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In the condition of hypothyroidism the Thyroid Stimulating Hormone level is high in individuals. What signalling/metabolic pathway mediates this sensation of pain which is mostly experienced in feet and joints.
This isn't my field, and I'd love to see my answer surpassed by someone with expert knowledge. But I should say a recent case report (Pantazis, 2016), though it dealt with an unusual situation, discusses some of the current thinking:
hypothyroidism is characterized by decreased synthesis and degeneration of collagen. Hypothyroidism also inhibits epimerase, which results in reduced chondroitin sulfate and elevated hyaluronic acid, hence weakening the matrix. Moreover, it causes accumulation of glycosaminoglycans (GAGs) in the extracellular matrix (ECM), being involved in the pathogenesis of carpal tunnel syndrome during hypothyroidism and predisposing patients to tendon calcification
THs have known effects at the cellular level on the proliferation and differentiation of bone and cartilage. The hypothyroid state appears to induce abnormalities in these tissues, which results in such clinical manifestations as epiphyseal dysgenesis, aseptic necrosis, possibly crystal-induced arthritis, and an arthropathy characterized by highly viscous non-inflammatory joint effusions primarily affecting the knees, wrists, and hands. Neuropathic and myopathic symptoms accompanying hypothyroidism may manifest as joint region abnormalities when in fact there is no underlying arthropathy.
These paragraphs cite three much older sources. I don't see a tremendous amount of activity on this narrow issue in PubMed - the broader issue that this case illustrates is whether there are better ways of diagnosing and treating hypothyroidism to restore the balance more effectively; see Midgeley, 2019 for example.
11 Things You Only Understand If You Have Hypothyroidism
It can be hard to understand hypothyroidism if you don’t have the condition. Here’s what life with hypothyroidism is really like.
Hypothyroidism is a condition that influences the release of your body’s thyroid hormones — in this case it doesn’t produce enough. According to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), thyroid hormone plays a vital role in metabolism brain, heart, and liver function reproductive health and fertility, and more. So, even subtle fluctuations in your thyroid can contribute to some big changes in your body. And that’s why living with a thyroid condition like hypothyroidism can be challenging on a daily — and even hourly — basis.
While nearly 20 million people in the United States have some type of thyroid disorder, according to the American Thyroid Association (ATA), hypothyroidism can be a misunderstood condition. Your coworkers, friends, and loved ones may not realize how much it can impact your everyday life.
Here, people with hypothyroidism describe what it’s really like to live with the condition. Share this list with the people in your life to help them better understand what you’re going through:
1. Coffee isn’t the answer. “I am tired . all the time. It hits me around 2PM,” says Christina Nicholson, 33, from Coral Springs, Florida. She was diagnosed with Hashimoto’s disease — an autoimmune disorder that can cause hypothyroidism — at age 27. “Some people say, ‘oh yeah’, I get tired around then too and brush it off like I need a cup of coffee or something.” Talia Mariani, 27, from New York, also finds that other people don’t understand her fatigue. “I'll get asked often why I don't just drink more caffeine,” she says. “What people fail to recognize is that caffeine is an additional stressor on the system, so for me, caffeine ultimately becomes more of a threat than a blessing.”
“The best way to combat fatigue is to do things to promote good health, such as eating healthy, getting regular exercise, and getting a good night’s sleep,” says Alan P. Farwell, MD chief of the section of endocrinology, diabetes, and nutrition and director of endocrine clinics at Boston Medical Center.
2. Going to bed on time doesn’t necessarily mean you’ll get a good night’s sleep. Getting enough sleep at night can be easier said than done. There are a number of factors that can affect your ability to get good sleep, including your thyroid medication. According to the Cleveland Clinic, taking too much thyroid medication can cause difficulty sleeping. “ When I was first treated, I would have to take a mix of different doses on different days to help find the right dose,” says Trish Hoffman from Laguna Beach, California, who was diagnosed at 34 and has many family members who also have hypothyroidism. “One time I was overmedicated and couldn't sleep for three days.”
“If you’re unable to sleep through the night, you’re likely to be tired the following day,” Dr. Farwell says, so this can make symptoms of fatigue even more intense. “Sleep problems such as sleep apnea are becoming recognized as very common and can be evaluated with a sleep study that your doctor can order.”
3. To-do lists are your best friend … your brain fog is not. An underactive thyroid can cause problems with concentration and memory, according to the University of Maryland Medical Center. You may have difficulty concentrating at work or even at home while you’re talking to your kids. You may seem forgetful to your friend while chatting at lunch, or absent-minded to your boss at your yearly review. If you’re experiencing these issues, there are a number of strategies you can try to help improve memory and concentration, such as focusing on one task at a time, using written lists and reminders, and sticking to a schedule.
4. Your mind isn’t the only thing that’s blocked. Constipation is another common symptom of hypothyroidism, according to the NIDDK. You may find that even eating a fiber-rich diet or taking the latest probiotic pill doesn’t help you — you’re still constipated and uncomfortable. If this becomes a constant issue, work with your doctor to find ways to remedy and prevent constipation.
5. Even if you eat right and exercise, you may have trouble losing weight. “Keeping weight off is a challenge, even with exercising regularly and eating right as I do,” says Suzanne Andrews, a licensed occupational therapy practitioner from Ormond Beach, Florida. Mariani agrees. “I'm a personal trainer in New York and I was diagnosed with Hashimoto's thyroiditis about four years ago,” she says. “People often ask me if I have ever thought about eating less and moving more. It's a super frustrating and even an offensive question on its own, but to throw in the fact that I'm a professional in this field takes it to another level.”
“The inability to lose weight in people with hypothyroidism doesn't follow the standard rules of cutting calories or exercising more,” says Westin Childs, MD, an integrative doctor who focuses almost solely on hypothyroidism. “Low thyroid leads to a decreased metabolic rate (which lowers overall metabolism) and can make weight loss very difficult without appropriate intervention.”
“One mistake many people make is to set an unachievable weight loss goal (for example, to lose 50 pounds in 3 months) — that sets you up to fail,” Farwell says. “It’s better to set several smaller goals (for example, to lose a pound a week, or 2-3 pounds per month). This also allows diet changes that can continue long term.”
6. It can feel like you just ran a race … but you just woke up from a nap. “I know if I wake up sweating or with heart palpitations, my medication dose is too high,” says Barbra Watson, 43, from Boston. “Changes in thyroid medication dosing take several weeks to get your thyroid levels to the new level,” Farwell says. “Some people have acute symptoms after changing their dose, but these subside over a few weeks.”
7. You miss the person you used to be. If you have hypothyroidism, you may find that you can’t fit into your old clothes, you don’t have the energy to play with your children like you once did, or you’re just not able to do the things you used to do. “The difficult thing about this condition is that the symptoms are often explained away — as if being a woman, a working mom, or in your 40s, is a reason these things are happening,” says Hollie Geitner, from Pittsburgh, Pennsylvania. Hollie was diagnosed in her mid-20s with Hashimoto’s thyroiditis and will soon be 42. “I suppose it has become a way of life for me.” But she goes on to share that the reality for her is that she’s had to learn to work through these changes — for better or worse. And with proper treatment, many of these hypothyroidism symptoms can be controlled, according to the ATA.
8. Gloves are a year-round accessory — so are socks and scarves and sweaters. Another symptom of hypothyroidism is the constant feeling of being cold. “People think I'm nuts when I say I'm cold,” Andrews says. “How can they relate when it's 74 degrees in the room and my hands are like ice?” In these situations, make yourself comfortable and forgo worrying about what others are thinking — gloves can be considered a classy fashion statement after all. Taking your thyroid medication can also help control cold intolerance and other symptoms of hypothyroidism.
9. You constantly feel like you have to prove you’re not lazy. “I think the biggest misconception is that those around you may just feel like you use this condition as an excuse for being tired or they may even think you're lazy,” Hoffman says.
Dr. Childs agrees. “I think the stigma surrounding weight and being lazy is a big one that wears on people with hypothyroidism,” he says. “This can be made worse by the fact that they almost always have fatigue with the weight-loss resistance.” Don’t let others get you down, do what you can, and be open with those you care about. Instead of making excuses for feeling tired or run down, explain that fatigue is a symptom of your condition.
10. Moody is your middle name. “I can tell if I feel like I’m moody all month long, it's probably my thyroid,” Watson says. According to the British Thyroid Foundation, an underactive thyroid can cause emotional symptoms, such as mood swings. Try to keep mood swings from becoming a problem by explaining your situation to your loved ones and asking for compassion and understanding when you do experience them.
11. You feel sick, but look “fine.” While some hypothyroidism symptoms are obvious to the naked eye, like weight gain and hair loss, others, like joint pain and depression, are invisible. “I believe the most deceiving thing about this condition is that, for the most part, other people can't see your pain,” says Kylie Wolfig, 46, from Perth, Western Australia and founder of Thyroid School, who has lived with Hashimoto's thyroiditis for over 25 years. “They can't see your anxiety, your confusion, or that you’re overwhelmed.”
“I never appreciated how much your thyroid does for you,” Watson says. “It regulates so much.” Focus on taking care of yourself and let go of worries about other people’s judgements of you. Work on communicating with your friends and family so they have a better idea of the challenges you face. Chances are, they’ll do their best to treat you with compassion.
If your hypothyroidism symptoms are very persistent, “Seeing an endocrinologist can help if you’re not feeling fine after your first dose of medication, if there is some disagreement on whether you should be treated in the first place, if you are considering a pregnancy (or are pregnant), or if you simply want to know more about the condition,” Farwell says.
The thyroid gland is one of the largest endocrine glands in the body. It is located in the front of the neck below Adam&rsquos apple (see Figure (PageIndex<2>)). The gland is butterfly-shaped and composed of two lobes. The lobes are connected by a narrow band of thyroid tissue called an isthmus.
Figure (PageIndex<2>): The thyroid gland is a two-lobed gland in the front of the neck
Internally, the thyroid gland is composed mainly of follicles. A follicle is a small cluster of cells surrounding a central cavity, which stores hormones and other molecules made by the follicular cells. Thyroid follicular cells are unique in being highly specialized to absorb and use iodine. They absorb iodine as iodide ions (I - ) from the blood and use the iodide to produce thyroid hormones. The cells also use some of the iodide they absorb to form a protein called thyroglobulin, which serves to store iodide for later hormone synthesis. The outer layer of cells of each follicle secretes thyroid hormones as needed. Scattered among the follicles are another type of thyroid cells, called parafollicular cells (or C cells). These cells synthesize and secrete the hormone calcitonin.
Muscle and Joint Pain and Hypothyroidism
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Many hypothyroid patients complain of muscle and joint pain being among the most bothersome thyroid symptoms.
As well as the intense fatigue that hypothyroidism causes, aches, pains, stiffness and weakness in joints (such as the knees and fingers, especially thyroid leg pain weakness ) and muscles (such as the calves, back and feet) are well reported. I’ve had experience with it myself.
It can keep us awake at night, cause us to need regular painkillers just to get through the day and make physical activity difficult to bear.
Muscle and Joint Pain with Hypothyroidism
Yes, it is expected that muscle pain will appear after a long walk, workout or other activity that has caused overexertion, but it shouldn’t be expected as part of your day to day life when you haven’t exerted your muscles very much. However, it does haunt many patients living with hypothyroidism, whether they do much physically all day or not.
Yes, muscle and joint pain can be another symptom of hypothyroidism.
Muscle and joint pain caused by hypothyroidism is known as hypothyroid myopathy, and can occur all over the body, though most commonly in the legs, feet, arms, hands and back and can range from mild to severe. It also includes cramping, stiffness and weakness, but hypothyroid myopathy can also lead to carpal tunnel syndrome or frozen shoulder. Some thyroid patients may also have been diagnosed with fibromyalgia, a separate condition that causes pain all over the body or at specific points, when they are actually experiencing hypothyroid myopathy.
What Causes It?
These symptoms are often caused by thyroid levels being below optimal – especially Free T3 so please make it a priority to optimise this, low magnesium levels, low vitamin D levels or even adrenal fatigue (though it is more accurately referred to as hypothalamic-pituitary axis dysfunction).
What Can I Do?
Therefore, ensuring that all your thyroid levels are optimal, supplementing magnesium, Vitamin D or using Epsom salts for baths/foot soaks and exploring whether you have adrenal issues and subsequently treating it, could help you resolve the symptoms. High Reverse T3 or low Free T3 levels in particular should be checked for and addressed.
Fluid retention, another somewhat common hypothyroid symptom, can cause pain, too. It’s most often seen around the ankles and feet and worsens with physical activity. This is also often solved with optimal thyroid and vitamin levels.
Other short term treatments for hypothyroid myopathy can include massaging the affected area/s, which increases blood flow and eases aches and pains, or a warm bath/foot soak which helps to relax muscles, bonus points if you use Epsom salts, which is a popular trick for relaxing and relieving tired and achy muscles, among other things (I love long, relaxing Epsom baths). You can get the ones I use by clicking here.
Magnesium spray or a Turmeric Supplement is also popular if you prefer to not add another supplement or tablet to your daily regimen and acupuncture has been helpful to some thyroid patients, too. A magnesium spray that is particularly popular with thyroid patients is this one.
Gluten-caused inflammation can cause joint and muscle pain in some people, too.
Joint pain and inflammation are (also) common symptoms of gluten sensitivity. And research does show links between the two diseases.
Of course, checking all your vitamin levels such as iron, ferritin, B12, D etc. is very beneficial, as any that are low can cause fatigue among other pesky symptoms, such as muscle weakness. Vitamin D can especially cause joint stiffness and pain, so ensuring your levels are optimal is key.
But if you’ve checked all of this and are still suffering, it may be time to talk to a rheumatologist for further evaluation. Rheumatologists are experts in joint and muscle problems, and treat arthritis, some autoimmune conditions, various musculoskeletal pain disorders, fibromyalgia and tendonitis.
Do you have muscle or joint pain?
You can click on the hyperlinks in the above post to learn more and see references to information given.
There is also the online thyroid course ‘Freedom From Thyroid Fatigue’, which walks you through how to overcome thyroid fatigue and flare up days with a personalised approach. You may benefit from this guidance if you still experience ongoing fatigue and low energy.
12 signs and symptoms of hypothyroidism
Hypothyroidism, or an underactive thyroid, is when the thyroid gland produces too few hormones. Low levels of thyroid hormones can cause a wide range of signs and symptoms from changes in mental functioning to digestive issues.
The thyroid is a butterfly-shaped gland that sits in front of the neck. Thyroid hormones play a vital role in regulating metabolism and energy use and affect almost all of the body’s organs.
In the early stages, a person may not notice any symptoms. However, without treatment, hypothyroidism can lead to severe complications, such as infertility and heart disease.
In this article, we describe 12 common signs and symptoms of hypothyroidism. We also discuss how common hypothyroidism is and when to see a doctor.
Share on Pinterest Image credit: Stephen Kelly, 2019
Fatigue is one of the most common symptoms of hypothyroidism.
Many people with the condition report feeling so exhausted that they are unable to go about their day as usual.
The fatigue occurs regardless of how much sleep a person gets or how many daytime naps they take. Treatment for hypothyroidism usually improves people’s energy levels and functioning.
Thyroid hormones help to regulate body weight, food intake, and the metabolism of fat and sugar. People with low levels of thyroid hormones can experience weight gain and an increase in body mass index (BMI).
Even mild cases of hypothyroidism may increase the risk of weight gain and obesity. People with the condition often report having a puffy face as well as excess weight around the stomach or other areas of the body.
Hypothyroidism can affect a person’s muscles and joints in numerous ways, causing:
- swelling of the joints
Research also suggests a link between thyroid disorders and rheumatoid arthritis, which is an autoimmune condition that causes painful swelling in the lining of the joints. Effective treatment for both conditions will help people manage their symptoms.
It is common for individuals with untreated hypothyroidism to experience:
These symptoms can occur because the brain requires thyroid hormones to function correctly. Research shows that low levels of thyroid hormones can cause changes in brain structure and functioning.
These brain changes can reverse once a person begins treatment.
Hypothyroidism can slow down metabolism, which can lead to a drop in core body temperature. As such, some people with low levels of thyroid hormones may feel cold all the time or have a low tolerance of the cold.
This feeling of coldness can persist, even when in a warm room or during the summer months. People with hypothyroidism often report having cold hands or feet, although they may feel that their whole body is cold.
These symptoms are not exclusive to hypothyroidism, however. Circulation problems or anemia can also cause people to feel chilly.
Digestion is another body function that can slow down due to hypothyroidism.
Studies report that an underactive thyroid can cause problems with movement through the gut and the activity of the stomach, small intestine, and colon.
These digestive changes cause some people to experience constipation.
Doctors typically define constipation as having fewer than three bowel movements a week. A person may also have hard stools, difficulty passing stool, or a feeling of being unable to empty the rectum fully.
Thyroid hormones play a vital role in removing excess cholesterol from the body via the liver. Low hormone levels mean that the liver struggles to carry out this function and blood cholesterol levels can increase.
Research suggests that up to 13 percent of individuals with high cholesterol also have an underactive thyroid. As a result, many experts recommend that doctors routinely test people with high cholesterol for hypothyroidism.
Treating the thyroid problem may help reduce cholesterol levels, even in those who do not take cholesterol-lowering drugs.
People with hypothyroidism may also have a slower heart rate, or bradycardia. Low thyroid levels can affect the heart in other ways too. These effects may include:
Bradycardia can cause weakness, dizziness, and breathing problems. Without treatment, this heart condition may result in serious complications, such as high or low blood pressure or heart failure.
Untreated hormone disorders, including thyroid problems, can contribute to hair loss. This is because thyroid hormones are essential for the growth and health of hair follicles. Hypothyroidism may cause hair loss from the:
People with thyroid problems are also more prone to developing alopecia, which is an autoimmune condition that causes hair to fall out in patches.
An underactive thyroid affects the skin in various ways and can cause symptoms, such as :
People with hypothyroidism may also develop dry, brittle, and coarse hair or dull, thin nails that break easily.
These symptoms usually clear up once people begin thyroid hormone therapy.
A goiter is an enlargement of the thyroid gland that appears as a swelling at the base of the neck. Other goiter symptoms include:
Many thyroid problems can result in a goiter, including iodine deficiency and Hashimoto’s thyroiditis, which is an autoimmune condition that damages the thyroid gland, stopping it producing enough hormones.
Other causes include underactive thyroid and, less commonly in the United States, iodine deficiency.
People with an underactive thyroid may experience heavy or irregular menstrual periods or spotting between periods.
According to the Society of Menstrual Cycle Research, hypothyroidism causes these problems because it affects other hormones that play a role in menstruation, such as by:
According to the National Institute of Diabetes and Digestive and Kidney Diseases, hypothyroidism affects around 4.6 percent of people aged 12 years or older in the U.S. However, most of these individuals experience only mild symptoms.
Hypothyroidism is more likely to occur in women and people over 60 years of age.
Other risk factors include:
- a personal or family history of thyroid problems
- previous thyroid surgery or radiation treatment to the neck or chest
- having been pregnant recently
- other health conditions, such as Turner syndrome, Sjögren’s syndrome, or certain autoimmune conditions
It is vital for people with unexplained fatigue or other signs or symptoms of hypothyroidism to see a doctor. Without treatment, an underactive thyroid can lead to serious complications, such as infertility, obesity, and heart disease.
A doctor can carry out a simple blood test to check a person’s thyroid hormone levels. Treatment for hypothyroidism involves taking synthetic thyroid hormones. These medications are safe and effective once a person takes the right dose.
Hypothyroidism is a relatively common condition, affecting almost 5 people out of 100 in the U.S. This condition occurs when the thyroid gland does not produce enough hormones.
Because thyroid hormones are essential for the normal functioning of many different parts of the body, low levels can cause a wide variety of symptoms.
It is vital that people with these symptoms or other symptoms of hypothyroidism see their doctor for evaluation and treatment. Doctors can prescribe hormone replacement pills to treat individuals with low levels of thyroid hormones effectively.
What is a joint pain?
Joints are connections between the bones that help you move around and provide support. Any damage to the joint from injury or disease results in acute pain and can interfere with your movement. There are many different ailments that eventually lead to joint pain, like sprains, gout, bursitis, rheumatoid arthritis, etc.
The relation between joint pain and hypothyroidism
It is not uncommon for hypothyroid patients to suffer from joint pain and back pain. The thyroid gland is an important part of the endocrine system and several cases dating as early as 1960 has reported generalized muscle pain in various parts of the body, like ankles, neck, legs, arms, back (upper and lower), wrists, etc. Most of these cases were made worse with exposure to cold and were sometimes combined with a tingling or numbing sensation.
Joint and muscle pain are also known as hypothyroid myopathy, which can be mild or severe. Hypothyroid myopathy can also lead to frozen shoulder, medically known as carpal tunnel syndrome. Some thyroid patients may also be diagnosed with fibromyalgia, a different condition that can cause pain in specific or all parts of the body when they are actually experiencing hypothyroid myopathy.
Several pieces of research on the connection between thyroid conditions and joint pain support the theory that chronic pain of the pelvis, muscles, and joints are common symptoms of autoimmune thyroid problems. In some cases, the pain is only one of the reported symptoms. A further assessment stated that thyroid antibodies were additionally found in blood levels that were free of T3 and/or T4.
These symptoms are often caused by the thyroid levels being below the optimal level (meaning TSH below 2, RT3 ratio over 20, free T3 in the top quarter of the specified range and midrange or higher T4), low vitamin D, low magnesium levels, or simply adrenal fatigue. Therefore, by making sure that all your thyroid levels are on optimal levels, supplementing vitamin D, magnesium, or using Epsom salts for bath or foot soaks can help resolve the symptoms.
Treatment for thyroid related pain in joints
Proper and timely treatment for thyroid-related conditions can help reduce joint pain or similar conditions. Hormone replacement therapy is one of the most common treatments where the regulation of the thyroid hormone level can help resolve muscle aches and joint pain. Epsom salts can also be used to relieve and relax joint pain.
Checking all your vitamins levels, like D, B12, ferritin, and iron can also prove to be beneficial. Low levels of any of these vitamins can lead to fatigue among many other symptoms, like joint pain and muscle weakness.
If medical treatments are not working well enough for you, it might be helpful to consider some other treatments like:
- Massage: A full body or targeted massage can help stimulate blood circulation and ease muscle pain.
- Warm shower/bath: Heat naturally relaxes the muscles of the body and is useful for treating temporary muscle tension and cramps.
- Light exercise: Although it is difficult to move when the thyroid gland is not functioning optimally (joint pain and fatigue are some of its symptoms), exercising lightly can help relieve cramps and pain.
- Rest: This is the most obvious way to remedy joint pains. Relaxing helps the muscles rest and cope up with joint pains.
- Magnesium: Unknown to many people joint and muscle pain can be relieved by upping your magnesium levels. But, you must first ask your doctor to check your magnesium levels before you take this step.
Hypothyroidism and Foot Pain
Hypothyroidism (an under active thyroid) can lead to foot pain.
Thyroid disease can refer to any dysfunction of the thyroid gland, a large butterfly-shaped gland in the front of the neck. People who have thyroid disease, especially hypothyroidism, often experience foot pain.
Hypothyroidism occurs when the thyroid gland is underactive and no longer produces all the hormones the body needs. The lack of hormones causes chemical disruptions throughout the rest of the body, including the autoimmune system and metabolism. Fortunately, treatment of hypothyroidism is fairly easy if caught early. Patients with the condition often take hormonal supplements in order to keep their body balanced.
Advanced Foot & Ankle of Wisconsin helps patients with hypothyroidism manage foot pain caused by this condition. Learn more about hypothyroidism including:
Primary hypothyroidism symptoms:
- Weight gain
- Enlarged thyroid (goiter)
- Fatigue and weakness
- Hair loss or thinning
- Dry skin or flaking
- Cold sensitivity
- Muscle pain or stiffness
If you notice many of these symptoms, it is best to see your doctor for a formal diagnosis. Once you have confirmed hypothyroidism as the cause of your pain, it is time to move on to treatment. An untreated underactive thyroid can lead to a fatal condition known as myxedema. Other long term complications include heart problems and depression.
Who Is Most Likely to Develop Hypothyroidism?
A hypothyroidism diagnosis is your first step to treatment.
Post-menopausal women develop hypothyroidism more than any other group since body no longer produces enough hormones after menopause is complete. However, men and women of all ages can develop hypothyroidism.
Hypothyroidism commonly occurs in those with autoimmune disorders like type 1 diabetes. Rheumatoid arthritis is another condition which can increase your likelihood of a thyroid disorder. If you have an autoimmune disorder you should be on the lookout for symptoms of either an overactive or underactive thyroid.
Finally, if anyone in your family has hypothyroidism your chances of having it increase. Check with your doctor if you have a family history of thyroid disorders.
How Hypothyroidism Causes Foot Pain
The disruption of chemical and hormone production of the body can lead to autoimmune problems. The body begins to attack healthy parts of the body like joints and muscles. The affected areas can swell from inflammation and become stiff. In hypothyroid patients, this frequently occurs in the feet and ankles.
Another foot condition caused by hypothyroidism is tarsal tunnel syndrome (posterior tibial neuralgia). Similar to carpal tunnel syndrome in hands and wrists, this condition occurs after the tibial foot nerve is pinched or damaged by pressure. The result is painful burning, numbness, or tingling throughout the foot. Hypothyroidism inflammation is enough to compress the tibial nerve and cause tarsal tunnel syndrome.
Advanced Foot & Ankle of Wisconsin podiatrists help those experiencing foot pain from hypothyroidism. Visit one of our five Milwaukee area foot and ankle clinics for treatment.
Hypothyroidism Foot Pain Treatment in Wisconsin
Don't live with foot pain from an under active thyroid - get treatment!s
The podiatrists of Advanced Foot & Ankle of Wisconsin help local hypothyroidism patients handle their foot pain. Stiffness can be treated with physical therapy exercises determined by our podiatrists. We are able to treat pain in the:
One option we offer patients is custom orthotics to alleviate foot pain from hypothyroidism inflammation and swelling. These devices are either rigid, semi-rigid, or accommodative to best support your feet as you walk. They fit directly into your shoes to comfort your feet as you go about your day.
Severe tarsal tunnel syndrome may require surgical intervention. Our orthopedic surgeons will discuss treatment options with you to determine your best options.
Visit Advanced Foot & Ankle of Wisconsin to get treatment for your hypothyroidism foot pain. Our podiatrists are ready to help you!
What is hypothyroidism?
Hypothyroidism is a condition where the thyroid gland does not produce enough thyroid hormone. The thyroid is a small butterfly-shaped organ at the nape of your neck. Although small, this organ plays a significant role in regulating cellular metabolism and energy production. Thyroid hormones even help manage your blood pressure, heart rate, and body temperature.
The most common cause of hypothyroidism in the United States is Hashimoto's thyroiditis—an autoimmune condition where your immune system mistakenly attacks your thyroid cells. Over time, chronic inflammation of the thyroid makes cells unable to produce sufficient quantities of thyroid hormones. Every bodily system is affected when thyroid hormone levels are low.
Common symptoms of hypothyroidism include:
- Brain fog
- Depression and sadness
- Peripheral neuropathy
- Cold intolerance
- Thinning hair
- Dry skin
- (enlarged thyroid gland)
- High blood pressure
- Stomach bloating
- Joint and muscle pain
If hypothyroidism is left untreated, it can lead to many health conditions, including cardiovascular disease, osteoporosis, and even infertility. Some people can develop secondary conditions caused by hypothyroid symptoms. For example, people that suffer from joint pain may be more likely to gain weight, which can lead to metabolic syndrome.
Hypothyroidism: Potential Symptoms and Causes of an Underactive Thyroid Gland
Hypothyroidism is a thyroid disease that affects people globally. Two- to three-percent of Americans have hypothyroidism 10-15% mild hypothyroidism. Hypothyroidism affects women more than men. The thyroid gland is located in the neck and secretes hormones into the blood, which are then carried into the body’s tissues. The thyroid gland mainly produces a hormone called thyroxine (T4), which is then converted by each of the body’s organs to the active form triiodothyronine (T3). They both work to keep the body’s organs functioning properly. Thyroid hormone is important for regulation of body temperature, heart rate, blood pressure, and metabolism.
Hypothyroidism is a disease where the person affected has an under-functioning thyroid. When you have hypothyroidism, certain body functions slow down and may lead to fatigue, dry skin, and memory problems. Hypothyroidism is diagnosed with a blood test. You may experience a variety of symptoms—some resembling other health issues. Some symptoms you might be aware of and some you may not notice at all.
The most common and noticeable symptoms may include:
- Loss of energy, fatigue
- Feeling cold
- Dry skin and hair
- Hair loss
- Mild weight gain
- Loss of appetite
- Memory loss
- Feeling pins and needles in hands and feet
- Carpal tunnel syndrome
- Heavier or worsening menstrual periods and cramps
- Growth delay (in children)
Some symptoms are considered severe, although the ranges of severity differ from person to person. The symptoms listed below can be caused by hypothyroidism and may affect other health problems (eg, worsen a condition).
More severe symptoms associated with hypothyroidism may include:
- Slow than normal (for the patient) heart rate
- High blood pressure
- High cholesterol
Potential Causes of Hypothyroidism
Hypothyroidism, an under-performing thyroid, may have many different causes—and some are more prevalent than others. The most common cause of hypothyroidism is an autoimmune disease.
About Autoimmune Disease
Our bodies’ immune systems are charged with protecting us from bacterial and viral invaders. The immune system attacks invaders (eg, cells). People with autoimmune hypothyroidism are at a disadvantage because their immune system attacks the normal thyroid gland. These attacks cause the thyroid hormone producing cells to malfunction, and inhibit the thyroid gland’s ability to synthesize thyroid hormone. Eventually, there are not enough cells left to meet the body’s need for thyroid hormone. This is more common in women than men—and can begin at any point in a person’s life, but tends to become more common as people age.
The most prevalent type of autoimmune hypothyroidism is a disease that causes the thyroid to shrink—it is called Hashimoto’s disease and may cause Hashimoto’s thyroiditis .
Thyroiditis means that the thyroid gland is inflamed. In addition to Hashimoto’s disease, viral infections can occasionally cause thyroiditis. In the case of a viral infection, the thyroid gland may release its entire supply of stored thyroid hormone at once into the blood. In turn, this causes the thyroid to become over-active (or, hyper thyroidism) for a short amount of time. After all the thyroid hormone is released, then the thyroid becomes underactive. Fortunately, about 75% of patients who suffer from viral thyroiditis regain proper thyroid function. Approximately 25%, however, are left with permanent hypothyroidism.
There are several other causes of hypothyroidism that are less common than autoimmune-related disorders, but still somewhat prevalent.
Partial or Complete Removal of the Thyroid
When a portion of the thyroid gland is surgically removed (eg, patients with thyroid nodules, thyroid cancer, Graves’ disease), this causes the remaining thyroid tissue to stop working properly—and may result in hypothyroidism. In some cases, such as patients with thyroid nodules, thyroid cancer, or Graves’ disease, the entire thyroid may even require removal.
Some patients undergo radiative iodine therapy as part of treatment for thyroid cancer, Graves’ disease, or a nodular goiter. Radioactive iodine destroys the thyroid tissue resulting in hypothyroidism. Some diseases treated using radioactive iodine lead to hypothyroidism (eg, Hodgkin's disease or lymphoma, cancers of the head and neck).
Congenital Problems: Born Without a Thyroid Gland
Some babies are born without a thyroid or the thyroid is malformed (about 1 in 4,000 babies each year). A smaller number of babies are born with the thyroid intact, but in the wrong place. When the thyroid is in the wrong place, it is called an ectopic thyroid. In some patients with an ectopic thyroid gland, the thyroid cells or enzymes malfunction.
Furthermore, there are other cases where the thyroid works properly for months or years, but stops functioning later in the child’s life. The United States tests all children at birth for hypothyroidism.
Medication-related Causes of Hypothyroidism
Additionally, there are certain medications that can cause a thyroid to lose its ability to produce thyroid hormone. Medications that trigger hypothyroidism onset include lithium, amiodarone, interferon- alpha, interleukin-2, and some medications used to treat cancers.
Iodine levels can also affect thyroid hormone production. The thyroid needs iodine to make thyroid hormone. An imbalance in iodine—too much or too little—can cause or make hypothyroidism worse. Iodine comes into the body, mostly via diet, such as dairy, chicken, beef, pork, fish, and iodized salt.
In the United States, iodine deficiency is a rare cause of hypothyroidism due to supplementation of salt with iodine. The most common reason a person can have a high iodine level is due to the use of dietary supplements containing kelp. These supplements may be marketed for weight loss.
Pituitary Gland Dysfunction
The pituitary gland works together with the thyroid gland. The pituitary gland tells the thyroid how much thyroid hormone to produce via a hormone called thyroid stimulating hormone (TSH). If the pituitary gland doesn’t produce TSH properly (eg, due to injury, radiation, tumor, surgery), the thyroid gland may not produce thyroid hormone adequately.
American Thyroid Association. Hypothyroidism. A Booklet for Patients and Their Families. 2013.
Broda Barnes was an American doctor who worked mainly in endocrine dysfunction and focused on hypothyroidism. He argued that body temperature was the best basis of diagnosing thyroid function.
Eating – its effect on temperature
Normally: We know food, especially protein and carbohydrate is thermogenic (heat producing). When we eat, our body breaks the food down and we observe an increase in blood sugar and thyroid hormone. The process of metabolism creates heat and we can say eating creates heat. Blood sugar causes an increase in insulin, which promotes the conversion of T4 to T3. As a reminder: T4 is inactive thyroid hormone and T3 is active thyroid hormone.
Hypothyroid patient: There is a strong relationship between hypothyroidism and hypoglycemia many people with hypothyroidism have poor sugar stores and therefore fall hypoglycemic . So if hypothyroid patients have less sugar stores, they essentially have less energy stores. So in between meals, their body has less fuel to burn. Heat production is a consequence of metabolizing sugar, so a hypothyroid person will generate less heat since they have less energy stores. If your body is constantly creating energy from stored sugar, it will be constantly generating small amounts of heat. This is one reason why a hypothyroid patient will present with both low energy and low temperature (or cold intolerance). The reason the extremities will feel cold is because the adrenal system will keep the brain and heart (vital organs) a normal temperature by diverting blood away from the periphery to these vital organs.
Nightly Blood Sugar and its effect on temperature
Figure 1: Glycemic Load Effect. Notice the dotted lines - this marks the normal range of blood sugar. After eating (Point 0) we observe a rise in blood sugar. Insulin will then act to take sugar out of the blood and put it into tissue (hence the drop in blood sugar). As the night continues, blood sugar continues to drop to a point it drops below the normal range. Cortisol will then increase to thereby increase the blood sugar.
Normally: Regardless of thyroid status, blood sugar falls at night. Although we’re sleeping, our body needs a constant flow of energy. Our bodies will rely of stored sugar to provide energy. Cortisol will usually wake us up as it peaks around 6am as it attempts to raise our blood sugar. See Figure 1, to get a better idea of what is happening physiologically.
In hypothyroidism: many of these patients will have very little stored sugar , so epinephrine and cortisol begin to rise. Epinephrine and cortisol rise whenever blood sugar drops as a means to raise blood sugar through a process called glycogenolysis. Our body stores sugar as a molecule called glycogen. When epinephrine and cortisol are around, glycogen will release the stored sugar bit by bit. So at night, if the blood sugar drops too much, epinephrine will raise around 3 am and cortisol will spike around dawn . Some people will wake up during the epinephrine peak with a pounding heart they may not be able to fall asleep until they eat something they need to provide some sugar to signal epinephrine to go back to normal levels. The reason the heart races is that epinephrine also has stimulatory effects on the heart (amongst other tissues). In this condition, the low thyroid function would result in a lower body temperature, but the burning of sugar and rise in cortisol and epinephrine may actually raise the temperature. The net effect can be either an overall drop, a rise or a normal temperature.
Waking up, Stress and their effect on temperature
Remember stress causes rises in epinephrine and cortisol. If night time stress is high, epinephrine will be high in the morning and that would result in an increased temperature and pulse rate. Once we eat, our blood sugar will be maintained by the food rather than our stress hormones.
Normally: we wake up due to a rise in cortisol (with a rise in blood sugar). Our body temperature should be normal because there wasn’t excessively high epinephrine or cortisol (if epinephrine or cortisol are high, we see a raised body temperature). Once we eat breakfast our core temperature will actually rise, and our pulse will speed up. Again, temperature goes up due to our body’s metabolism causing heat and pulse rate increases because when we eat, thyroid hormones go up, which have an effect on pulse rate.
In hypothyroidism: Two conditions may occur. Hypothyroidism may exist with hypoglycemia or without.
Starting with hypothyroidism without hypoglycemia: Say a hypothyroid patient has adequate blood sugar stores. That means overnight, their body will tap into those stores and cortisol and epinephrine won’t need to rise. This means our body temperature will be low in fact it may be too low. Why is it low? Low thyroid leads to sluggish ion (potassium, sodium, calcium) metabolism and causes low pulse rate and blood pressure – which lowers the circulation of warm blood. Also, if you have low thyroid function, you’re not as efficient in burning and using energy – so you generate less heat. You wake up with a low temperature. You may not feel cold per se, but your temperature measurement may be below what is ideal.
Finally, let’s discuss hypothyroidism with hypoglycemia: Remember there is a strong link between hypothyroidism and hypoglycemia. Hypoglycemia causes high stress hormones which raises epinephrine and cortisol to raise blood sugar, but consequently raises temperature. So when some of these patients wake, their core temperature and heart rate is elevated. In those who are severely hypothyroid, they may actually see a drop in temperature and pulse rate because once they eat and they have more blood sugar, the stress hormones can drop. Don’t forget those stress hormones are excitatory and exert a strong effect on temperature. Once these stress hormones drop, so too will the temperature and pulse rate. Yes their temperature would raise from the ingestion of food, but to a lesser degree to the drop seen when the stress hormones are lowered.