Thyroid Disease Neuromuscular Symptoms

Thyroid disease patients can experience a number of different complications as a result of their hypothyroid (underactive thyroid) or hyperthyroid (overactive thyroid) conditions. Two of these complications are nerve pain and dysfunction, referred to as “peripheral neuropathy” and muscle weakness with possible atrophy (shrinkage of muscles), referred to as “thyroid myopathy”.

In some cases, these two problems that are co-morbid to thyroid disorders can coexist, so that they are occurring at the same time and this may be referred to as “neuromuscular disease”. This is a symptom-aspect that has less information available on it via online medical search, than do the more common thyroid-related problems, such as weight gain, joint pain and fatigue.

What Components of Thyroid Disease causes Neuropathy and/or Myopathy?

After reading much of the medical research that is available regarding peripheral neuropathy and myopathy that results from thyroid disease, I have come to the conclusion that these problems can potentially result from the autoimmune aspect of thyroid disease or from the metabolic aspect of it or as a result of both these components, simultaneously.

While myopathy is simply a term for muscle weakness that can include atrophy (muscle wasting), peripheral neuropathy is a term that includes sensory symptoms (i.e. burning, tingling and numbness), motor symptoms (i.e. muscle weakness and difficulty controlling movements in them) and autonomic symptoms (i.e. changes in involuntary body functions, such as digestion, sweating, cardiopulmonary and other organ functions). In some patients with nerve pain, only one limb or area of their body is affected (mono-neuropathy), while others see many areas of the body affected simultaneously (poly-neuropathy).

Autoimmune Hypothyroidism

The autoimmune aspect of thyroid disease that can be involved in the previously-described symptoms and others is the disease process that results in hormone imbalances of either the underactive or overactive thyroid types. The underactive type, also referred to as “hypothyroidism”, is often the result of auto-antibodies from the immune system, that mistakenly attack the thyroid gland, which is referred to as autoimmune thyroiditis.

The types of hypothyroid autoimmunity are somewhat varied but the most common type in industrialized countries is “Hashimoto’s disease”, also referred to as “chronic lymphocytic thyroiditis”. This common form of thyroiditis, results from the creation of auto-antibodies, from the immune system, that attack key thyroid proteins that are responsible for the manufacture of thyroid hormones, from iodine that enters the body via the diet.

These two key proteins are the “thyroid Peroxidase” and the “thyroglobulin” and when these are attacked and destroyed by auto-antibodies, they are referred to as the “anti-thyroidperoxidase” and “anti-thyroglobulin” antibodies (abbreviated on blood lab tests as “Anti-TPO” and anti-TG”). These eventually cause enough damage and destruction to the thyroid gland as to cause it to manufacture abnormally low levels of thyroid hormone, which reduces the speed of metabolism in the body. The purpose of these hormones is to regulate a proper level of metabolism -- the production of energy that results from things consumed into the body (i.e. food, water and oxygen).

Autoimmune Hyperthyroidism

In the case of autoimmune overactive thyroid gland disease, also referred to as “Graves’ disease”, the type of auto-antibodies that cause the opposite effect of abnormally high thyroid antibodies in the body, are called “thyroid stimulating immunoglobulin” (abbreviated “TSI”). These are sent from the immune system and attach to key proteins in the thyroid gland, causing them to become overly-stimulated in producing thyroid hormone from iodine.

Some medical sources state that the TSI antibody mimics the effects of a naturally occurring hormone sent from the pituitary brain-gland, called “thyroid stimulating hormone” (abbreviated “TSH”). The pituitary gland fluctuates in the level of this necessary hormone that it sends to the thyroid gland, to properly regulate the amount of thyroid hormones manufactured and dispersed throughout all the cells of the body. It does-so, by sensing how much of these hormones the body needs at any given time, the main ones being the “T4” (containing 4 iodine molecules) and the “T3” (containing 3 iodine molecules). It is a very sensitive system that adjusts to physical activity levels and other factors that require changes in bodily metabolism but it becomes disrupted when the thyroid gland is being attacked by either hypothyroid or hyperthyroid causing antibodies.

Autoimmunity of any kind is a strange thing. With autoimmune diseases, the body begins to attack itself for reasons that we simply have no understanding of at this stage; this despite there being significant numbers of medical research studies on the subject that have been published by medical groups for decades. For some reason, the immune system will begin to attack natural, normal tissues in the body, as if they are something that presents a danger to the rest of the body. These specially-created antibodies are usually sent-out to destroy viruses and bacteria or to control allergens that might enter the body via airborne particles that are breathed-in or that are consumed in food or water. When a part of the body that does not present a threat to us is attacked by this autoimmune response, apart from these obvious reasons, it is a mystery to medical doctors and researchers who diagnose and study diseases of autoimmunity.

Bodily Metabolism Depends on Thyroid Hormones

Since both the muscles and nerves are highly dependent upon a normal metabolism to operate correctly, they can become negatively hindered and possibly damaged by thyroid hormone imbalances that are severe or when treatment is delayed for them.

My belief after corresponding with literally 100s of fellow-thyroid patients since the year 2003 is that some patients experience problems with neuropathy and/or myopathy, even after receiving adequate or optimal thyroid treatment and I am in-fact one of them.

The “metabolic aspect” of thyroid disease previously described which causes either a slowed hypothyroid metabolism or a sped-up hyperthyroid metabolism can be a factor that causes development of neuropathy and myopathy as well. This is true even if it is secondarily-caused, rather than being a problem within the thyroid gland itself.

Secondary causes of thyroid dysfunction result from other problems within the body, that affect thyroid hormone production but that still affect bodily metabolism as a result, due to an imbalance in the hormones. If the pituitary gland for example, becomes disrupted due to a tumor that develops within it, this can cause it to either slow-down or speed-up the dispersing of TSH to the thyroid gland. This is referred to as “central hypothyroidism” and “central hyperthyroidism”, meaning there is a problem occurring in the brain-center from which proper thyroid regulation normally originates. In females, tumors on the ovaries can be a secondary cause of an overactive thyroid gland as well.

Small tumors within the thyroid gland itself, called “hot nodules” which would actually be a “primary cause” of hyperthyroidism but that can occur without thyroid autoimmunity being present, can also develop. A long-term, uncorrected abnormal increase or decrease in metabolism due to thyroid hormone imbalances can become detrimental to the body.

Symptoms of Thyroid Hormone Disorders

When hypothyroidism occurs due to any cause, the resulting symptoms can include the following.

• Muscle and joint aches

• Nerve pain in the extremities
• Feeling cold in warm temperatures
• Dry skin and brittle fingernails
• Hair that has become brittle and breaks off or falls out
• Thinning of the eyebrows and loss of the outer 1/3 portion of them
• Unexplained weight gain with no diet change
• Constipation
• Slowed heart rate and breathing
• Depression
• Physical tiredness/fatigue
• Myxedema (fluid retention-tissue swelling)
• Feeling a fullness or tightness in the throat (goiter)

When hyperthyroidism occurs due to any cause, the resulting symptoms can include the following.

• Muscle and joint aches aches (possible muscle atrophy)

• Nerve pain in the extremities

• Rapid heart rate

• Hyperventilation

• Hypertension

• Sweating

• Inability to sleep

• Nervousness and anxiety

• Diarrhea

• Excessive energy followed by fatigue

• Hair loss

• Weight loss

• Osteoporosis (bone loss)

• Myxedema

• Swelling of the thyroid gland (goiter)

In many cases the “myxedema” symptom, shown in both lists, is directly related to nerve pain in the body due to fluid-retention causing excessive pressure on the nerves. When either of these thyroid hormone imbalances has been diagnosed, treatment for them will begin, which can improve or resolve any associated neuro-muscular symptoms.

Recognizing Differences between Neurosis and Psychosis

Common anxiety and clinical depression are types of "neurosis”.

Psychosis is the term for a mental disorder that causes a person to lose touch with reality and that may cause them to have hallucinations and delusions. Mental disorders that are in the psychosis category include types of bipolar disorder and schizophrenia. Anxiety and common clinical depression are both in the neurosis category, meaning they are stress and nerve-related and not typically caused by a severe underlying mental disorder.

Persons with severe forms of depression, such as bipolar disorder, may have psychotic episodes but the more common type of clinical depression and anxiety disorders are not in the psychosis category, but rather are types of neurosis (psycho-neurosis). According to the National Institute of Mental Health, psychosis affects an estimated 1% of the U.S. population, while the more common anxiety and depression conditions affect a much higher percentage. Perhaps as many as 1 in 4 or 25% of the American population experience an anxiety disorder and/or clinical depression at some time during their lives.

Anxiety-related “depersonalization” and “de-realization” can be mistaken for psychotic episodes.

Depersonalization is an anxiety-induced experience where a person feels he or she is “unreal” or no longer exists as a person (a sensation rather than a true delusion). They may even feel they are no longer visible to other people and that others around them remain real but they no longer are. Some anxiety patients describe it as feeling like they are watching their own actions from outside of themselves, and they no longer feel like a human being but have become robotic. Patients have described episodes, for example, of looking at their own face in a mirror and wondering if they are really there. They may also feel as if they no longer recognize themselves and feel as if they are having an identity crisis.

De-realization, is similar, except that the person’s surroundings seem to lose reality. With de-realization, an anxiety sufferer will have episodes of experiencing feelings that their surroundings have become unreal. They may also feel as if reality itself is no longer something they can fully recognize during these moments. They may also question the reality of many things at these times, and may begin to wonder if life is simply a dream of some type.

Some anxiety sufferers describe this experience as being like “living inside a bubble”, or like they are trying to see everything through a haze or a thick fog. This is also referred to as “brain fog” when if neither hinders the ability for a person to concentrate with the same sharpness, as when they are nor experiencing unreality symptoms.

Anxiety sufferers need to understand the fact that these de-realization and depersonalization symptoms do not indicate that they are going insane or actually losing touch with reality. They are sensations rather than an actual manifestation of losing touch with reality in the true sense, as occurs with psychotic illnesses. They are both very common occurrences in anxiety sufferers, especially in those who experience panic attacks and will not cause damage to a person’s mind or sanity.

This fear of going insane is a very concerning one to people who experience severe anxiety and panic, and also to those who experience major/clinical depression. Indeed, anxiety and panic often co-exist, but these are irrational thoughts that will not happen. 

General Symptoms of Anxiety Mood Disorders

Helping anxiety sufferers learn not to fear the symptoms of anxiety, is an aspect of "Cognitive Behavioral Therapy" (CBT) that, in my opinion is the single most effective one in overcoming anxiety disorders. It is also important to teach people who suffer chronic anxiousness, methods of stress-reduction because added stressors can result in "anxiety sensitization". I will be adding articles to this site, on these treatment and self-help aspects in the near future, so look for those.

Anxiety is one of the most common emotions we all experience. Without the anxiety mechanism, we might not have the sudden "presence of mind" and the sudden increased ability to react and jump out of the way of an oncoming truck that is barreling down the street, on a direct path to run over us! This mechanism, called the "fight or flight response", that gives us the extra strength and energy, to fight or run, is designed to protect us and so in situations like these (to use a cliché that might sound silly but that is true non-the-less), "anxiety is our friend".

Anxiety also helps us when we have tasks to perform. People who perform as actors in Broadway plays or have important public speeches to make or a Fireman who has a fire to put out etc..., all depend on the fight or flight response, to enhance their performance and to provide them added inspiration for the task at hand, so again, in cases like these, anxiety is our friend.

Symptoms of Anxiety

Symptoms generally include the following.

• apprehension

• worry

• feelings of fear

• rapid heart beat

• hyperventilation

• excessive sweating

• blushing

• trembling

• increased blood pressure

• muscle tension

• an urge to escape

These symptoms are included in what are called "anxiety disorders" and are experienced to varying degrees, depending upon which of them a person has developed. It can take years for mood disorders of any type to manifest and so it can also take a significant period of time to see them resolved or to at-least to be brought significantly under control, so that ongoing coping can be successfully practiced. 

Asthmatic Bronchitis: Could Some of Us Have It?

I posted the information that follows below, on an asthma patient support forum, sometime ago and I wanted to include it as an article on this site. ---

“Fellow Asthma patients,

I ran across information on a condition called “asthmatic bronchitis” that I found very interesting and I believe this to be very likely the type of asthma flares I sometimes experience. The reason I say this is because I actually mentioned to my wife, that my persistent asthma flares (the more noticeable long-term ones, occurring only about once-yearly for the past two years) seem a great deal like bronchitis but without fever or huge amounts of sputum being coughed up (Also: I’ve never been a habitual smoker). Still the mucous/phlegm I do have coming up, is constant during these flares and requires me chronic throat-clearing. I do have some coughing spells (mostly at might), which triggers more of the mucous, to come up into my throat from my lungs but I cough less than most asthmatics do.

I know the passages of my lungs are clogged during these flares and that they are inflamed and constricted as with asthma but mine have a tendency to not release the mucous, so that I can clear it out. A medicine like Mucinex would likely help me at these times when I can’t seem to clear the obstructed passages, at least for a period of time (I know it will return due to the nature of asthma). I do know that the feeling of congestion in my chest can be a very uncomfortable one, especially because it causes a feeling like I can’t fully take-in a breath or sometimes fully expel one and as-if my intake of oxygen, isn’t hitting the mark as it should (not being absorbed properly). I also feel an irritation in my lungs at these times, as if they actually hurt just a bit – like when you have a cold that goes to your chest and I get an instant urge to cough if I take-in a deep breath during these flares.

Anyway, my present bronchitis type manifestation of my asthma came this year, when the weather changed in my area, to colder temperatures. The sources I read that listed triggers for asthmatic bronchitis, included “weather changes” and also “GERD” (Gastroesophageal reflux disease) the latter of which I’ve had ongoing problems with as well. The sources I read on the subject, clearly distinguish asthmatic bronchitis from chronic bronchitis but both are considered diseases of COPD by some of them. Not a surprise, sense asthma itself is referred to as a form of COPD by many reputable medical sources as well. Still, the meaning I take from some of these articles, is that asthmatic bronchitis, actually has a better prognosis if properly treated than does chronic bronchitis, which in the majority of cases, is caused by long-term cigarette smoking.

Asthmatic bronchitis is not smoking-caused, although I’m sure this can be a contributing factor and it is often experienced in children. The med-sources I read on the condition also stated that the condition can be triggered in people, after their experiencing upper respiratory viruses and infections. In some cases, antibiotics are used to get the condition under control but the general treatments for it, are the same as with typical asthma, including inhaled corticosteroid/glucocorticoid steroids and bronchodilator medications. It’s my understanding that a good pulmonary doctor knows how to recognize the condition and to differentiate it from typical asthma. If you want to see information on the condition, use “asthmatic bronchitis” as a search term, which will yield you lots of information on the subject.

Many of us who are asthma patients, have ongoing problems, such as difficulty finding adequate doctors and getting proper treatment or even the correct diagnosis of our asthma types but we must remain diligent in getting adequate health care. Poorly treated asthma, can cause an undue worsening of asthmatic conditions and a progression toward lung damage. Self-education is also very important because this can give us additional hints on how to take care of ourselves, apart from the needed prescribed treatments by our doctors.

While asthma and related chronic respiratory disorders have no cures, we can remain inspired to achieve and maintain the best possible quality of life for ourselves, with the help of our doctors. Patients should remain proactive in their cases, to avoid unnecessary negative experiences, regarding inadequate treatment and unqualified doctors. I will add that there are wonderful doctors who treat asthmatic patients, who are passionate and certainly looking out for their patient’s best interests. This scenario can be even better, when patients partner with their doctors, to the best of their ability, following their treatment-plans, as adequately as possible and reporting any significant symptom-changes to their doctors.