Hyperthyroidism and Joint Pain?

This information is for educational and informational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Always consult with a qualified healthcare provider regarding any medical condition or health objectives.

Since December last year, I’ve been having persistent elbow pain that refuses to resolve itself. It initially present as classic tennis elbow – location of pain and the cause of pain (carrying and moving lots of boxes). I got treated for it and did the rehab exercises that are supposed to help tennis elbow. The treatment and exercises helped but only to a certain extent. It would feel better but never get to 100%. Some days would be better, other days would be worse. I couldn’t figure it out.

What I did notice was that the pain and discomfort was morphing even as I was getting treated for it. Some days, I would wake up fine and it would suddenly start aching again just as I was moving around the house, getting ready for the day. Other days, I would go to sleep feeling fine and wake up with a sore elbow. What did I do in my sleep? Go figure. At times, I would get a niggly feeling in my shoulder blade – nothing painful, just “not quite right”. Then the days when I go for a walk and my elbow will feel “pressure” as if gravity was annoying it.

While the discomfort takes on various forms, the most commonly recurring triggers are end-range straightening of my arm and supination rotation. Actions like farmer’s carry can also trigger pain on bending which improves by simply bending and straightening my arm multiple times.

What made it feel better? Well, a variety of things (including treatment from my physio), but the following are the most effective at producing immediate relief when I’m on my own:

• Foam rolling my shoulder blade.
• Certain upper body strength movements, like parallel-bar knee raises (I’m sure it’s not the knee raise but the fact that I have to stabilise my upper body with my arms).

I’ve been scratching my head at this perplexing problem for a while until I stumbled upon an old diary entry I wrote while going through the recovery phase of my first hyperthyroid episode.

I have been getting knee discomfort that wakes me up at night sometimes. If I’ve been lying in the foetal position for too long, it will start to ache and I feel the need to straighten my leg. It’s the sort of ache I would imagine old people with arthritis experiencing, except that I wouldn’t know for sure since I don’t have arthritis – I hope. When I sleep at night, the best position is on my back with a pillow propped under my knees. The pain feels worst in the morning, immediately when I wake up, but improves as I start moving around. It feels as though immobility makes it worse and movement helps.

The knee pain persisted for so long that I thought it was something I would have to live with. I don’t even remember when it went away but it obviously did because I no longer experience it. At the time when it happened, I stumbled across a study that talked about anti-thyroid medications causing joint pain as a side effect. It’s called Antithyroid arthritis syndrome and it involves joint stiffness, swelling, and muscle aches that typically begin within the first two months of starting the treatment. I wasn’t sure if that description fit me exactly, but it prompted me to look further into how my thyroid condition could be contributing to my joint pain.

My hyperthyroid condition is caused by Grave’s Disease which can also cause joint pain. Treating the thyroid and normalising hormone levels can resolve the joint pain. Since my knee pain went away, I guess I can assume it was the result of my thyroid condition being brought under control the first time around? If we accept that it was my thyroid condition that aggravated my knee pain the first time around, it would only be logical to assume it could be the same issue with my elbow pain.

With both conditions, I know that the pain had been triggered by specific activities – the knee from overdoing my stairclimbs; the elbow from carrying too many boxes. My knee improved once my thyroid had been stable for a while – unfortunately, I did not track how long it took so I can only wait and see for now. Currently, my FT3 and FT4 are normal but TSH (detectable) is still below the recommended range. Underlying hyperthyroidism acts as a massive “amplifier” for the nerve irritation and structural vulnerabilities in my arm so it is very likely contributing to the problems I am experiencing. Will my elbow resolve when my thyroid is stable? I guess only time will tell.

Why does my elbow hurt?

Radial nerve irritation (neurodynamics) combined with a mechanical restriction in the upper back and shoulder blade (kinetic chain). The continuous heavy gripping from box carrying is likely to have trapped or strained the radial nerve as it passed through the forearm and shoulder.

The radial nerve travels down the back of the shoulder, wraps around the arm, and runs through the forearm.

• The “Neurodynamic Stretch”: Fully straightening the arm and rotating it outwards (supination) places the radial nerve at its maximum mechanical length. If the nerve is irritated or caught in tight forearm tissue (like the supinator muscle), this stretch creates a sharp, mechanical pinch or pull.
• The Farmer’s Carry Effect: Holding heavy weights causes intense, prolonged isometric contraction of the grip and forearm muscles. This cuts off temporary blood flow and highly compresses the local tissues. When the weight is released, the sudden change in muscle pressure combined with immediate arm movement triggers a “rebound” discomfort in the compressed nerve.
• Walking Mechanics: When walking, the arms naturally hang and swing. Gravity pulls downward on the arm while the nervous system maintains low-level tone. If the radial nerve is hypersensitive, this constant, passive pull creates a false sensory perception of vascular “fullness,” pressure, or heaviness.

How does a hyperthyroid status make it worse?

Although I am being treated for hyperthyroidism, my body is still in a state of flux. Even though T3 and T4 are normal, it can take weeks to months for TSH to normalise. My cellular metabolism, muscle tissue, and peripheral nerves are still adapting to this sudden metabolic shift. The systemic hypermetabolic state caused by my thyroid depletes cellular nutrients and alters local blood supply, thereby affecting my ability to recover from the physical strain of moving boxes.

Hyperthyroidism makes the nervous system hypersensitive. When thyroid hormones are high, irritation to the radial nerve that would normally be ignored when the body is well, can cause exaggerated, lingering pain signals. Since my radial nerve is highly sensitive to stretching (when I straighten my arm) and pressure (when I’m walking), it does sound a lot like systemic nerve irritability.

Additionally, hyperthyroidism preferentially targets and weakens the proximal muscles, particularly the shoulder girdle and rotator cuff. Carrying heavy boxes with thyroid-weakened shoulder blade muscles (latissimus dorsi and teres major) exhausted them and caused them to lock up much faster than they normally would. The structural collapse led to pinching of the radial nerve pathway under the armpit.

There is an argument that I might be overestimating the impact of my thyroid condition on my elbow pain. If it was the thyroid, then why is it only affecting one elbow and not the other? Hyperthyroidism is a systemic condition, therefore it shouldn’t single out one specific joint. Unless that joint was compromised beyond it’s reserve capacity compared to the other joints? Would that be a fair assumption? I have always been significantly weaker on the left side of my body and the pain is on my left side. When the problem had been my knee, it was also the left knee (my weak side) and it had also been compromised by an injury. So we could postulate that the other joints were spared because they were stronger.

So, in a nutshell, I chose the worst time to move boxes – when I was in a weakened state and most prone to injury. Although I’m on the road to thyroid recovery, my body is still struggling to repair the damage caused because there is a lag behind my hormone stabilisation.

Why does it feel better when…

I bend and straighten my arm: this movement acts as a mechanical pump. It’s called “nerve flossing”, an action that manually slides the nerve back and forth through its tight tissue pathways. The movement restores local blood supply, clears metabolic waste, and rapidly reduces the “heavy” or “pressure” sensation.

I do parallel box knee raises: Pushing down on the boxes forces the shoulder blades downward (scapular depression). This action stretches and relaxes the overactive, locked muscles under the armpit (the latissimus dorsi and teres major). It also opens the thoracic outlet where the nerve bundle that forms the radial nerve exits the neck and travels under the collarbone and armpit. Pushing down on the parallel boxes opens up this narrow bony tunnel, immediately taking the physical pressure off the nerve root. Finally, by pressing down on the boxes firmly, the forearm muscles lock into a stable, static contraction. Pushing the body upward while the arms are straight creates a gentle, loaded traction down the entire length of the arm. This serves as a highly effective mechanical reset that unpins the sensitive radial nerve.

I foam roll my shoulder blade: Our bodies operates in connected chains (called the kinetic chain connection). If a muscle under the shoulder blade (like the latissimus dorsi or teres major) becomes locked or tight, it alters how the shoulder moves. This mechanical shift forces the elbow to overwork. Foam rolling the shoulder blade relaxes the anchor point of the chain, immediately slackening the tension on the lower arm and elbow.

Unfortunately, while all these things help with pain management, they don’t completely remove the pain permanently. They feel a little like bandaid therapy – just something to get me by while I wait for systemic changes in my body. How long will that be? 4 to 6 weeks for TSH to return to normal, during which time, baseline inflammation and hypersensitivity will decline. 2 to 3 months before I can expect everything to return to normal.

What should I do now?

Aside from waiting for my labs to improve and body to return to normal, the following rehab exercises are supposed to help manage the shoulder and elbow in the interim.

1. “Scapular Dips” (Parallel Bar Shrugs)

• Support yourself on the parallel bars with straight arms.
• Let your shoulders shrug up gently toward your ears (keeping your arms perfectly straight).
• Actively push down through your hands to drive your shoulders down as far as possible, lifting your body up.
• Hold the top, depressed position for 3–5 seconds. Repeat for 10 reps. This keeps the armpit muscles from locking back up.

2. Modified Farmer’s Carries

• Before picking up the weights, actively push your shoulders down and back.
• When you finish a set, do not just drop the weights and instantly bend your arm. Set them down, keep your arms straight by your side for 5 seconds, perform 2 or 3 of those downward shoulder shrugs, and then slowly bend your elbow.

3. Targeted Armpit and Shoulder Release

• Use a tennis ball instead of a foam roller against a wall.
• Place the ball right in the fleshy area under your armpit (on the side of the shoulder blade).
• Lean your weight into the wall, raise your arm up and down, or rotate your forearm to actively slide the muscle underneath the pressure point.

While I wait for August/September to come around?