Musculoskeletal manifestations in patients with thyroid disease

OBJECTIVE Thyroid dysfunction may cause musculoskeletal symptoms. We have evaluated the prevalence of adhesive capsulitis, Dupuytren's contracture, trigger finger, limited joint mobility and carpal tunnel syndrome in a series of patients with various thyroid diseases and differing levels of function. DESIGN AND PATIENTS Patients with euthyroid (diffuse and/or nodular) goitre, Hashimoto's thyroiditis, Graves' disease, toxic nodular goitre, toxic diffuse goitre and patients with goitre who had partial thyroidectomy were included in the study (n = 137). Neurological and musculoskeletal examinations were performed after a standardized symptom questionnaire. The prevalence of musculoskeletal problems was analysed with respect to thyroid function and thyroid autoantibody status. MEASUREMENTS Serum concentrations of free T3, free T4, TSH and thyroglobulin and thyroperoxidase antibodies were determined. Serum levels of creatine kinase, lactate dehydrogenase, calcium and phosphate along with erythrocyte sedimentation rate were measured to exclude other causes of musculoskeletal complaints. RESULTS When the study group (n = 137) was divided according to thyroid status, 30.6% (n = 42) were thyrotoxic, 16.8% (n = 23) had subclinical thyrotoxicosis, 28.5% (n = 39) were euthyroid, 7.3% (n = 10) had subclinical hypothyroidism and 16.8% (n = 23) were hypothyroid. Overall, adhesive capsulitis was found in 10.9% (n = 15), Dupuytren's contracture in 8.8% (n = 12), limited joint mobility in 4.4% (n = 6), trigger finger in 2.9% (n = 4) and carpal tunnel syndrome in 9.5% (n = 13) of the patients. The prevalence of adhesive capsulitis was highest in patients with subclinical thyrotoxicosis (17.4%); Dupuytren's contracture, limited joint mobility and carpal tunnel syndrome were commonest in hypothyroid patients (21.7%, 8.7% and 30.4%, respectively). Trigger finger occurred in 10% of patients with subclinical hypothyroidism. When these prevalences were analysed with respect to thyroid status, carpal tunnel syndrome was significantly more prevalent in the hypothyroid group (P = 0.004). When thyroperoxidase antibody-positive and -negative patients were compared, adhesive capsulitis negatively (P = 0.03, r = -0.18) and trigger finger positively correlated with (P=0.03, r=0.21) thyroperoxidase antibody existence. CONCLUSIONS These results demonstrate that musculoskeletal disorders often accompany thyroid dysfunction. In addition to the well-known observation that these disorders are common in patients with hypothyroidism, they are also observed in patients with thyrotoxicosis. Patients with thyroid dysfunction should be questioned for musculoskeletal complaints and referred to a specialist if necessary.