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Thyroid Awareness Is Part of Arthritis Management
By Petya Stoeva, MARRTC Staff
Joint or muscle pain and fatigue are usually symptoms of a rheumatic condition but they also may point to a dysfunction of the thyroid gland which produces hormones regulating the body's metabolism. Thyroid hormone production is critical in controlling a person's mood, weight, mental and physical energy. Thyroid diseases and arthritis are connected on several different levels and people having either condition should be aware of those links, so they can better safeguard their health, experts say.
Thyroid diseases include the following:
Underproduction of thyroid hormone (hypothyroidism or underactive thyroid)
Overproduction of thyroid hormone (hyperthyroidism or overactive thyroid)
Noncancerous thyroid disease
Thyroid cancer
The most common cause of underactive thyroid in the United States is an autoimmune process such as Hashimoto's thyroiditis in which the body's immune system directly attacks and destroys the thyroid gland. In many countries outside the United States, however, the main culprit in causing an underactive thyroid is the insufficient consumption of iodine. In the United States, table salt is fortified with iodine so almost everyone has an adequate intake of iodine. The most common cause of overactive thyroid is also autoimmune (Graves' disease). In this instance, the immune system attacks the thyroid gland in such a way that there is overproduction of thyroid hormones.
According to experts in the field, thyroid dysfunction often goes unnoticed. "Twenty-seven million Americans have overactive or underactive thyroid glands but more than half remain undiagnosed," says the American Association of Clinical Endocrinologists. Women account for more than 80 percent of the people with thyroid disease.
Joint pain
"Thyroid excess or too little thyroid can have many symptoms that include pain, joint pain, fatigue, muscle aching and so both conditions can act as other rheumatic symptoms and be misdiagnosed as fibromyalgia," says Dr. Steven Overman, medical director of rheumatology and director of musculoskeletal planning and development at Northwest Hospital and Medical Center in Seattle.
The Thyroid Foundation of America also reports that people with Graves' disease or Hashimoto's thyroiditis have three times as many cases of painful tendonitis and bursitis of the shoulder, compared to the general population.
Autoimmunity
"Autoimmune thyroid deficiency can be associated with other autoimmune conditions such as Sjogren's syndrome, RA, lupus, and inflammatory bowel diseases such as Crohn's disease and celiac disease. Celiac is thought of as children's disease of wheat sensitivity, but it's more common in adults than generally recognized," Overman says.
The co-occurrence of autoimmune thyroid and rheumatic conditions is due to the presence of abnormal antibodies which attack the thyroid and affect the joints, says Dr. Melissa Dee Katz, assistant professor of clinical medicine at Weill Cornell Medical College in New York City.
Katz says she sees a lot of people with RA who also have autoimmune thyroid disease but she always cautions her patients not to get panicked.
"Just because you have autoimmune thyroid problems it doesn't mean you have RA and just because you have RA it doesn't mean you'll get thyroid problems. But it's possible," she says.
Such co-occurrence of autoimmune diseases can also lead to misdiagnosis, Overman says. He gives an example with the antinuclear antibody (ANA) test which is often useful in the diagnosis of lupus but the presence of that antibody can also be a sign of other autoimmune syndromes, including autoimmune thyroid problems.
"It just shows that the immune system is over active and people may think they have lupus when in fact they may have thyroid problems," Overman says.
He says rheumatologists very often advise their patients to be tested for thyroid problems.
The first test for measuring the function of the thyroid gland is the blood test for thyroid-stimulating hormone (TSH) which shows how much hormone the gland is producing.
Osteoporosis
Excess production of thyroid hormone (or taking too much of the synthetic thyroid hormone that's prescribed for people with underactive thyroids) raises the risk of osteoporosis but this bone thinning disease can also develop as a result of other autoimmune conditions which co-occur with autoimmune thyroid disease.
Overman says it's common for immune system conditions such as Crohn's disease and celiac disease to cause intestinal malabsorption of calcium or vitamin D and thus lead to the development of osteoporosis.
"Osteoporosis has hit the screen so much and everyone is thinking of being on a biphosphonate drug like Fosamax, Acetonel or Boniva," Overman says, "but we need to look into the metabolism of calcium and vitamin D. We need to consider other causes of osteoporosis and metabolic bone problems."
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