Hypothyroidism of the knee joint treatment. Thyroid gland and joint diseases How hyperthyroidism is related to the shoulder joint

Some diseases of the endocrine glands associated with metabolic disorders in the bones are accompanied by damage to the joints. This leads to the emergence of characteristic articular syndromes, often simulating rheumatic diseases.

Pituitary arthropathy

They occur with hypersecretion of somatotropic hormone (growth hormone), caused in most patients by the presence of eosinophilic pituitary adenoma. In connection with the anabolic effect of growth hormone in such patients, an increase in the mass of soft tissues, including joint capsules, synovial membranes, as well as cartilage and bones, occurs; body weight increases (in about 40% of cases). There is hypertrophy of skeletal muscles, thickening of synovial bags, especially ulnar, prepatellar and subacromial.

Hypertrophy of the fibrous joint capsule leads to hypermobility. In connection with the thickening of the interarticular cartilage, approximately 1/3 of patients radiographically show an increase in the interarticular spaces, especially in the proximal interphalangeal joints (normally, these interarticular spaces are 3 mm in men and 2 mm in women). Collarbones, sternum, ribs thicken. Due to the increase in the anterior-posterior size, the chest becomes barrel-shaped. Cervical-thoracic kyphosis and lumbar lordosis are formed. In most patients, there is an expansion of the terminal phalanges of the "drumsticks" type of fingers. On radiographs, a thickening of the cranial vault, an increase in the lower jaw, hyperostosis of the frontal bone, exostoses and periosteal reactions are determined.

clinical picture. At the onset of the disease, hypermobility of the joints, reversible effusions are noted, later bone hypertrophy, joint deformity and a decrease in mobility in them occur. Both large and small joints are affected, there is a proliferation of periarticular tissues without signs of inflammation. Typically, patients complain of recurrent joint pain lasting weeks or months. Sometimes joint pain is combined with stiffness of movements. Significantly pronounced crepitus of the joints is characteristic. In blood tests, a high content of somatotropic hormone, alkaline phosphatase and phosphorus is noted.

Diagnosis A. g. is not difficult if there are obvious signs of pituitary adenoma: acromegaly, changes in the Turkish saddle, hypertrophy of the bones of the skull, etc. The disease should be differentiated from deforming osteoarthritis, in which there is no hypermobility of the joints, thickening of the interarticular cartilage. In contrast to rheumatoid arthritis, synovitis is rare in A. g., synovial effusion is non-inflammatory, swelling of the joints occurs due to thickening of the periarticular tissues, and giant osteophytes are found on x-rays.

Treatment It is aimed at eliminating hyperproduction of somatotropic hormone: surgical removal of pituitary adenoma, X-ray therapy, introduction of radioisotopes into the pituitary gland.

At Hypothyroidism There are aching pains in the joints and muscles, arthritis rarely occurs, usually symmetrically; knees, ankles are more often affected, less often small joints of the hands and feet. On palpation of the joints, pain and an increase in the temperature of the skin are noted. Periarticular tissues thicken, synovial effusion contains a small amount of leukocytes (less than 1 x 109/l) with a significant increase in viscosity due to the presence of hyaluronic acid in it. In 1/3 of patients, weakness of the ligamentous apparatus, tenosynovitis of the flexors of the hands, and carpal tunnel syndrome are observed. Chondrocalcinosis and crystals of calcium pyrophosphate in the synovial fluid are found in more than 1/2 of patients, and uric acid crystals are often found. However, this is not accompanied by an increase in the articular syndrome, since the phagocytic function of leukocytes is reduced. Asymptomatic hyperuricemia is sometimes noted.

The first signs of the disease may be radiculitis and neuritis. Cases of severe polyneuritis with muscle atrophy, paresis and paralysis of the upper and lower extremities are described. Damage to the cranial nerves and related disorders are noted. Lengthening of time of contraction and relaxation of muscles is characteristic. Hypochromic anemia, hypercholesterolemia often develop, and the content of lipoproteins in the blood serum increases. Characterized by swelling of the subcutaneous tissue of the back of the hands and feet (absence of a fossa when pressed), hyperkeratosis in the area of ​​the palms and soles. The radiological picture is nonspecific. As a result of changes in the articular ends of the bones, signs of secondary osteoarthritis appear early.

Treatment. The basis of therapy is the use of thyroid hormones. Assign thyroidin, starting with 0.05 g 2-3 times a day (average daily dose of 0.15-0.2 g) or triiodothyronine.

With hyperthyroidism An early symptom is severe muscle fatigue with varying degrees of muscle atrophy. Often, patients cannot stand up without the help of their hands from a squatting position. Attacks of weakness of the femoral muscles are described, up to the development of the so-called periodic paralysis. Fingers and toes take the form of "drumsticks" (due to periostitis and swelling of the soft tissues). Characterized by arthralgia, often marked joint pain on palpation. Often there is a humeroscapular periarthritis. In the blood, a decrease in cholesterol, an increase in the level of thyroid hormones T3 and T4 are found. Strengthening the function of the thyroid gland is confirmed by an increase in the absorption of I131 by its tissues.

Treatment. The main direction of therapy is the long-term prescription of thyreostatic drugs - diiodotyrosine (0.1-0.3 g per day) or Mercazolil (0.01-0.04 g per day). With the ineffectiveness of such therapy within 6 months, the issue of surgical treatment is decided.

hyperparathyroidism

It is characterized by excessive formation of parathyroid hormone and a violation of calcium-phosphorus metabolism, leading to a decrease in bone density, the formation of cysts and subperiosteal erosions. Distinguish between primary G. (due to the development of adenoma or hyperplasia of the parathyroid gland) and secondary (primary violation of calcium-phosphorus metabolism leads to hyperproduction of parathyroid hormone). G. is observed more often in women aged 20-50 years.

clinical picture. The disease develops imperceptibly. The early symptoms are bone pain that worsens with movement. The resorptive effect of parathyroid hormone leads to the formation of a characteristic "shaggy" type of subperiosteal erosion of the middle phalanges of the fingers, to a greater extent of the tibia and femur, and the clavicles. Rarely, there is a clear connection between the interarticular gap and erosions, since parathyroid hormone does not cause cartilage destruction. The weakness of the ligamentous apparatus is characteristic, which is explained by an increase in the activity of collagenase. Tendon ruptures or tears, subluxations of the vertebrae, especially in the cervical spine, the formation of kyphosis with arched protrusion of the sternum and hypermobility in the lumbar spine are noted. Weakness of the ligamentous apparatus leads to degenerative changes in the joints. Chondrocalcinosis is noted in 1/5 of patients. The deposition of calcium pyrophosphate crystals is often manifested by pseudo-gouty attacks. G. becomes one of the causes of nephrolithiasis.

In the blood, hypercalcemia, hypophosphatemia, increased activity of alkaline phosphatase are noted; characterized by hypercalciuria. X-ray examination reveals in most cases osteoporosis, cysts (sometimes large). Often there is subperiosteal resorption of the phalanges of the fingers. In the bones of the skull, millet-like granularity with foci of enlightenment is determined. A decrease in the height of the vertebral bodies and an increase in the contrast of the teeth in the jaws are revealed, since the teeth are not subjected to decalcification.

Treatment. In primary G., only the removal of the parathyroid tumor leads to the disappearance of the symptoms of the disease. Any other treatment, including radiotherapy, is ineffective. At secondary G. first of all treatment of a basic disease has to be provided. Patients with hypercalcemia and hyperphosphatemia are prescribed a diet with restriction of calcium and phosphorus salts. To bind and remove calcium, disodium salt of ethylenediaminetetraacetic acid is administered intravenously in a 5% glucose solution (at the rate of 2-4 g of the drug per 500 ml of glucose). The course is 3-6 days. Re-appointed if necessary.

With diabetes Musculoskeletal involvement can manifest as destructive arthropathy, carpal tunnel syndrome, interosseous muscle atrophy, and proximal muscle weakness due to neuropathic changes. Hyperuricemia, ankylosing hyperostosis, humeroscapular periarthritis, Dupuytren's contractures, flexor tenosynovitis are often observed. The consequence of neuropathy is severe arthropathy, observed in 0.1% of patients with long-term suffering from SD. Destructive changes are initially unilateral, much later bilateral, more often in the bones of the tarsus, metatarsus, phalanges, as well as in the tarsus-metatarsal and metatarsophalangeal joints, less often in ankle and knee joints (see Neuropathic arthropathy). There is local swelling of the joints, a discrepancy between a slight pain syndrome and pronounced radiological changes (erosion, bone sequestration, osteolysis) is characteristic.

Treatment. Appointment of hypoglycemic preparations is shown. With hyperproduction of glucocorticosteroids (tumor of the adrenal glands, pituitary adenoma) or as a result of the therapeutic use of glucocorticosteroids, some patients develop generalized osteoporosis, avascular necrosis of the heads of the humeral and femoral bones, and pathological bone fractures. Vertebral porosity causes severe back pain. In the future, flattening of the vertebrae occurs, the formation of kyphosis, which significantly reduces the growth of the patient.

There is a non-inflammatory myopathy with progressive damage to the muscles of the pelvic and shoulder girdle. At the same time, the content of muscle enzymes in the blood serum remains normal, and creatinuria increases.

Ovariogenic joint lesions Occur due to a decrease or loss of ovarian function during their disease, radiotherapy or surgical removal, as well as in connection with menopause. Usually interphalangeal, metacarpophalangeal, metatarsophalangeal, less often knee joints are affected. Initially, arthralgia appears, aggravated after physical exertion, stiffness after a state of rest, rarely - transient synovitis. During this period, there are no changes in X-ray examination. Subsequently, deformity of the joints occurs, fibrous changes in the periarticular tissues predominate, and signs of deforming osteoarthritis with small osteophytes appear on the radiographs of the affected joints.

Treatment. Colpocytology makes it possible to determine the nature of endocrine disorders and prescribe appropriate drugs - estrogens, androgens, progesterone.

Dysfunction of the thyroid gland can lead to symptoms of damage to the musculoskeletal system. At thyroid pathology the most common are osteoporosis, adhesive capsulitis, Dupuytren's contracture, index finger syndrome, limited joint mobility, and carpal tunnel syndrome. In studies by M. Cakir (2003), adhesive capsulitis was detected in 10.9% of patients, Dupuytren's contracture - in 8.8%, limited mobility in the joints - in 4.4%, index finger syndrome - in 2.9% and symptom carpal tunnel - in 9.5% of patients in a group of 137 patients with various pathologies of the thyroid gland.

Hyperthyroidism (thyrotoxicosis)- This is a hypermetabolic syndrome that develops with an excess of thyroid hormones in the body. A significant amount of data has been obtained demonstrating the direct effect of thyroxine and T3 on bone tissue. In all parts of the bone and cartilage tissue, the expression of their receptors was found both in osteoblasts and osteoclasts. A number of researchers have obtained data on the participation of the receptor - 1 fibroblast growth factor in T3-dependent formation of bone tissue and the pathogenesis of bone tissue damage in thyroid pathology.

It has been established that resorption processes prevail in the bones in manifest thyrotoxicosis, and their rate is determined by the level of thyroid hormones. Elevated levels of thyroid hormones lead to a negative mineral balance with loss of calcium, which is manifested by increased bone resorption and reduced intestinal absorption of this mineral. Patients with hyperthyroidism have low levels of the vitamin D-1,25(OH)2D metabolite, sometimes hypercalcemia, and decreased serum parathyroid hormone levels. According to the study by E. I. Marova [et al.] (1999), a significant correlation was found between the levels of free thyroxine in the blood serum and alkaline phosphatase, as well as the content of hydroxyproline in the urine.

Clinically, all these disorders lead to the development of diffuse osteoporosis. In terms of BMD, osteopenia was detected in patients with thyrotoxicosis more often in the proximal parts of the femur (Benevolenskaya L.I., 2003). Pain in the bones, pathological fractures, collapse of the vertebrae, the formation of kyphosis are possible. Based on the results of a meta-analysis of 20 studies on bone mineral density and the risk of fractures in patients with thyrotoxicosis, a statistically significant decrease in bone mineral density and an increased risk of hip fracture were obtained. It has been shown that after the elimination of thyrotoxicosis, bone mineral density returns to normal even though the patient does not receive any specific treatment for osteoporosis (Vestergaard P., 2003). The presence of a history of thyrotoxicosis in postmenopausal women increases the risk of fractures by 2.4 times compared with those who have not suffered this disease.

Arthropathy in thyrotoxicosis develops rarely, according to the type of hypertrophic osteoarthropathy with thickening of the phalanges of the fingers and periosteal reactions. Describe thyroid acral syndrome (exophthalmos, pretibial myxedema, marked thickening of the fingers, and hypertrophic osteoarthropathy) occurring in patients receiving treatment for thyrotoxicosis. More often than arthropathy, myopathy is observed with the development of muscle weakness, sometimes myalgia. Also, in patients with hyperthyroidism, adhesive capsulitis (17.4%), a symptom of the carpal tunnel, occurs.

Hypothyroidism- a condition characterized by a decrease in the level of thyroid hormones in the serum. An insufficient level of thyroid hormones in organs and tissues leads to a decrease in the processes of bone tissue remodeling. It has been demonstrated that hypothyroidism does not impair calcium kinetics, is characterized by a smaller trabecular resorption surface and increased cortical bone thickness. There is evidence of a decrease in the level of calcitonin and an increase in the level of calcitrol, as well as a decrease in the levels of markers of bone formation (osteocalcin and thyroid factor), a decrease in the excretion of pyridinoline and deoxypyridinoline in the urine, indicating a slowdown in bone resorption with a deficiency of thyroid hormones (Lukert V., 1990; Aoki Y., 1993). Systemic osteoporosis occurs only with a long and severe course of the disease.

Hypothyroidism leads to a slowdown in oxidative processes and thermogenesis, the accumulation of metabolic products, which leads to the development of tissue dystrophy with the formation of a kind of mucous edema (myxedema) due to the impregnation of tissues with mucopolysaccharides. Quite often, with this pathology, arthropathies and myopathies develop.

Arthropathy develops in 20-25% of patients with myxedema. It is manifested by a slight pain in the joints, swelling of soft tissues, articular rigidity, sometimes the appearance of a non-inflammatory effusion in the joint cavity. In a number of patients, crystals of calcium pyrophosphate or urate are found in the synovial fluid, which do not cause a clear inflammatory reaction, which is explained in such patients by a decrease in the functional activity of neutrophilic leukocytes. The knee, ankle, and small joints of the hands are commonly affected, and radiographs show periarticular osteoporosis. There is information about destructive arthropathy with damage to the knee joints, although progressive destruction, the formation of erosions are not typical. Cases are described when the only complaint in patients with autoimmune thyroiditis with hypofunction was pain in the knee joints without any other clinical manifestations (Gillan M. M., 2000). There is evidence in the literature that patients with chronic autoimmune thyroiditis have polyarthralgia even without thyroid dysfunction (Punzi L., 2002). M. Cakir (2003) revealed in patients with hypothyroidism Dupuytren's contracture in 21.7% of cases, limited mobility in the joints - in 8.7% and carpal tunnel syndrome - in 30.4% of cases, index finger syndrome occurred in 10% of patients.

Thus, disorders of the musculoskeletal system often accompany thyroid dysfunction. These symptoms are common in hypothyroidism, but they are also seen in thyrotoxicosis.

Joint diseases
IN AND. Mazurov

Muscle and joint pain in thyroid diseases

Hypothyroidism, like hyperthyroidism, is a condition that affects skeletal muscle, causing both muscle and joint pain.

What happens in case of hypothyroidism (thyroid hormone deficiency)?

Most often, muscle and joint pain induced by hypothyroidism is the result of inflammation in the muscles with compression of nerve endings, which leads to the following symptoms:

• general weakness
• pain, cramps, and muscle stiffness;
• pain and stiffness in the joints;
• carpal tunnel syndrome: pain, tingling, weakness, numbness in the hand, fingers or forearm. This is due to inflammation of the muscles that compress the nerves in the forearm.
• tarsal tunnel syndrome, similar to carpal tunnel syndrome with pain, tingling, burning and discomfort in the lower leg, spreading to the toes.
• frozen shoulder.

What happens in case of hyperthyroidism (excess thyroid hormones)?

In the case of hyperthyroidism, muscle weakness and fatigue develop, known as hyperthyroid myopathy. People lose muscle tone and strength, a process called "muscle atrophy". For hyperthyroidism, muscle pain is not specific. Other symptoms include:

• difficulty climbing stairs;
• difficulty grasping objects with hands;
• difficulty in trying to raise the arms above the head.

In some cases, the muscles involved in swallowing are affected, resulting in hoarseness or difficulty swallowing.

If the pain persists.

Usually these symptoms disappear with adequate treatment of thyroid disease. But if muscle and joint pain persists after treatment, then you should look for answers to the following questions: Stay close to us on facebook:

1. Is the regimen prescribed by the doctor fully followed? Thyroid hormones should be taken in the morning 1.5-2 hours before breakfast to achieve maximum absorption and better compensate for the state of hypothyroidism.
2. If you suffer from a hypothyroid condition, are you receiving sufficient, correct and adequate treatment? Sometimes it is necessary to take medications containing T3 hormones at the same time.
3. If the response to the treatment of thyroid pathology is satisfactory, but pain persists in the muscles and joints, is it necessary to consult a rheumatologist, neurologist? Yes, a rheumatologist and neurologist will be able to exclude other diseases that also occur with muscle and joint pain.
4. Should alternative pain treatment be used? Yes, in some patients with chronic joint and muscle pain associated with thyroid disease, alternative pain management with various therapies, such as massage, acupuncture, and myofascial therapy, has been successfully applied.

Hypothyroidism is a silent thief that steals life. Symptoms, treatment of hypothyroidism.

Hypothyroidism(myxedema) - a disease caused by insufficient provision of organs with thyroid hormones. With hypothyroidism, practically nothing hurts, but life passes by: nothing pleases, the quality of life of patients with hypothyroidism leaves much to be desired. Patients with hypothyroidism often suffer from depression and often cannot understand what is happening to them.

Symptoms of hypothyroidism

Hypothyroidism is more common in women. Many attribute the symptoms of hypothyroidism to fatigue, overwork, some other illness or the current pregnancy, so hypothyroidism is rarely detected immediately. Only the sharp severity of symptoms and the rapid development of hypothyroidism allow us to diagnose it in time. Subclinical hypothyroidism often goes unrecognized for a long time. A test with thyroliberin will reveal hidden forms of primary hypothyroidism.

How to suspect hypothyroidism

With hypothyroidism for a long time worried about:

• Drowsiness (patients with hypothyroidism can sleep for 12 hours a day for several days in a row). Hypothyroidism causes daytime sleepiness.
• Chilliness without the presence of any colds, decreased body temperature, increased sweating.
• Decreased immunity, frequent colds, including infectious diseases (for example, sore throats ).
• General lethargy, seizures laziness not uncommon in hypothyroidism.
• Emotional lability: irritability, tearfulness.
• Decreased memory and performance, fatigue.
• Difficulty absorbing new information.
• Reducing the speed of reaction, slowing down reflexes.
• Swelling of the face and extremities (unlike other edema, hypothyroidism does not leave a hole when pressing on the anterior surface of the lower leg).
• Paleness of the skin, possibly with a yellowish tint.
• Dull eyes, brittleness and hair loss .
• Tendency to hypotension (low blood pressure).
• Thickening of the tongue, imprints of teeth along its edges (a symptom characteristic not only of hypothyroidism, but also of pancreatic diseases).
• Violation of the motility of the stomach (gastrostasis). At the same time, the emptying of the stomach slows down, belching, a feeling of heaviness in the stomach area are disturbing.
• Feeling of a lump in the throat and discomfort in the neck (optional symptom).
• Palpitations or slow heart rate, pain in the heart area.
• Unexplained weight gain despite not exceeding daily calorie intake. Hypothyroidism causes a sharp slowdown in metabolism, losing weight with hypothyroidism becomes problematic, but it is possible if you follow the doctor's prescription and the following recommendations .
• Elevated levels of cholesterol in the blood can trigger the development of atherosclerosis.
• Sometimes patients with hypothyroidism are concerned about arthralgia (pain in the joints).

The severity of symptoms of hypothyroidism depends on the degree of thyroid insufficiency, the individual characteristics of the organism.

In the presence of concomitant diseases, the clinic of hypothyroidism is supplemented by additional symptoms.

Is there a link between hypothyroidism and breast cancer?

Hypothyroidism, like other chronic diseases, increases the risk of developing breast cancer . Women after forty years of age must do an annual mammogram of the mammary glands in two projections in order to catch the disease at the very beginning and start treatment on time. After the age of 50, mammography is performed every six months, even if the woman is not bothered by anything, and she does not suffer from hypothyroidism.

How does hypothyroidism progress during pregnancy?

During pregnancy, the symptoms of hypothyroidism may worsen.

In the absence of treatment or improper treatment of hypothyroidism, the development of hypothyroid (myxedematous) coma is possible. Lethality (mortality) at which reaches 80% in the absence of adequate treatment.

Congenital hypothyroidism is especially dangerous in children, it is necessary to recognize and start treating it as early as possible, and even better - to identify latent hypothyroidism in preparation for pregnancy in order to give birth healthy child .

Causes of hypothyroidism

Hypothyroidism is divided into primary and secondary.

1. Primary hypothyroidism develops against the background of the pathology of the thyroid gland itself:

• With congenital anomalies or surgical removal of the thyroid gland
• Inflammation of the thyroid gland (thyroiditis)
• With damage of an autoimmune nature or after the introduction of radioactive iodine
• With nodular or endemic goiter
• Chronic infections in the body
• With a lack of iodine in the environment
• In the treatment of thyreostatics (Mercazolil - active ingredient Thiamazole).
• When eating foods and drugs that depress thyroid function (for example, rutabagas, cabbage, turnips, salicylates and sulfa drugs, thyme herb with long-term use).

Primary autoimmune hypothyroidism can be combined with insufficiency of the adrenal glands, parathyroid and pancreas. Hypothyroidism often develops iron deficiency anemia. Perhaps a combination of hypothyroidism, lactorrhoea (as a result of hyperprolactinemia) and amenorrhea (absence of menstruation).

1. Secondary and tertiary (central) hypothyroidism is caused by dysfunction of the pituitary gland and hypothalamus.
2. With tissue resistance to thyroid hormones, inactivation of T3 circulating in the blood ( triiodothyronine) and T4 ( thyroxine ) or TSH ( thyroid-stimulating hormone ) causes peripheral hypothyroidism. Symptoms of hypothyroidism often occur with elevated levels cortisol and estrogen , the latter stimulate the production of thyroxin-binding globulin (TSG) in the liver, and can weaken the effects of thyroid hormones.

Treatment of hypothyroidism

After the examination of the level of thyroid-stimulating hormone, thyroxine and triiodothyronine prescribed by the endocrinologist, according to indications replacement therapy of hypothyroidism with synthetic thyroid hormones. The dosage of levothyroxine or Euthyrox for the treatment of hypothyroidism is determined only by a doctor. In the absence of cardiac pathology, during pregnancy, the patient is under 50 years of age, a full replacement dose is prescribed to achieve a euthyroid state (without a gradual increase). In secondary hypothyroidism, the therapy of the existing insufficiency of the adrenal cortex must be carried out even before the appointment of L-thyroxine in order to prevent the development of acute adrenal insufficiency.

If the recommendations for taking the drug are not followed, it is difficult to achieve full compensation. This is further aggravated by the fact that patients with hypothyroidism are often depressed, do not listen to what they are told, and skip medication. Therefore, the treatment of hypothyroidism should be complex, including the correction of the psychological state of the patient.

With hypothyroidism caused by iodine deficiency, the drug Endonorm (contains organic iodine) is effective. There are contraindications to the use of Endorm, consult your doctor.

Not bad for hypothyroidism helps the method of computer reflexology and acupuncture (a kind of reflexology), conducted by competent specialists. But on the condition that hypothyroidism is not caused by an organic lesion of the thyroid tissue.

What vitamins can be drunk with hypothyroidism in addition?

Diet for hypothyroidism

With hypothyroidism, it is necessary to exclude from the diet foods that depress thyroid function (listed above). Preparations containing soy may reduce the absorption of levothyroxine, and treatment of hypothyroidism will be ineffective.

The intake of fats in hypothyroidism should also be limited, since they are poorly absorbed by tissues and can lead to the development of atherosclerosis.

Nutrition for hypothyroidism should be balanced, rich in vitamins and trace elements (especially selenium). To cheer up, it is desirable to include in the diet products containing tryptophan .

Alefa.ru

Blog Search

Muscle and joint pain in thyroid diseases

While not yet generally known, hypothyroidism and hyperthyroidism can cause a variety of muscle and associated joint symptoms. Both hypothyroidism and hyperthyroidism cause what is known as myopathy, the medical term for diseases that affect the skeletal muscles.
Skeletal muscles are muscles that are connected to your bones.
An example is the skeletal muscle of the biceps in the upper arm or the quadriceps in the thigh. Myopathies are most often observed in the so-called proximal muscles. These muscles, for example, in the hips and shoulders, are closer to the center of the body. In myopathy caused by inflammation or a metabolic condition, such as autoimmune thyroid disease, white blood cells (leukocytes) may attack part of the muscle and surrounding blood vessels, or abnormal levels of certain biochemicals accumulate in the muscle, eventually leading to weakness or pain. Various thyroid disorders can also be associated with specific muscle types and joint problems.

Muscle and joint pain in hypothyroidism.

Hypothyroidism can create a variety of muscle and related joint symptoms. In most cases, these symptoms are associated with swelling of the muscles, or swelling that is pressing on the nerves.
Various problems include:

• General muscle weakness and pain, including cramps, and stiffness
• General joint pain, tenderness, stiffness known as "arthropathy"
• Tendinitis (inflammation of the tendons) in the hands and feet
• Carpal tunnel syndrome includes pain, tingling, weakness, tenderness, or numbness in the hand, fingers, or forearm. This is due to swelling of the membranes that compress the nerve in the forearm.
• Tarsal tunnel syndrome - similar to carpal tunnel syndrome, with pain, tingling, burning, and other discomfort in the lower legs, possibly extending into the toes.

DTG/Hyperthyroidism/Graves' disease.

With hyperthyroidism or Graves' disease, muscle weakness and fatigue can occur. Muscle pain does not occur very often. Some people with hyperthyroidism actually lose muscle tone and strength, a process that can be referred to as "muscle atrophy".
Some common complaints include:

• Difficulty climbing stairs
• Difficulty holding or grasping objects with hands
• Difficulty raising your arms above your head

Up to 70% of people with hyperthyroidism develop proximal muscle weakness, most commonly affecting the pelvis and thigh muscles.
In some cases, the affected muscles may be those that help you swallow, in which case you may have some hoarseness or difficulty swallowing.
The worst of all these symptoms are usually resolved by proper treatment of the thyroid disorder.

When muscle and joint pain doesn't go away with proper thyroid treatment, it's time to ask yourself a few questions.

Firstly, if you're hypothyroid, are you getting enough and really the right treatment? Thyroid deficiency, or the need for additional T3 hormones, may be needed to resolve muscle and joint pain.

Secondly, if you are receiving optimal thyroid treatment and still suffer from joint and muscle problems, should you get a referral to a rheumatologist for further evaluation and possible treatment?
A trained rheumatologist can provide a more thorough evaluation for arthritis and fibromyalgia. Rheumatologists are experts in joint and muscle problems and the treatment of arthritis, some autoimmune diseases.

Thirdly, have you been tested for fibromyalgia? Interestingly, on the subject of fibromyalgia, some practitioners are actually convinced that fibromyalgia is actually a manifestation of hypothyroidism. Fibromyalgia is a syndrome that shows specific pain points on the body and is characterized by chronic weakness and fatigue.

Fourth, should we look at alternative therapies? Some patients with chronic joint and muscle pain associated with their thyroid disease have had success with therapies such as massage, acupuncture, and myofascial therapy.
In terms of supplementation, researchers at the National Institutes of Health (USA) found that glucosamine and chondroitin "may have some efficacy for [osteoarthritis] symptoms."

Hypothyroidism: signs, causes, diagnosis

This or that disease of the thyroid gland can be manifested by an increase in the functional activity of the gland. For their designation, the Greek terms hypo- (under, below) and hyper- (above, above) thyroidism are used. The latter is often replaced by the word thyrotoxicosis. Most likely, this is due to the fact that all the symptoms depend on the excessive production of hormones, and not on the appearance of some toxic substances.

The main signs of a decrease in thyroid function are a rare pulse and an increase in the size of the heart. The pulse of a person with hypothyroidism is usually less than 70 beats per minute. This can be either low or high blood pressure. With a more severe course or prolonged existence of hypothyroidism, cholesterol levels are also elevated, which can worsen the course of angina pectoris. Sometimes, in severe cases, weakening of the heart muscle can also occur and heart failure can develop. Fortunately, this is rare, and the existence of severe hypothyroidism should be long enough. Consider the changes that occur in this state.

Thyroid size

The thyroid gland is usually enlarged due to a chronic inflammatory process, especially in autoimmune thyroiditis. But sometimes, due to the pronounced process of destruction of the gland tissue, its size can decrease, and, finally, the size of the gland can be changed if the cause is a previous surgical intervention.

The skin can become dry and rough to the point where it starts to peel when you scrape it. Cracks appear on the knees and elbows. The skin acquires a yellowish tint, which is due to the presence of carotene, which normally turns into vitamin A, but this process is slowed down in hypothyroidism. Reduced heat production pushes the body to strive to keep warm for the internal organs, so the skin becomes cold. White spots may appear on it, which is associated with a local loss of pigment (vitiligo).

The nails become more brittle, the appearance of lines is characteristic, sometimes pronounced to such an extent that a manicure is simply impossible.

Hair becomes dull and thinner, often dry and brittle. Because of this, you have to constantly use nourishing balms. Intense hair loss leads to baldness.

Other hair also falls out: on the body, arms, legs, pubis, eyebrows, eyelashes.

Faint expressionless face, slow, slurred speech, hoarse voice

The changes are due to swelling of the tissue and tongue and the pressure of the enlarged thyroid gland on the laryngeal nerves.

Slow growth in children

Often a mother, wondering why her twelve-year-old child looks no more than 9 years old, takes him to a doctor who, after conducting the necessary research, finds out that the cause of everything is insufficient thyroid function.

Complaints presented by patients with hypothyroidism:

The patient cannot find a warm enough place and often wonders why it is always cold there. Even in summer he wears warm woolen clothes. Feels more comfortable in hot weather, humid weather, and may not sweat.

Fatigue and sleepiness

The classic symptom of hypothyroidism is marked lethargy and weakness. The patient constantly wants to sleep, even if he slept for 12 hours in a row the night before.

Digestive problems and weight gain

Intestinal motility deteriorates, leading to constipation, belching, poor appetite, and heartburn. This is due to the fact that the food eaten passes through the stomach slowly, and hydrochloric acid is thrown into the esophagus.

Pain, stiffness in joints and muscles

Often with hypothyroidism, convulsions and muscle pain are noted. They are so strong that they do not let you sleep at night, and the patient sometimes thinks that he has a disease of the joints. Please note that not all phenomena disappear after the elimination of hypothyroidism.

Often there is a violation of muscle coordination and the patient feels so constrained that he cannot even perform the simplest movements.

Failure of the menstrual cycle, colostrum discharge from the nipples

Menstruation becomes more abundant and frequent than normal. Hypothyroidism can cause an increase in the production of prolactin, which is responsible for the formation of human milk.

Reasons for the development of hypothyroidism

They are numerous, and the most common is an autoimmune thyroid disorder known as Hashimoto's thyroiditis, in which the cells are destroyed by the patient's lymphocytes and antibodies that appear in his blood.

Treatment of hyperthyroidism can also lead to an excessive decrease in thyroid function. This is especially often observed after treatment of diffuse toxic goiter with radioactive iodine. External irradiation of the head and neck during radio or X-ray therapy can lead to the same result.

Hypothyroidism also develops after surgical interventions, when the entire thyroid gland or a significant part of it is removed.

Sometimes a child is born without a thyroid gland, and then congenital hypothyroidism occurs, which is noted in 10% of cases.

And finally, hypothyroidism can develop as a result of a disease of the pituitary gland - a gland that regulates the production of hormones by the thyroid gland.

But even in the absence of such extreme factors, a decrease in thyroid function may occur. Many common foods are capable of causing hypothyroidism if consumed in significant amounts, especially in conditions of iodine deficiency. These foods are called goitrogens because, along with hypothyroidism, they cause an enlarged thyroid gland. Their action is that they block the transition of thyroxine (T4) to a more active form - triiodothyronine (T3). The most common of these products are: cabbage, cauliflower and Brussels sprouts, turnips, corn, almonds.

The occurrence of hypothyroidism can also lead to the intake of certain drugs, the mechanism of action of which corresponds to that described above for food.

These medicines include:

• steroids such as prednisolone;
• amiodarone, a medicine used for heart conditions;
• antithyroid drugs such as mercazolil and propylthiouracil used to treat hyperthyroidism;
• lithium preparations used in psychological practice;
• propranolol is a beta-blocker used for cardiac arrhythmias.

The doctor, after examining a patient who complains and has the symptoms described above, prescribes studies to confirm the diagnosis.

The results of two of them are the most significant:

Treatment is simple. Patients are prescribed thyroid hormone replacement therapy. Synthetic hormones are widely used today, and not preparations made from animal thyroid glands, as was the case in the past.

The correctness of the selection of the dose is controlled by the level of TSH. It is not always possible to choose the right dosage right away. If the amount of the hormone is too high, the patient may develop hyperthyroidism, if it is low, hypothyroidism remains uncured.

Dose selection usually takes more than a month and requires regular control studies of TSH levels.

Changes in the musculoskeletal system in diseases of the thyroid gland

Dysfunction of the thyroid gland can lead to symptoms of damage to the musculoskeletal system. At thyroid pathology the most common are osteoporosis, adhesive capsulitis, Dupuytren's contracture, index finger syndrome, limited joint mobility, and carpal tunnel syndrome. In studies by M. Cakir (2003), adhesive capsulitis was detected in 10.9% of patients, Dupuytren's contracture - in 8.8%, limited mobility in the joints - in 4.4%, index finger syndrome - in 2.9% and symptom carpal tunnel - in 9.5% of patients in a group of 137 patients with various pathologies of the thyroid gland.

Hyperthyroidism (thyrotoxicosis)- This is a hypermetabolic syndrome that develops with an excess of thyroid hormones in the body. A significant amount of data has been obtained demonstrating the direct effect of thyroxine and T3 on bone tissue. In all parts of the bone and cartilage tissue, the expression of their receptors was found both in osteoblasts and osteoclasts. A number of researchers have obtained data on the participation of the receptor - 1 fibroblast growth factor in T3-dependent formation of bone tissue and the pathogenesis of bone tissue damage in thyroid pathology.

It has been established that resorption processes prevail in the bones in manifest thyrotoxicosis, and their rate is determined by the level of thyroid hormones. Elevated levels of thyroid hormones lead to a negative mineral balance with loss of calcium, which is manifested by increased bone resorption and reduced intestinal absorption of this mineral. Patients with hyperthyroidism have low levels of the vitamin D-1,25(OH)2D metabolite, sometimes hypercalcemia, and decreased serum parathyroid hormone levels. According to the study by E. I. Marova [et al.] (1999), a significant correlation was found between the levels of free thyroxine in the blood serum and alkaline phosphatase, as well as the content of hydroxyproline in the urine.

Clinically, all these disorders lead to the development of diffuse osteoporosis. In terms of BMD, osteopenia was detected in patients with thyrotoxicosis more often in the proximal parts of the femur (Benevolenskaya L.I., 2003). Pain in the bones, pathological fractures, collapse of the vertebrae, the formation of kyphosis are possible. Based on the results of a meta-analysis of 20 studies on bone mineral density and the risk of fractures in patients with thyrotoxicosis, a statistically significant decrease in bone mineral density and an increased risk of hip fracture were obtained. It has been shown that after the elimination of thyrotoxicosis, bone mineral density returns to normal even though the patient does not receive any specific treatment for osteoporosis (Vestergaard P., 2003). The presence of a history of thyrotoxicosis in postmenopausal women increases the risk of fractures by 2.4 times compared with those who have not suffered this disease.

Arthropathy in thyrotoxicosis develops rarely, according to the type of hypertrophic osteoarthropathy with thickening of the phalanges of the fingers and periosteal reactions. Describe thyroid acral syndrome (exophthalmos, pretibial myxedema, marked thickening of the fingers, and hypertrophic osteoarthropathy) occurring in patients receiving treatment for thyrotoxicosis. More often than arthropathy, myopathy is observed with the development of muscle weakness, sometimes myalgia. Also, in patients with hyperthyroidism, adhesive capsulitis (17.4%), a symptom of the carpal tunnel, occurs.

Hypothyroidism- a condition characterized by a decrease in the level of thyroid hormones in the serum. An insufficient level of thyroid hormones in organs and tissues leads to a decrease in the processes of bone tissue remodeling. It has been demonstrated that hypothyroidism does not impair calcium kinetics, is characterized by a smaller trabecular resorption surface and increased cortical bone thickness. There is evidence of a decrease in the level of calcitonin and an increase in the level of calcitrol, as well as a decrease in the levels of markers of bone formation (osteocalcin and thyroid factor), a decrease in the excretion of pyridinoline and deoxypyridinoline in the urine, indicating a slowdown in bone resorption with a deficiency of thyroid hormones (Lukert V., 1990; Aoki Y., 1993). Systemic osteoporosis occurs only with a long and severe course of the disease.

Hypothyroidism leads to a slowdown in oxidative processes and thermogenesis, the accumulation of metabolic products, which leads to the development of tissue dystrophy with the formation of a kind of mucous edema (myxedema) due to the impregnation of tissues with mucopolysaccharides. Quite often, with this pathology, arthropathies and myopathies develop.

Arthropathy develops in 20-25% of patients with myxedema. It is manifested by a slight pain in the joints, swelling of soft tissues, articular rigidity, sometimes the appearance of a non-inflammatory effusion in the joint cavity. In a number of patients, crystals of calcium pyrophosphate or urate are found in the synovial fluid, which do not cause a clear inflammatory reaction, which is explained in such patients by a decrease in the functional activity of neutrophilic leukocytes. The knee, ankle, and small joints of the hands are commonly affected, and radiographs show periarticular osteoporosis. There is information about destructive arthropathy with damage to the knee joints, although progressive destruction, the formation of erosions are not typical. Cases are described when the only complaint in patients with autoimmune thyroiditis with hypofunction was pain in the knee joints without any other clinical manifestations (Gillan M. M., 2000). There is evidence in the literature that patients with chronic autoimmune thyroiditis have polyarthralgia even without thyroid dysfunction (Punzi L., 2002). M. Cakir (2003) revealed in patients with hypothyroidism Dupuytren's contracture in 21.7% of cases, limited mobility in the joints - in 8.7% and carpal tunnel syndrome - in 30.4% of cases, index finger syndrome occurred in 10% of patients.

Thus, disorders of the musculoskeletal system often accompany thyroid dysfunction. These symptoms are common in hypothyroidism, but they are also seen in thyrotoxicosis.

Functionality of the thyroid gland and diseases of the joints are interconnected. Disturbed synthesis of hormones leads to metabolic dysfunctions, in particular, calcium metabolism, which provokes the occurrence of degenerative and dystrophic changes in the structures of the musculoskeletal system (MDA).

Main connection

The thyroid gland affects the functioning of all systems. Thanks to the production of hormones, the immune processes and protective functions are activated. Metabolism depends on the gland. In case of violation of its work, the body weakens and is not able to independently resist viruses and bacteria. Inflammatory processes occur, in particular, arthritis of the articular joints. The main reason for the development of diseases of the musculoskeletal system against the background of thyroid dysfunction is calcium deficiency and excessive accumulation of phosphorus, which occurs due to failures in their absorption.

Causes of damage and symptoms

Hyperthyroidism and joints

manifestation of hyperthyroidism.

The accumulation of thyroid hormones, which is noted with excessive activity of the gland, leads to a violation of the synthesis and breakdown of calcium. This is manifested by a significant deficiency of the element and causes fragility of the bone structure. At the same time, the body becomes weaker and loses the ability to fully resist foreign pathogens. Against this background, inflammatory reactions develop in less protected areas of the body.

More often with hyperthyroidism, arthritis of the knee joint and small joints develops.

A number of symptoms indicate a pathological change in the body, which include:

• fast fatiguability;
• weight loss;
• emotional instability;
• pain in the joints;
• swelling of the periarticular tissues;
• hyperemia of the skin;
• stiffness in the affected joint.

Hypothyroidism as a cause

Osteoporosis can be caused by thyroid problems.

Weak hormonal synthesis in the thyroid gland causes a slowdown in metabolic processes, which provokes the accumulation of decay products. Therefore, with hypothyroidism, tissue dystrophy develops, in particular, bone and cartilage. At the same time, the occurrence of such a pathology as diffuse systemic osteoporosis is noted.

Often, an inflammatory reaction spreads in the joints, which causes the development of arthritis. At the same time, characteristic symptoms of hypothyroidism are noted, including decreased activity, drowsiness, apathy, muscle rigidity, overweight, and others. And also the clinical picture is supplemented by non-specific signs of arthritic lesions in the form of pain in the joints, swelling of soft tissues, fluid accumulation and changes in motor activity. Considering how the thyroid gland is located, the temporal and jaw joints suffer from inflammation. In this case, pain also affects the teeth, which further leads to jaw dysfunction.

The disease is characterized by an inflammatory reaction in the structure of the thyroid gland, which acquires a chronic course. Mainly affects women. Autoimmune thyroiditis is accompanied by the breakdown of gland cells and poisoning of the body, due to a decrease in protective functions. Autoimmune inflammation has a negative impact on all systems and often affects the structures of the musculoskeletal system. At the same time, in addition to weakness and drowsiness, a person’s joints hurt, which violates his natural mobility.

How is it diagnosed?

To determine the exact cause of joint pain, the doctor collects an anamnesis of complaints and a history of concomitant ailments. An external examination of the affected joint is also carried out. If thyroid dysfunction is suspected, its palpation is used. Next, hormonal tests are prescribed to determine the ratio of hormones in the blood. Mandatory studies are carried out, which are shown in the table.

Thyroid dysfunction leads to negative changes throughout the body. Due to the violation of calcium metabolism, joints and bone and cartilage tissue suffer. Improper production of thyroid hormones leads to joint pain and provokes the development of an inflammatory process, which often causes arthritis and other pathologies.

Joint and thyroid diseases

The thyroid gland has a direct impact on all processes that occur in the human body. Its main function is to provide proper protection by activating the immune system, and to control metabolism. If these processes are violated, the body becomes weak, which provokes the development of ailments, including arthritis. The thyroid gland has a direct effect on the phosphorus-calcium metabolism in the body. With a lack of calcium and an excess of phosphorus, bone and cartilage tissues occur, which lead to inflammation in the joints.

Due to the close proximity to the thyroid gland, arthritis of the temporal and jaw region often develops. At the same time, not only joints, but also teeth hurt in patients, a characteristic crunch is noted when moving the jaw, which can subsequently cause its complete immobilization.

Hypothyroid disorders

Hypothyroidism is often accompanied by diffuse systemic osteoporosis.

A decrease in the production of thyroid hormones leads to a slowdown in metabolic processes and the accumulation of metabolic decay products in the body. This causes dystrophic changes in tissues, including bone. More often in patients with hypothyroidism, diffuse systemic osteoporosis is diagnosed. The development of the disease with a decrease in hormone production is manifested by non-specific symptoms in the form of pain in the joints, swelling of soft tissues, impaired mobility and accumulation of exudate in the affected area. Even with hypothyroidism, there is a violation of muscle activity (myalgia).

Hyperthyroidism as a cause of arthritis

Excessive productivity of thyroid hormones provokes a violation of the absorption of calcium by the body, which causes depletion and impaired mineralization of bone and cartilage tissue. The body becomes weakened and does not resist the attack of disease-causing agents, which leads to an inflammatory process in the most vulnerable areas of the body. With the development of arthritis against the background of hyperthyroidism, damage to the knee and other small joints is noted. The active development of the disease provokes a number of clinical manifestations:

• pain in the joints;
• swelling and redness of the skin;
• feeling of stiffness when moving;
• development of secondary osteoarthritis;
• an increase in temperature at the site of inflammation.

Autoimmune thyroiditis

AIT is also characterized by a decrease in working capacity in patients.

A fairly common disease that affects the female part of the population 20 times more often than the male. It is manifested by a chronic inflammatory process in the thyroid gland, which leads to the destruction of gland cells. In this case, intoxication of the body and a decrease in protective functions occur. Under the influence of these negative factors, many organs and systems are affected. Patients with autoimmune thyroiditis complain not only of the clinical manifestations of gland dysfunction, but also of joint pain, weakness and decreased performance.

Therapeutic measures

Before proceeding with the treatment of arthritis against the background of a malfunction of the thyroid gland, it is necessary to determine what exactly became the root cause of the development of the disease: hypothyroidism or hyperthyroidism. Based on the root cause, drugs are prescribed that compensate for the missing amount of hormones or inhibit their active production. To restore normal bone density and saturate the bones with minerals, agents that contain calcium and vitamin D are used. For severe pain, non-steroidal painkillers are used.

Bisphosphonates are widely used to prevent bone loss.

To alleviate the manifestations of inflammation in the joints, massage procedures are prescribed.

Rehabilitation methods in the form of exercise therapy, physiotherapy and massage are used for inflammation of the joints of a different nature and to improve metabolic processes in case of violations of the gland. Therapeutic gymnastics improves blood circulation, strengthens the muscular frame and normalizes mobility in the joints. Under the influence of exercises, all processes in the body are activated, which stabilizes the protective functions. Massage and physiotherapy are aimed at eliminating swelling and pain. Under the influence of irritants, local trophism improves. Particular attention is paid to nutrition. Fresh vegetables and fatty fish varieties are introduced into the diet. Based on the underlying ailment, the intake of iodine-containing products is corrected.

Prevention of joint problems

The main preventive action is the timely and correct treatment of the underlying disease. To minimize the risk of developing arthritis, attention is paid to the mineral and vitamin saturation of the body. For this purpose, biologically active additives containing calcium are used. It is recommended to adhere to an active lifestyle, increase the number of walks in the fresh air, which also contributes to the saturation of the body with vitamin D. It is advisable for people with problems with the functionality of the thyroid gland to exclude the use of alcohol and caffeine, which provoke calcium leaching from the bones.