Dominic Stone
Thyroid problems can cause a variety of symptoms, including muscle twitches. An overactive thyroid (hyperthyroidism) can lead to an irregular and fast heart rate, weight loss, and eye problems. On the other hand, an underactive thyroid (hypothyroidism) can cause muscle weakness, pain, and stiffness, a condition known as hypothyroid myopathy. Hypothyroid myopathy affects skeletal muscles and can lead to paralysis in rare cases. Additionally, hypoparathyroidism, a condition related to thyroid problems, can cause muscle twitching due to low calcium levels. While thyroid issues can be concerning, they are often treatable with medication, lifestyle changes, or in some cases, surgery.
| Characteristics | Values |
|---|---|
| Thyroid-related muscle twitches | Hypoparathyroidism, a rare condition where the parathyroid glands produce too little parathyroid hormone, leading to low blood calcium levels and muscle twitching |
| Hypothyroid myopathy, a skeletal muscle disease caused by low thyroid hormone levels, can lead to muscle weakness, atrophy, stiffness, and in rare cases, periodic paralysis | |
| An overactive thyroid can cause muscle weakness and twitching or tremors |
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What You'll Learn
Hypothyroid myopathy
The condition can manifest in both congenital and acquired cases, and it is observed in 30-80% of individuals with hypothyroidism. The symptoms can be gradual and nonspecific, requiring clinicians to differentiate it from fatigue and other muscle disorders. It is important for patients diagnosed with hypothyroidism to be evaluated for musculoskeletal symptoms. Hypothyroid myopathy is not inherited but may have a genetic predisposition to autoimmune diseases. Common causes of hypothyroidism leading to hypothyroid myopathy include iodine deficiency, thyroid surgery, radiation therapy, certain medications, congenital hypothyroidism, and aging.
One of the key manifestations of hypothyroid myopathy is muscle weakness, which is caused by a decrease in muscle carnitine and a transition in myosin isoforms, leading to reduced energetic consumption. Other factors contributing to muscle weakness include global inhibition of oxidative pathways and respiratory chain dysfunction within cells. Myoedema, observed in one-third of patients with hypothyroidism, is characterised by the mounding of muscle tissue after light percussion. It is associated with delayed Ca++ reuptake, prolonging muscle contraction and potentially leading to muscle hypertrophy.
Certain drugs, such as lipid-lowering medications, may exacerbate myopathy in patients with hypothyroidism. Studies have found a correlation between prolonged hypothyroidism and decreased levels of irisin, a myokine associated with the thyrometabolic state and muscle damage. Hypothyroid myopathy can be effectively managed by restoring normal thyroxine levels through medication or, in some cases, surgery.
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Hyperthyroidism
An overactive thyroid, or hyperthyroidism, can cause a wide range of symptoms, though it is unlikely that a person will experience all of them. The symptoms may develop gradually or suddenly, and for some people, they may be mild, while for others, they may be severe and significantly affect their lives. An overactive thyroid can cause muscle weakness, but it is not directly associated with muscle twitches or spasms.
If you suspect you may have hyperthyroidism, it is important to see a doctor. They will ask about your symptoms and may arrange for you to have a blood test to determine if you have a thyroid problem. If you are diagnosed with an overactive thyroid, you will usually be referred to an endocrinologist (a specialist in hormone conditions) to discuss treatment options. Treatment options include radioiodine treatment, where radiation is used to damage the thyroid and reduce its ability to produce hormones, or surgery to remove some or all of the thyroid.
While hyperthyroidism does not directly cause muscle twitching, it can lead to other complications if left untreated or poorly controlled. These complications may include deterioration of pre-existing heart disease, depression, or anorexia, which can make diagnosis more difficult. Therefore, it is important to seek medical advice if you are experiencing any symptoms of hyperthyroidism.
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Graves' disease
An overactive thyroid can cause a wide range of symptoms, including muscle weakness, diarrhoea, increased thirst and frequent urination, itchiness, weight loss, eye problems, and an irregular or unusually fast heart rate. In addition, neurological symptoms such as seizures, cognitive impairment, and tremors can be observed in people with Graves' disease. While more complex movement disorders like chorea and myoclonus are less common, muscle twitching has been reported by some patients with Graves' disease, particularly during periods of stress.
Muscle weakness and tenderness are also common in people with Graves' disease, with proximal muscles such as those in the thighs, calves, forearms, biceps, and shoulders being particularly affected. This can result in sleep disturbances and impact activities such as climbing stairs, rising from a seated position, or lifting objects. While rare, severe muscle aches and pain associated with Graves' disease can be indicative of myopathy or autoimmune disorders of the muscles, such as polymyositis and myasthenia gravis.
The treatment for Graves' disease aims to reduce the overactivity of the thyroid gland and manage the associated symptoms. Radioiodine treatment, surgery, and medication such as Tapazole are commonly used to treat hyperthyroidism and improve muscle-related symptoms. It is important to consult a healthcare professional for a proper diagnosis and treatment plan.
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Hypoparathyroidism
The primary symptoms of hypoparathyroidism are related to low calcium levels in the blood, which can cause an unpleasant tingling or burning sensation in the fingers, toes, lips, tongue, and mouth. It can also lead to muscle aches, cramps, twitching, or spasms in the legs, feet, stomach, face, throat, hands, and arms. These muscle-related issues are often accompanied by subjective symptoms like fatigue, headaches, bone pain, insomnia, and abdominal pain.
The diagnosis of hypoparathyroidism is typically made through blood tests, genetic testing, and other investigations, depending on the suspected cause. Treatment for hypoparathyroidism focuses on correcting the low calcium and vitamin D levels associated with the condition. Calcium and vitamin D supplementation are commonly used to manage the condition and ameliorate symptoms. However, these treatments can increase the risk of kidney stones and chronic kidney disease.
In more severe cases of hypoparathyroidism, muscle weakness, pain, and dysfunction may occur. The pathophysiology of muscle weakness in hypoparathyroidism is not yet fully understood, but it is believed to be related to the disruption of calcium and phosphorus homeostasis, which are essential for adequate muscle function.
It is important to note that while hypoparathyroidism can cause muscle twitches and other related issues, the presence of these symptoms does not necessarily indicate hypoparathyroidism. A healthcare professional should be consulted for a proper diagnosis.
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Thyroid surgery
There are several methods for performing a thyroidectomy. The most common approach is through a small incision in the neck with the aid of a camera (minimally invasive video-assisted thyroidectomy or MIVAT). Other methods include making incisions through the mouth, armpit, shoulder blade, breast, or ear, which do not leave visible scars on the neck but carry additional surgical risks.
Before surgery, patients typically undergo imaging tests, such as a thyroid ultrasound, to locate any abnormal thyroid growth. A fine needle aspiration or needle biopsy may also be performed to determine if a growth is cancerous. On the day of surgery, patients are advised to fast and may be asked to temporarily discontinue certain medications, including blood thinners.
The surgery itself typically lasts one to three hours for a whole thyroid removal and less time for a partial removal. After the procedure, patients will need to avoid heavy lifting for two weeks to prevent bleeding.
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Frequently asked questions
Yes, thyroid problems can cause muscle twitches. An overactive thyroid (hyperthyroidism) can cause muscle twitching or tremors. On the other hand, an underactive thyroid (hypothyroidism) can lead to hypothyroid myopathy, a skeletal muscle disease that may cause muscle spasms after exercise.
Symptoms of an overactive thyroid may include a swelling in your neck due to an enlarged thyroid gland (goitre), an irregular and/or unusually fast heart rate (palpitations), warm skin and excessive sweating, red palms, loose nails, and eye problems such as redness, dryness, or vision issues.
Symptoms of an underactive thyroid may include muscle weakness, pain, stiffness, fatigue, and generalised myalgias. Proximal muscles such as those in the thighs, hips, shoulders, and neck are particularly affected, impacting activities such as climbing stairs, rising from a seated position, and lifting objects.
