause muscle symptoms as well.

7 Sources

Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.

1. Muscular Dystrophy Association. Hyperthyroid and hypothyroid myopathies — types of endocrine myopathies — diseases.
2. Achappa B, Madi D. Hoffmann’s syndrome- A rare form of hypothyroid myopathy. J Clin Diagn Res. 2017;11(5):OL01-OL02. doi:10.7860/JCDR/2017/21234.9913
3. Salehi N, Agoston E, Munir I, Thompson GJ. Rhabdomyolysis in a Ppatient with severe hypothyroidism. Am J Case Rep. 2017;18:912-918. doi:10.12659/AJCR.904691
4. Sridhar A, Sundarachari N, Lakshmi V. Rare yet treatable: Hypothyroid myopathy (hoffman′s syndrome). J Dr NTR Univ Health Sci. 2013;2(3):203. doi:10.4103/2277-8632.117190
5. Muscular Dystrophy Association. Endocrine myopathies — hyperthyroid and hypothyroid myopathies.
6. Li Q, Liu Y, Zhang Q, Tian H, Li J, Li S. Myopathy in hyperthyroidism as a consequence of rapid reduction of thyroid hormone: A case report. Medicine (Baltimore). 2017;96(30):e7591. doi:10.1097/MD.0000000000007591
7. Chawla J. Stepwise approach to myopathy in systemic disease. Front Neurol. 2011;2:49. doi:10.3389/fneur.2011.00049

Additional Reading

• Kim TJ, Lee HS, Shin JY, et al. A case of thyrotoxic myopathy with extreme type 2 fiber predominance. Exp Neurobiol. 2013;22(3):232-234. doi:10.5607/en.2013.22.3.232
• Miller ML, Rubin DI. Hypothyroid myopathy.
• Sindoni A, Rodolico C, Pappalardo MA, Portaro S, Benvenga S. Hypothyroid myopathy: A peculiar clinical presentation of thyroid failure: Review of the literature. Rev Endocr Metab Disord. 2016 Dec;17(4):499-519. doi:10.1007/s11154-016-9357-0
• Villar J, Finol HJ, Torres SH, Roschman-Gonzalez A. Myopathy in patients with Hashimoto’s disease. Invest Clin. 2015 Mar;56(1):33-46.

By Mary Shomon
Mary Shomon is a writer and hormonal health and thyroid advocate. She is the author of «The Thyroid Diet Revolution.»

What Does Hashimoto’s Disease Do to Your Body?

My aunt was recently diagnosed with Hashimoto’s thyroiditis. I had never heard of this thyroid condition before my aunt received her diagnosis. She doesn’t seem worried, but I am. What does Hashimoto’s disease do to you? What are the symptoms and signs?

Doctor’s Response

The signs and symptoms of Hashimoto’s thyroiditis are the same as those of hypothyroidism. The disease is slow to progress, and the onset of symptoms is gradual. It may take years for true hypothyroidism to develop.

The signs and symptoms of hypothyroidism vary widely, depending on the severity of hormone deficiency. Some of the complaints experienced by those with hypothyroidism include:

1. Fatigue
2. Mental fogginess and forgetfulness
3. Feeling excessively cold
4. Constipation
5. Dry skin
6. Fluid retention
7. Non-specific aches and stiffness in muscles and joints
8. Excessive or prolonged menstrual bleeding (menorrhagia)
9. Depression
10. Weight gain
11. Puffiness in the face
12. Infertility (difficulty getting pregnant)
13. Thinning, brittle hair
14. Hair loss
15. Slow heart rate
16. Irregular menstrual periods
17. Decreased sweating (perspiration)
18. Thick or brittle nails
19. Decreased reflexes
20. Swollen hands and feet
21. Cold skin
22. Sleepiness

These signs and symptoms can increase in severity as the condition worsens.

The complications of Hashimoto’s thyroiditis are the same as those of an underactive thyroid gland.

Goiter: As described above, the pituitary will try to stimulate production of thyroid hormone in an underactive thyroid gland affected by Hashimoto’s thyroiditis. This may cause the gland to become enlarged. Unlike a thyroid nodule, in which only a part of the gland is enlarged, in this case the entire gland enlarges, a condition known as a goiter. Goiterous glands are usually no more than a cosmetic nuisance. However, in extreme cases, growth of the gland may cause impingement on the esophagus or the trachea, impairing swallowing and breathing, respectively.

Cardiac complications: Prolonged hypothyroidism that may result from untreated Hashimoto’s thyroiditis also may be associated with an increased risk of heart disease. The heart disease may be directly related to hypothyroid effects on the heart, causing changes in contraction and rhythm that may lead to subsequent heart failure. There may also be indirect influences, such as hypercholesterolemia (an increase in «bad» cholesterol is often seen with hypothyroidism).

Psychiatric complications: Depression may occur early in Hashimoto’s thyroiditis and if underlying depression exists, the addition of Hashimoto’s may worsen the condition. Patients may complain of mental fogginess or slowing of reaction times, and a decrease in sexual desire is often observed.

Myxedema coma: In its severest form, untreated hypothyroidism may result in a rare life-threatening condition called myxedema or myxedema coma. There is mental slowing, profound lethargy, and ultimately coma. This is a life-threatening emergency.

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How to Spot, Avoid, and Manage Hashimoto’s Flare-Ups

Hashimoto’s causes a low functioning thyroid, creating a cascade of symptoms that can be triggered at any time. Adding to the fire: it’s an autoimmune condition, meaning each flare damages the ever-important gland.

What is Hashimoto’s disease? This autoimmune condition is what happens when your own immune system makes antibodies that attack and damage your thyroid, which is the butterfly-shaped gland at the base of your neck. About five percent of people have Hashimoto’s disease, and it affects 8 times more women than men, most often between ages 40 and 60, according to the National Institute of Diabetes and Digestive and Kidney Diseases . Hashimoto’s disease symptoms vary from person to person.

The autoimmune condition is a primary cause of hypothyroidism , which means your thyroid hormones are low . Thyroid hormones are essential for regulating your metabolism, body temp, heart rate, energy, menstrual cycle, mood, and hair and nail growth. When these hormones are out of whack, your body is, too. If you’re wondering, «Does Hashimoto’s cause headaches?», research has shown that once hypothyroidism has developed, migraines and headaches can become more frequent and severe. You may also feel fatigue, gain weight, be perpetually cold, experience constipation, have fertility issues, brain fog, or have aching joints and muscles, all of which are symptoms of Hashimoto’s. (Thyroid hormone levels can also be too high, a condition called hyperthyroidism, which may be caused by Grave’s disease.)

But these symptoms can be vague. It’s easy to chalk them up to stressful weeks or lack of sleep, so you may not even notice there’s a problem at first. “Many people don’t know they have Hashimoto’s,” says Neeti Sharma, MD, formerly a board-certified internal medicine physician at Parsley Health . “They may know they have hypothyroidism, but doctor’s offices don’t frequently check for antibodies that signal an autoimmune condition,” she explains. While it’s not entirely clear why people develop autoimmune conditions, Dr. Sharma says that it’s likely that you have a genetic predisposition to autoimmunity that’s activated by something in the environment. “Your immune system goes into dysfunction when the body is not in a healthy environment, and your thyroid tends to be the system that’s most responsive when things are off.”

Knowing if you have these antibodies—something that can be done with a simple blood test —is essential because Hashimoto’s is a progressive disease. These antibodies will eventually damage and destroy your thyroid gland, even if symptoms of Hashimoto’s disease are not present now, says Dr. Sharma. Along with ongoing inflammation, that damage will impair the functioning of your thyroid gland so that it cannot make the hormones needed to keep you feeling well. “It helps to know if you have it so that you can do something about it early on and avoid the specific triggers that cause a flare,” she says.

What is an autoimmune flare-up?

A flare-up can happen in any autoimmune disease, and it means that symptoms suddenly and swiftly return , and while they look like the symptoms you normally experience, they tend to be more severe in a flare. Just as you’ve been coasting along and feeling pretty great, you’re hit again with familiar symptoms. You haven’t pooped in days . You’re wearing your “summer sweaters,” you’re mopey as heck, and no number of naps can relieve the unrelenting fatigue. Flares happen because there’s additional stress on your body, which taxes an immune system that already acts unnaturally hyper vigilant, sending it into a tailspin. “When flares happen, there is a greater antibody response going on at that time, which leads to more destruction of the thyroid gland,” says Dr. Sharma.

What are the symptoms of Hashimoto’s disease?

• Fatigue
• Cold intolerance
• Constipation
• Dry skin
• Puffy face
• Muscle aches
• Brain fog
• Insomnia
• Low mood or depression
• Irregular or heavy periods
• Enlarged thyroid gland (this is called a goiter)

Also be aware that it’s possible that a Hashimoto’s flare-up could actually cause your body to go into a hyperthyroid state, which means your thyroid is overactive. “With the destruction of thyroid cells, the gland releases thyroid hormones quickly into the bloodstream,” says Dr. Sharma. In that case, you can actually experience symptoms of hyperthyroidism , like:

• Fatigue
• Heat intolerance
• Irritability
• Rapid heartbeat
• Sleep problems
• Anxiety

What is a Hashimoto’s flare-up?

So, what does a Hashimoto’s attack feel like? Not every person with Hashimoto’s will have the same triggers. “Each individual will have a unique immune system that responds differently to the environment. There is no one-size-fits-all when it comes to triggers,” explains Dr. Sharma. However, there are some common lifestyle factors that may precede a flare and they fit in several larger buckets: diet, lifestyle, environmental, and medical. Knowing what they are can help you pinpoint the ones that are true to you:

Your diet: According to Dr. Sharma, many people find that grains (specifically gluten -containing grains, like wheat, barley, or rye), high sodium intake, as well as high iodine intake are common triggers for a Hashimoto’s flare-up. Table salt is traditionally iodized, so if you’re eating a lot of high-salt foods you’re also likely consuming too much iodine.

Your lifestyle: Lack of sleep or insomnia, high levels of stress, as well as being too sedentary—or conversely—overtraining with high-intensity exercise are triggers for flare-ups.

The environment: Studies show that chemicals in plastics like bisphenol A (BPA), pesticide exposure, and air pollution, can disrupt thyroid function.

Medical: These may include pathogens. “Helicobacter pylori (H. pylori), is the bacteria that causes stomach ulcers, and is an unrecognized Hashimoto’s trigger in patients,” says Dr. Sharma. An illness can also trigger the disease, as can hormonal fluctuations, which is one reason why the disease may disproportionately affect women.

What is Hashimoto’s disease treatment?

You’ll want to work with a doctor who can spend time with you to find what sets off your Hashimoto’s disease. “We have to figure out each individual’s reason for why they have these autoimmune antibodies in the first place,” says Dr. Sharma. Identify what might have happened in your life to lead to the flare, and then hone in on those factors to better manage symptoms throughout a flare—and help you feel your best. These are some ways Parsley Health’s doctors work with members to help them manage increased antibody formation and inflammation that leads to flares.

Address your stress.

We all have stress, but when you have Hashimoto’s, it’s important to guard your time, give yourself some grace on your to-dos, and relax when you need it. It’s also important to realize that an overload of mental stress isn’t just a trigger for a flare itself, but can also impact your ability to care for yourself as you otherwise would, says Dr. Sharma. For instance, if you’re under stress, you might reach for less healthy foods or might be going to bed later or staying up late with worry and anxiety. Now is the time to go full-stop with self-care: unplugging when you need to/temporarily deleting social media apps, going to bed early, calling a friend to vent, and taking walks outside if you have the energy.

Check your supplements.

Is your body getting what it needs to fully support thyroid function? “We want to make sure that you’re supplemented enough with selenium and vitamin D in particular. You need all of the building blocks it takes to make thyroid hormone so that you’re not going into a hypothyroid state because of nutritional deficiencies,” says Dr. Sharma.

Eat fresh, whole foods.

Inflammation increases the autoimmune reaction, so focus on eating an anti-inflammatory diet, says Dr. Sharma. “Focus on non-processed foods, lots of vegetables and greens, organic meats, and reduce sugar intake,” she advises. Eat more dark leafy greens, which pack a powerful antioxidant called glutathione to help reduce inflammation, she says.

Ditch sugar and gluten.

Cookies and ice cream may be comforting in times of stress, but they’ll only exacerbate your symptoms now. Loading up your diet with sugar will lead to spikes and dips in blood sugar, something that activates your immune system, says Dr. Sharma. Since gluten is a trigger for many people, consider avoiding gluten-containing foods (many packaged snacks, wheat pastas, bread, cereal, and junk foods).

Watch your iodine.

Iodine is a mineral that your thyroid uses to make thyroid hormones. However, a high iodine intake, which can come from too much table salt (in the form of processed, packaged foods) will negatively affect thyroid functioning, says Dr. Sharma. She recommends sticking to a low iodine diet during Hashimoto’s flare-ups.