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Thyroid problems can cause a wide range of symptoms, and it is unlikely that someone will experience all of them. Muscle twitching can be a symptom of both an overactive thyroid (hyperthyroidism) and an underactive thyroid (hypothyroidism). Hypothyroid myopathy, a skeletal muscle disease caused by hypothyroidism, can cause muscle spasms, stiffness, and weakness. Hyperthyroidism can also cause muscle weakness, and in rare cases, acute compartment syndrome, which is characterised by increased pressure within a muscle compartment.
| Characteristics | Values |
|---|---|
| Thyroid-related muscle twitches | Hypoparathyroidism, a rare condition where the parathyroid glands produce too little parathyroid hormone, can cause muscle twitches due to low calcium and high phosphorus levels in the body. The parathyroid glands lie near the thyroid. |
| Hypothyroid myopathy, a skeletal muscle disease caused by hypothyroidism, can lead to muscle spasms and twitches. It is observed in 30% to 80% of individuals with hypothyroidism. | |
| An overactive thyroid (hyperthyroidism) can cause twitching or tremors as a symptom. |
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What You'll Learn
Hypothyroid myopathy
The symptoms of hypothyroid myopathy can include generalized myalgias, muscle weakness, muscle pain, and stiffness. These symptoms typically affect proximal muscles, such as those in the thighs, hips, shoulders, and neck, impacting activities such as stair climbing, rising from a seated position, and lifting objects. The disease can also cause muscle enlargement and a slowing of reflexes. In rare cases, severe hypothyroid myopathy can result in muscle necrosis, acute compartment syndrome, or respiratory failure.
The diagnosis of hypothyroid myopathy is based on clinical evaluations and laboratory findings. Clinicians need to differentiate the muscle weakness associated with hypothyroid myopathy from other conditions with similar presentations. Laboratory findings may include elevated serum creatine kinase levels, although this is not specific to myopathy. Physical evaluations can include a 6-minute walking test, hand grip strength test, and timed chair-standing test to assess proximal muscle strength. Electromyography (EMG) can also be used to demonstrate low or small amplitude potentials, aiding in the diagnosis.
Treatment for hypothyroid myopathy aims to restore normal thyroid hormone levels through medication or, in some cases, surgery. Certain drugs, such as lipid-lowering medications, may need to be avoided as they can exacerbate myopathy in patients with hypothyroidism.
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Hyperthyroidism
Some common symptoms of hyperthyroidism include muscle weakness, tremors or twitching, unexplained weight loss, sensitivity to heat, diarrhoea, sleeping difficulties, sweating, irritability, nervousness, agitation, and anxiety. Older people may present with few symptoms or other symptoms, such as deterioration of pre-existing heart disease, depression, or anorexia, which may make the diagnosis more difficult.
An overactive thyroid can also cause physical signs, including a swelling in the neck caused by an enlarged thyroid gland (goitre), an irregular and/or unusually fast heart rate (palpitations), warm skin and excessive sweating, red palms, loose nails, a raised itchy rash, patchy hair loss or thinning, eye problems such as redness, dryness or vision problems, and difficulty swallowing.
If you suspect you have hyperthyroidism, it is important to see a medical professional. They may perform a blood test to determine whether your symptoms are caused by a thyroid problem. Treatment options for hyperthyroidism 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.
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Graves' disease
Muscle weakness associated with Graves' disease may be due to thyrotoxic periodic paralysis, a potentially fatal complication of thyrotoxicosis. It can also be related to autoimmune disorders of muscles such as polymyositis and myasthenia gravis. Myalgia, or muscle pain, is an unusual presenting symptom of Graves' disease, and it can be severe. It is seen more often in the proximal muscles, such as those in the thighs, calves, forearms, biceps, trapezius, fingers, shoulders, and neck.
Muscle twitching is not a commonly reported symptom of Graves' disease. However, there are some accounts of people experiencing muscle twitching, especially in the calves, along with the disease. These twitches can come and go and may be related to stress and anxiety. In one case, a person with Graves' disease reported experiencing muscle twitching all over their body, along with other hyperthyroid symptoms, but their blood tests were normal.
If you are experiencing muscle twitching or other symptoms that you think may be related to Graves' disease or another thyroid condition, it is important to consult a medical professional for proper diagnosis and treatment.
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Hypoparathyroidism
Symptoms of hypoparathyroidism are related to low calcium levels in the blood and can include tingling or burning sensations in the fingers, toes, lips, tongue, and face; muscle aches, weakness, cramping, pain, and twitching or spasms, particularly in the hands, arms, throat, and face; abdominal pain; numbness around the mouth; contraction or tightening of the muscles in the hands and feet; fits; fainting; confusion; headaches; tiredness; brittle nails; dry skin and hair; uncontrolled spasms causing muscle cramps; and seizures or spasms in the airways causing breathing difficulties.
The aim of treatment is to relieve symptoms and minimise complications by maintaining adequate calcium intake (1.0–1.5 g per day) through calcium supplements and active forms of vitamin D tablets. Patients with hypoparathyroidism often require modest magnesium supplements as well. In severe cases, urgent hospital treatment may be needed to correct calcium levels using an intravenous drip.
Myopathy secondary to hypoparathyroidism is unusual, although perioral and distal paresthesia and tetany secondary to hypocalcemia can occur. Severe tetany can cause stridor, apnea due to vocal cord involvement, bronchospasm, and diaphragmatic chest wall contraction.
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Thyroid surgery
An overactive thyroid (hyperthyroidism) can cause a wide range of symptoms, including muscle twitches and tremors. The thyroid gland can become overactive due to Graves' disease, an autoimmune condition where the immune system attacks the thyroid gland. Treatment options for hyperthyroidism include radioiodine treatment and thyroid surgery.
There are several methods for performing a thyroidectomy, including traditional open surgery through an incision in the neck, and minimally invasive video-assisted thyroidectomy (MIVAT), which uses a smaller incision and a camera. Other approaches include the trans-oral thyroidectomy, which involves three cuts placed inside the mouth, and the Bilateral Axillo-Breast Approach (BABA), where incisions are made under the armpit and below the breast. These methods avoid visible scars on the neck but carry additional surgical risks.
After a total thyroidectomy, patients will require lifelong supplementation with thyroid hormones. There is also a small risk of damage to the parathyroid glands, which can lead to low blood calcium levels and symptoms such as numbness, tingling, and muscle cramps. Wound infection and neck hematoma are rare but possible complications of thyroid surgery.
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Frequently asked questions
An overactive thyroid, or hyperthyroidism, is when the thyroid gland produces too much thyroid hormone.
Symptoms of an overactive thyroid include muscle weakness, diarrhoea, needing to pee more often than usual, persistent thirst, itchiness, loss of interest in sex, a swelling in your neck, an irregular and/or unusually fast heart rate, twitching or trembling, warm skin and excessive sweating, red palms, loose nails, a raised itchy rash, patchy hair loss or thinning, weight loss, and eye problems.
Hypothyroid myopathy is a skeletal muscle disease caused by an underactive thyroid (hypothyroidism). It is observed in 30% to 80% of individuals with hypothyroidism.
Symptoms of hypothyroid myopathy include myasthenia, muscle spasms after exercise, myalgia, muscle stiffness, and muscle weakness.
