Hypothyroidism and pseudogout
by Nathan Wei, MD, FACP, FACR
Nathan Wei is a nationally known board-certified rheumatologist and author of the Second Opinion Arthritis Treatment Kit. It's available exclusively at this website... not available in stores.
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People with underactive thyroid (hypothyroidism) often have joint and muscle problems that occur because of low levels of thyroid hormone.
These problems include:
1. Muscle aches, tenderness and stiffness, especially in the shoulders and hips
2. Joint pain and stiffness
3. Swelling of the knees and hands and feet
4. Carpal tunnel syndrome
Joint problems caused by hypothyroidism can be difficult to distinguish from rheumatoid arthritis. Both can cause painful, swollen and stiff joints often worse after rest. But people with hypothyroidism usually have less morning stiffness. They may also have attacks of pseudogout. Unfortuantely, this makes the distinction from rheumatoid arthritis even more difficult.
Pseudogout is a form of arthritis triggered by deposits of calcium pyrophosphate dehydrate crystals in the joints. It is also called calcium pyrophosphate deposition disease (CPPD). This disease can cause joint swelling, most frequently in the knee, wrist, shoulder, ankle, elbow or hand. This condition can appear similar to gout, another arthritic condition caused by another type of crystal that commonly causes the sudden pain and swelling in a single joint. However, gout is caused by uric acid crystals, and gout tends to occur early in the big toe or midfoot and then involve other joints. Pseudogout also can resemble osteoarthritis or rheumatoid arthritis.
Pseudogout most commonly affects older individuals.
In some cases, other medical conditions can make people more susceptible to pseudogout. Besides hypothyroidism, these include a genetic disorder of iron overload (hemochromatosis) or excessive blood levels of calcium (hypercalcemia). Pseudogout also can be triggered by joint injury, such as joint surgery or a sprain or the stress of a medical illness. Frequently, however, nothing can be identified that might have triggered the disease.
Treatment of joint and muscle problems due to hypothyroidism is directed at the underlying thyroid disorder. These problems often improve dramatically with thyroid hormone replacement. NSAIDS may help joint discomfort. If pain, stiffness and swelling don't improve after adequate thyroid treatment, further evaluation is indicated.
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