Why does hypothyroidism (underactive thyroid) cause muscle cramping?

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From the Guidelines

Hypothyroidism causes muscle cramping primarily due to electrolyte imbalances and metabolic changes that occur when thyroid hormone levels are low. The thyroid gland regulates metabolism throughout the body, and when it's underactive, it affects how muscles function. Specifically, hypothyroidism can lead to decreased calcium absorption and altered sodium-potassium balance, which are essential for proper muscle contraction and relaxation. Additionally, hypothyroidism slows down the body's ability to process and clear creatine kinase, an enzyme released when muscle damage occurs, potentially contributing to muscle pain and cramping, as suggested by the need to obtain a thyroid-stimulating hormone level in patients with muscle symptoms 1. The condition also causes general slowing of metabolic processes, leading to poor circulation and reduced delivery of oxygen and nutrients to muscles. This can result in muscle fatigue, weakness, and cramping, especially during physical activity. Some key points to consider in patients with hypothyroidism and muscle cramping include:

  • Ensuring proper thyroid hormone replacement therapy, typically with levothyroxine (doses individualized based on lab results and symptoms)
  • Adequate hydration
  • Gentle stretching exercises
  • Ensuring proper intake of electrolytes like potassium, calcium, and magnesium through diet or supplements if recommended by their healthcare provider It is also important to rule out other common causes of muscle soreness, tenderness, or pain, such as exercise or strenuous work, and to monitor for adverse reactions and adjust therapy accordingly, as outlined in the clinical advisory on the use and safety of statins 1.

From the Research

Hypothyroidism and Muscle Cramping

  • Hypothyroidism is a condition where the thyroid gland does not produce enough thyroid hormones, which can lead to various symptoms, including muscle cramping 2.
  • The exact mechanism of muscle cramping in hypothyroidism is not fully understood, but it is thought to be related to the lack of thyroid hormones, particularly triiodothyronine (T3), which plays a key role in regulating muscle function 2.
  • Muscle stiffness and cramping are common symptoms of hypothyroidism, and in severe cases, it can lead to rhabdomyolysis, a condition where muscle tissue breaks down 2.
  • The treatment of hypothyroidism typically involves thyroid hormone replacement therapy with levothyroxine, which can help alleviate symptoms, including muscle cramping 3, 4, 5, 6.
  • However, some patients may still experience persistent symptoms, including muscle cramping, despite adequate treatment, highlighting the need for further research into the underlying mechanisms and potential new treatments 6.

References

Guideline

Guideline Directed Topic Overview

Dr.Oracle Medical Advisory Board & Editors, 2025

Research

Hypothyroidism: Diagnosis and Treatment.

American family physician, 2021

Research

Hypothyroidism.

Lancet (London, England), 2017

Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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