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Carpal tunnel is a condition that frequently afflicts people with thyroid problems. Identifying signs of carpal tunnel early on is essential to help maintain mobility and strength in the hands and wrists. Therefore, it is essential for anyone with a thyroid condition to know the signs and symptoms of carpal tunnel and to be familiar with treatment options available for those who have this condition.

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Carpal tunnel syndrome (CTS) is a neuropathic medical condition where the median nerve gets compressed in the opening of your wrist. As the nerve goes through the wrist to the hand, it passes through the carpal tunnel, which is made by the carpal bones and transverse carpal ligament.

The median nerve is responsible for giving you sensory and motor functions in the thumb and three middle fingers. Thus, when a person has CPS, they often experience the following symptoms:

• Pain in the hand
• Numbness or tingling in hand and fingers
• Feelings of electric shocks up the hand and fingers and into the wrist and arm
• Weakness to where you may drop objects you are holding

Plenty of evidence shows that people with thyroid disease often have carpal tunnel syndrome. Why thyroid patients, specifically those with hypothyroidism (an underactive thyroid), often have carpal tunnel is unclear. However, one study from the Journal of Clinical and Diagnostic Research states that "hypothyroidism is one of the most important causes of CTS." Other studies find there is more of a modest association between hypothyroidism and CTS.

There are several potential explanations for why hypothyroidism is a risk factor for CTS. Firstly, glycosaminoglycans (GAGs), hyaluronic acid, and other mucopolysaccharides naturally occurring in the subcutaneous tissue can accumulate in the carpal space. When they build up, the median nerve can get compressed in the carpal tunnel. Incidentally, this accumulation of polysaccharides is also one of the causes of dermal edema, which is behind the classic "moon face" that can show up in patients with myxedema.

Intriguingly, an increased BMI in patients with hypothyroidism has also been associated with a higher risk for CTS. Moreover, people with hypothyroidism often experience bilateral pain, as it is caused by a systemic disease, not overuse.

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While hypothyroidism is a well-known risk factor for carpal tunnel syndrome, the research shows that there are often multiple reasons behind the development of CTS. The following are other risk factors for carpal tunnel syndrome:

• Obesity
• Diabetes and other conditions that cause nerve damage
• Smoking
• An increase in age
• Being female
• Inflammatory diseases like rheumatoid arthritis
• Hormonal shifts caused by menopause
• Overuse due to repetitive movements from work or day-to-day activities
• States where body fluid levels increase, such as pregnancy
• Anatomical changes from bone fracture, bone loss, and joint problems

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Your doctor may be able to diagnose CTS with information about your medical history, symptoms, and a physical examination. Likely, they will test the muscle strength in your hand and fingers and press in certain areas to assess for nerve pain or discomfort. X-rays and ultrasounds may also be used to visualize what is happening with the ligaments and bones in the wrist, but these tools are not always necessary. Furthermore, some providers may use a diagnostic tool called an electromyogram, which studies the electrical activity in muscles. Depending on the measurements gained from this study, your doctor can conclude if there is damage to the median nerve or not.

Treating CTS starts with non-surgical methods, including giving the hand frequent breaks, avoiding aggravating activities, and using cold therapy to decrease swelling. NSAIDs can also help reduce discomfort and swelling; if the pain persists, it is important to see a health provider. You may benefit from steroid injections into or around the carpal space to relieve severe pain. And if that does not relieve pain, or you have persistent numbness, you may require surgery.

There are a few things you can do to prevent carpal tunnel syndrome. Of course, you cannot always change certain risk factors, such as being female, getting older, or going through menopause. However, making some lifestyle changes may help improve your pain. For example, performing repeated movements or wrist positions (such as typing on a keyboard, moving a computer mouse, using power tools, etc.) helps you take frequent rest breaks and allow your wrist to stretch.

Lastly, people with hypothyroidism can help improve symptoms of CTS by treating their low thyroid hormone levels. Taking your thyroid hormone replacement medication, such as levothyroxine, may help improve neuropathy of the median nerve by decreasing fluid retention in the carpal space. If you are treating hypothyroidism with medication and struggling with CTS, an excellent first step may be to check your thyroid hormone levels to be sure you are on the correct dose of thyroid medication.

THYROID GUIDE

Your Guide To Thyroid Medication

Optimizing your thyroid levels with thyroid hormone replacement medication is usually the first step in minimizing symptoms.

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Keeping your thyroid levels closely managed is crucial fot optimal thyroid health and potentially preventing conditions such as carpal tunnel. The Paloma Health at-home thyroid test kit contains everything you need to collect and test your Thyroid Stimulating Hormone (TSH), Free T4, Free T3, and thyroid antibodies (Thyroid Peroxidase TPO). You'll also have the option to add on reverse T3 and vitamin D tests.

Patients can also schedule a virtual visit with one of Paloma’s thyroid doctors to review lab results and determine the best thyroid medication and treatment plan to restore optimal thyroid function. 

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