Hyperthyroid Myopathy

Hyperthyroid myopathy (also called thyrotoxic myopathy) is a muscle disease that happens when the body has too much thyroid hormone for a long time. The extra hormone speeds up metabolism and makes muscle cells break down faster than they can repair. This mainly affects the big muscles close to the shoulders and hips, and causes weakness, tiredness, and sometimes muscle wasting. In most people, the muscle problem improves when the hyperthyroidism is treated and thyroid levels return to normal. Wikipedia+2Muscular Dystrophy Association+2

Other names of hyperthyroid myopathy

Doctors and books may use different names for the same condition. Common other names include:

• Thyrotoxic myopathy

• Hyperthyroid proximal myopathy

• Endocrine myopathy due to hyperthyroidism

• Myopathy in thyrotoxicosis

• Chronic thyrotoxic myopathy (for the long-lasting form)

• Acute thyrotoxic myopathy (for the sudden, severe form)

These names all describe muscle weakness and muscle damage caused by high thyroid hormone levels, usually in people with conditions such as Graves’ disease or toxic nodular goiter. Wikipedia+2PubMed+2

Types of hyperthyroid myopathy

Hyperthyroid myopathy does not look the same in every person. Doctors often describe several types based on how fast it starts and which muscles are most affected. Wikipedia+2Muscular Dystrophy Association+2

• Chronic hyperthyroid proximal myopathy – This is the most common type. Muscle weakness comes on slowly over months. It mainly affects muscles near the shoulders and hips, so lifting arms or climbing stairs becomes hard. PubMed+1

• Acute thyrotoxic myopathy – This type starts suddenly over days. Muscle fibers can break down quickly and cause severe pain, cramps, or even rhabdomyolysis (mass muscle breakdown). It is less common but can be serious. Wikipedia+1

• Thyrotoxic periodic paralysis (TPP) – In this special form, people have sudden attacks of flaccid weakness or paralysis, often in the legs. These attacks are linked to low blood potassium and very high thyroid hormone levels. PMC+2CPD Bulletin Clinical Biochemistry+2

• Respiratory muscle involvement – In some people, the breathing muscles become weak. This can cause shortness of breath, low exercise tolerance, and in rare severe cases, respiratory failure. Muscular Dystrophy Association+2brainfacts.org+2

• Bulbar and swallowing muscle involvement – In advanced or acute cases, muscles of the throat and upper esophagus can weaken, causing trouble swallowing and choking on food or liquids. Wikipedia+2PubMed+2

• Ocular (eye muscle) myopathy in hyperthyroidism – Some patients with Graves’ disease have eye muscle weakness and stiffness, leading to double vision or difficulty moving the eyes, together with systemic muscle weakness. Wikipedia+2brainfacts.org+2

Causes of hyperthyroid myopathy

Hyperthyroid myopathy is almost always caused by hyperthyroidism (too much thyroid hormone). Anything that produces strong or long-lasting hyperthyroidism can lead to this muscle problem. AAFP+2Mayo Clinic+2

1. Graves’ disease
   Graves’ disease is the most common cause of hyperthyroidism in many countries. It is an autoimmune disease where antibodies stimulate the thyroid gland to make too much hormone all the time. The constant hormone excess speeds up muscle metabolism and leads to gradual muscle wasting and weakness. AAFP+1

2. Toxic multinodular goiter
   In toxic multinodular goiter, many nodules in an enlarged thyroid produce thyroid hormone without proper control. This long-term hormone overproduction can cause chronic thyrotoxic myopathy, especially in older adults. AAFP+2Mayo Clinic+2

3. Autonomously functioning (toxic) thyroid nodule
   Sometimes a single thyroid nodule becomes “autonomous” and makes thyroid hormone on its own. This toxic nodule can raise hormone levels enough to trigger muscle weakness and wasting over time. AAFP+1

4. Subacute or painless thyroiditis with a thyrotoxic phase
   In thyroiditis, stored hormone leaks out of an inflamed gland, creating a temporary hyperthyroid phase. If this phase is strong or lasts several weeks, it may cause short-term hyperthyroid myopathy with fatigue and proximal muscle weakness. AAFP+2Mayo Clinic+2

5. Excess use or overdose of thyroid hormone tablets
   Taking too much levothyroxine or other thyroid hormone medicine, either accidentally or on purpose, can cause drug-induced hyperthyroidism. Long-term over-replacement can weaken muscles and cause exercise intolerance. AAFP+2RACGP+2

6. Iodine-induced hyperthyroidism
   High iodine exposure, such as from some contrast dyes or supplements, can trigger too much hormone release in people with nodular thyroid disease. This extra hormone may cause myopathy in vulnerable patients. AAFP+1

7. Amiodarone-induced thyrotoxicosis
   Amiodarone is a heart rhythm drug rich in iodine. In some people it causes a special form of hyperthyroidism called amiodarone-induced thyrotoxicosis. Because the drug also affects muscle and mitochondria, patients can develop marked weakness and myopathy. PMC+1

8. TSH-secreting pituitary adenoma
   A rare pituitary tumor can make excess thyroid-stimulating hormone (TSH). This drives the thyroid to produce huge amounts of T4 and T3, leading to severe hyperthyroidism and, over time, muscle wasting and weakness. AAFP+1

9. hCG-secreting tumors or very high hCG states
   Certain tumors and some pregnancy-related conditions produce high levels of human chorionic gonadotropin (hCG), which can mildly stimulate the thyroid. When levels are very high, this can cause hyperthyroidism and associated myopathy. AAFP+1

10. Postpartum thyroiditis
    After childbirth, some women develop a short-term hyperthyroid phase due to postpartum thyroiditis. If hormone levels are high and the mother is already tired and low in reserves, proximal muscle weakness and hyperthyroid myopathy can appear. AAFP+1

11. Genetic susceptibility to thyrotoxic periodic paralysis
    In thyrotoxic periodic paralysis, mutations in ion channels make muscle cells extra sensitive to high thyroid hormone. This means hyperthyroidism that might be mild in someone else can cause severe, episodic weakness and paralysis in these patients. PMC+2CPD Bulletin Clinical Biochemistry+2

12. Long-standing untreated hyperthyroidism
    Even moderate hormone excess, if present for many months or years, slowly breaks down muscle proteins. People who stay untreated for a long time have a higher chance of developing chronic hyperthyroid myopathy. PMC+2Nature+2

13. Very severe levels of thyroid hormone (thyroid storm or near-storm)
    When hormone levels are extremely high, such as in thyroid storm or very severe Graves’ disease, muscle metabolism is pushed too hard. This can cause acute myopathy and even rhabdomyolysis, especially in people who are also dehydrated or stressed. PMC+1

14. Older age with hyperthyroidism
    Older adults often have less muscle mass to begin with (sarcopenia). When hyperthyroidism is added, muscle loss is faster and myopathy is more likely, even if symptoms of hyperthyroidism are not very obvious. PMC+2Nature+2

15. Heavy physical activity while hyperthyroid
    Intense exercise uses a lot of energy and puts strain on muscle fibers. If a person is hyperthyroid at the same time, the extra metabolic stress can worsen muscle breakdown and make myopathy more severe or appear earlier. PMC+2CPD Bulletin Clinical Biochemistry+2

16. Rapid weight loss and malnutrition from hyperthyroidism
    Many people with hyperthyroidism lose weight and muscle bulk because the body burns calories very fast. If food intake is low, the body uses muscle protein as fuel, which contributes to the development of myopathy. PMC+2Healthline+2

17. Low blood potassium (hypokalemia) in thyrotoxic periodic paralysis
    In TPP, thyroid hormone and hormones like insulin drive potassium into cells, leaving too little in the blood. Low blood potassium makes muscles unable to contract properly and triggers episodes of paralysis, a dramatic form of hyperthyroid myopathy. PMC+2CPD Bulletin Clinical Biochemistry+2

18. Coexisting neuromuscular diseases worsened by hyperthyroidism
    Conditions like myasthenia gravis or motor neuron disease can be made worse by hyperthyroidism. In such people, extra thyroid hormone can unmask or intensify muscle weakness, leading to significant myopathy. PubMed+2etj.bioscientifica.com+2

19. Other drugs that disturb thyroid function (for example, interferon-α, immune therapies)
    Some immune and cancer drugs can trigger autoimmune thyroid disease or thyroiditis. When this leads to hyperthyroidism, a secondary myopathy can develop, especially if the drug is continued and hormone levels stay high. AAFP+1

20. Major stress, infection, or surgery in a hyperthyroid person
    Big physical stress, like severe infection or surgery, can worsen an already overactive thyroid or trigger thyroid storm. The sudden hormone surge plus stress can cause acute muscle breakdown and severe hyperthyroid myopathy. AAFP+2PMC+2

Symptoms of hyperthyroid myopathy

Symptoms may be mild at first and slowly get worse, or they may appear suddenly in acute or periodic paralysis forms. journals.viamedica.pl+3Muscular Dystrophy Association+3brainfacts.org+3

1. Proximal muscle weakness (shoulders and hips)
   The most typical symptom is weakness in the muscles closest to the body, such as the thighs and upper arms. People often say they cannot climb stairs easily or lift objects overhead. Muscular Dystrophy Association+2ScienceDirect+2

2. Difficulty climbing stairs or rising from a chair
   Everyday movements like standing up from a low seat, squatting, or climbing stairs become slow and tiring. This happens because thigh and hip muscles are too weak to push the body up. Muscular Dystrophy Association+2Healthline+2

3. Trouble lifting arms or combing hair
   Weak shoulder muscles make it hard to raise the arms for daily tasks such as combing hair, reaching high shelves, or dressing. People may feel they must rest their arms after short use. Muscular Dystrophy Association+1

4. Muscle wasting (loss of muscle bulk)
   Over time, the muscles around the shoulders and pelvic area can look thinner or “wasted”. Clothes may feel looser around the arms and thighs because muscle tissue has been broken down. Wikipedia+2PMC+2

5. General fatigue and low exercise tolerance
   Many patients feel very tired, even without intense activity. Simple walks or light exercise can cause early exhaustion because muscles are less efficient and the whole metabolism is over-active. Muscular Dystrophy Association+2Healthline+2

6. Muscle pain or tenderness (myalgia)
   Some people feel aching or burning in their muscles, especially the thighs and shoulders. Muscles may be tender to touch, and this can be worse after physical activity. brainfacts.org+2etj.bioscientifica.com+2

7. Muscle cramps and stiffness
   Muscles may cramp or feel stiff, particularly in acute thyrotoxic myopathy or during episodes of thyrotoxic periodic paralysis. Cramps can be painful and may come suddenly. Wikipedia+2CPD Bulletin Clinical Biochemistry+2

8. Heat intolerance and feeling too warm
   Because thyroid hormone speeds up the body’s metabolism, patients often feel too hot and sweat easily. This heat intolerance adds to fatigue and makes exercise or hot weather harder to handle. Wikipedia+2brainfacts.org+2

9. Tremor and shakiness of the hands
   Fine shaking of the hands is a classic sign of hyperthyroidism. It does not come from the muscles alone, but from the nerves and over-active metabolism. It can make precise movements difficult. AAFP+2Mayo Clinic+2

10. Weight loss with loss of muscle mass
    People with hyperthyroid myopathy often lose weight, especially muscle weight, even if they eat well. The body burns protein for energy, which makes muscles smaller and weaker. PMC+2Healthline+2

11. Shortness of breath and breathlessness on exertion
    If respiratory muscles are weak, climbing stairs, walking uphill, or lying flat can cause breathlessness. In severe cases, people may feel short of breath even at rest. Muscular Dystrophy Association+2brainfacts.org+2

12. Difficulty swallowing or choking on food
    When bulbar muscles (throat and swallowing muscles) are affected, swallowing can become hard. People may cough or choke when drinking or eating, which can be dangerous if food enters the airway. Wikipedia+2PubMed+2

13. Problems with posture and head control
    Weak trunk and neck muscles may cause difficulty keeping the back straight or holding the head up for long periods. Some patients develop a slouched posture or feel their head is too heavy. Nature+2ScienceDirect+2

14. Attacks of sudden flaccid weakness or paralysis (TPP)
    In thyrotoxic periodic paralysis, people, often young men of Asian or Latin American background, can suddenly lose strength in the legs or whole body. These episodes often happen after heavy meals or hard exercise and are linked to low blood potassium. PMC+2CPD Bulletin Clinical Biochemistry+2

15. Eye movement problems and double vision
    Some patients with Graves’ disease and hyperthyroid myopathy also have eye muscle involvement. They may notice double vision, trouble looking in certain directions, or a feeling of tightness around the eyes. Wikipedia+2brainfacts.org+2

Diagnostic tests for hyperthyroid myopathy

Doctors diagnose hyperthyroid myopathy by confirming hyperthyroidism and by checking how muscles and nerves are working. They use physical examination, bedside functional tests, blood and tissue tests, electrodiagnostic studies, and imaging. journals.viamedica.pl+4American Thyroid Association+4AAFP+4

Physical examination tests

1. General inspection and vital signs
   The doctor looks at the patient’s overall appearance and measures pulse, blood pressure, temperature, and breathing rate. A fast pulse, warm moist skin, and weight loss suggest hyperthyroidism, and visible muscle wasting supports the diagnosis of myopathy. AAFP+2Mayo Clinic+2

2. Examination of muscle bulk and tone
   The doctor inspects and feels muscles, especially around the shoulders and hips, to see if they are smaller than normal or softer and less firm. Reduced bulk and abnormally low or high tone point toward muscle disease rather than joint or nerve problems. Wikipedia+2PMC+2

3. Manual muscle strength testing
   Using standard scales, such as Medical Research Council (MRC) grades, the doctor asks the patient to push or pull against resistance. Proximal muscles usually test weaker than distal muscles in hyperthyroid myopathy, supporting the diagnosis. Muscular Dystrophy Association+2ScienceDirect+2

4. Reflex and coordination examination
   Deep tendon reflexes (like the knee jerk) and simple coordination tests (finger-to-nose, heel-to-shin) are checked. Reflexes are often brisk in hyperthyroidism, but sensation and coordination are usually normal, helping to separate myopathy from neuropathy or cerebellar disease. PubMed+2PMC+2

Manual functional tests

5. Sit-to-stand (chair rise) test
   The patient is asked to stand up from a chair several times without using their hands. People with proximal weakness often struggle or need to push with their arms. This simple test shows how much the hip and thigh muscles are affected. Nature+2ScienceDirect+2

6. Stair-climb or step-up test
   Climbing a few steps or stepping up and down on a platform lets the doctor see how the leg muscles perform under load. Slowness, use of handrails, or inability to climb without support indicates significant proximal muscle weakness. Muscular Dystrophy Association+1

7. Gait and balance assessment
   The patient is observed while walking normally, on heels, and on toes, and sometimes in a straight line (tandem gait). A waddling gait, difficulty with heel or toe walking, or frequent stopping from fatigue suggests muscle weakness rather than joint disease. Muscular Dystrophy Association+2journals.viamedica.pl+2

Lab and pathological tests

8. Serum TSH (thyroid-stimulating hormone) test
   TSH is usually low or undetectable in hyperthyroidism. A clearly suppressed TSH is a key sign that the thyroid is over-active, which supports hyperthyroid myopathy when muscle weakness is present. Gloucestershire Hospitals NHS Trust+3American Thyroid Association+3AAFP+3

9. Free T4 (FT4) level
   Free T4 measures the active thyroxine hormone that is not bound to proteins. High FT4 together with low TSH confirms hyperthyroidism and explains why muscles are over-stimulated and breaking down. American Thyroid Association+2Mayo Clinic+2

10. Free or total T3 level
    Some patients have mainly high triiodothyronine (T3) levels. Measuring free or total T3 helps detect T3-predominant hyperthyroidism, which can still cause strong muscle symptoms even if T4 is only mildly raised. AAFP+2Mayo Clinic+2

11. Thyroid antibody tests (TRAb/TSI, TPO antibodies)
    Antibody tests help find the cause of hyperthyroidism. Thyroid-stimulating immunoglobulin (TSI or TRAb) supports Graves’ disease, while other antibodies suggest autoimmune thyroiditis. Knowing the cause guides treatment and long-term management of the myopathy. AAFP+2nhs.uk+2

12. Serum creatine kinase (CK)
    CK is an enzyme released when muscle cells are damaged. In chronic hyperthyroid myopathy, CK may be normal or mildly raised, but in acute myopathy or rhabdomyolysis it can be high. CK helps distinguish simple weakness from severe muscle breakdown. PMC+2ScienceDirect+2

13. Serum potassium and other electrolytes
    In thyrotoxic periodic paralysis, blood potassium is often low during attacks. Measuring potassium and other electrolytes during or after an episode is essential to confirm the diagnosis and prevent dangerous heart rhythm problems. PMC+2CPD Bulletin Clinical Biochemistry+2

14. Muscle biopsy (histopathology)
    In unclear cases, a small piece of muscle is taken and examined under a microscope. Typical findings in hyperthyroid myopathy include type II fiber atrophy and other changes that show muscle protein breakdown, distinguishing it from inflammatory myopathies. PMC+2ScienceDirect+2

15. Additional blood tests (liver enzymes, glucose, lipids)
    Because hyperthyroidism affects many organs, doctors often check liver enzymes, blood sugar, and lipids. These tests do not diagnose myopathy directly but help understand the overall impact of hyperthyroidism and any other causes of weakness, like diabetes. AAFP+2Mayo Clinic+2

Electrodiagnostic tests

16. Electromyography (EMG)
    EMG measures the electrical activity of muscles at rest and during contraction. In hyperthyroid myopathy, EMG may show a “myopathic” pattern with small, brief motor unit potentials, or it can be near normal in early disease. EMG helps separate myopathy from neuropathy. Wikipedia+2ScienceDirect+2

17. Nerve conduction studies (NCS)
    NCS test how fast and how well signals travel along nerves. In pure hyperthyroid myopathy, nerve conduction is usually normal, which supports a primary muscle problem rather than a nerve disease causing the weakness. PubMed+2PMC+2

18. Repetitive nerve stimulation or related tests
    In some patients, doctors use repetitive nerve stimulation to rule out myasthenia gravis, which can coexist with thyrotoxicosis. A normal or only mildly changed test supports the diagnosis of hyperthyroid myopathy instead of a neuromuscular junction disorder. PubMed+2etj.bioscientifica.com+2

Imaging tests

19. Thyroid ultrasound
    Ultrasound uses sound waves to show the shape and structure of the thyroid gland. It can reveal an enlarged gland, nodules, or goiter that are causing hormone overproduction and the resulting myopathy. It is painless and widely available. Mayo Clinic+2AAFP+2

20. Radioactive iodine uptake and scan or related thyroid imaging
    A small dose of radioactive iodine is given, and a scanner measures how much the thyroid takes up. High uptake suggests Graves’ disease or toxic nodules, while low uptake suggests thyroiditis. This helps confirm the source of hyperthyroidism behind the myopathy. AAFP+2Mayo Clinic+2

Non-pharmacological treatments for hyperthyroid myopathy

1. Rest and temporary activity reduction
   In the early phase of hyperthyroid myopathy, your muscles tire very quickly. Short planned rest breaks and avoiding heavy lifting or long stair climbing give muscles time to recover and reduce injury risk. The purpose is to prevent over-use damage while the thyroid is being treated. The main mechanism is simple: less mechanical load and less energy demand reduces muscle fibre breakdown and pain.

2. Graded physical therapy exercise program
   A physiotherapist can design a gentle strengthening and balance program using light resistance, short walks, and stretching. The purpose is to slowly rebuild muscle strength and endurance without over-fatigue. The mechanism is “progressive overload”: tiny, controlled stress signals the muscle to repair and grow, while professional supervision helps prevent falls and joint strain.

3. Balance and fall-prevention training
   Many people with hyperthyroid myopathy feel shaky and unsteady. Balance exercises (standing on one leg near support, heel-toe walking, using balance boards) help the brain and muscles work together again. The purpose is to reduce falls, fractures, and fear of moving. The mechanism is improved nerve-muscle coordination and stronger stabilizing muscles around hips and ankles.

4. Occupational therapy and home safety changes
   Occupational therapists can suggest grab bars, raised toilet seats, non-slip mats, and different ways to do tasks, like sitting to dress or cook. The purpose is to keep independence and safety while muscles are weak. The mechanism is environmental adaptation: you change the setting, not just your body, to reduce strain and falls in daily life.

5. Posture and ergonomic training
   Weak shoulder and trunk muscles can cause a slumped posture and neck pain. Teaching neutral spine posture, adjusting desk height, and using supportive chairs reduces muscle fatigue. The purpose is to protect the spine and joints. The mechanism is better load distribution across muscles and joints, which lowers continuous strain and nerve compression.

6. Breathing and relaxation exercises
   Fast heart rate, tremor, and anxiety are common in hyperthyroidism. Slow breathing, diaphragmatic breathing, and simple mindfulness can calm the nervous system. The purpose is to ease palpitations and improve exercise tolerance. The mechanism is lowering sympathetic (“fight or flight”) activity, which reduces tremor, heart rate, and oxygen demand in over-active muscles.PubMed+1

7. Stress-management and psychological support
   Chronic illness and muscle weakness can cause fear, low mood, and sleep problems. Counselling, cognitive-behavioural therapy, or support groups help you cope and stay engaged in treatment. The purpose is to protect mental health and adherence to medical care. The mechanism is better coping skills, less stress hormone release, and improved motivation for exercise and medication routines.

8. Sleep hygiene and regular sleep schedule
   Thyroid over-activity often leads to insomnia and very poor-quality sleep. Going to bed at the same time, avoiding screens late at night, and keeping the room dark and quiet improve sleep depth. The purpose is better energy and muscle recovery. The mechanism is restoring normal hormone and muscle repair cycles that mainly happen during deep sleep.

9. Nutritional counselling for adequate protein and calories
   Hyperthyroidism increases metabolism, so you burn calories and protein much faster. A dietitian can adjust your intake so you do not lose too much weight or muscle. The purpose is to provide enough building blocks for muscle repair. The mechanism is supplying sufficient protein (amino acids) and calories to balance the catabolic (breakdown) effect of high thyroid hormone.MSD Manuals

10. Vitamin D and calcium optimization from lifestyle
    People with Graves’ disease and hyperthyroidism often have low vitamin D and weaker muscles and bones. Safe sun exposure, vitamin D-rich foods, and calcium intake support bone and muscle health. The purpose is to lower fracture risk and improve muscle performance. The mechanism is improved calcium handling in muscle and bone and better muscle contraction control.PMC+2PubMed+2

11. Smoking cessation
    Smoking worsens Graves’ disease and is linked to more severe eye and muscle problems. Quitting smoking reduces oxidative stress and improves treatment response. The purpose is to slow disease damage and protect muscles and eyes. The mechanism is less toxin exposure and better blood supply to muscles and thyroid-related tissues.Frontiers

12. Limiting caffeine and energy drinks
    Caffeine makes palpitations, tremor, and anxiety worse in hyperthyroidism. Cutting down coffee, tea, cola, and energy drinks can lessen shaking and fatigue. The purpose is symptom control. The mechanism is reduced stimulation of the heart and nervous system, so muscles are less over-activated and less easily exhausted.

13. Avoiding unnecessary high-iodine exposure
    Kelp supplements, some contrast dyes, and large amounts of seaweed can increase iodine intake and worsen hyperthyroidism. Avoiding these unless prescribed helps stabilize thyroid hormone levels. The purpose is to prevent sudden thyroid hormone surges. The mechanism is limiting the thyroid’s raw material (iodine) for hormone over-production.

14. Heat and cold therapy for painful muscles
    Warm packs or gentle showers can relax tight muscles, and short cold applications can reduce acute soreness. The purpose is simple pain relief without extra medicines. The mechanism is local blood flow changes and reduced pain signalling from irritated muscle fibres and nerves.

15. Hydration and electrolyte balance
    High metabolism and sweating can lead to dehydration and mineral loss. Drinking enough water and including some electrolyte-rich foods or drinks support muscle function. The purpose is to prevent cramps and fatigue. The mechanism is maintaining proper fluid and mineral balance for muscle contraction and nerve conduction.

16. Yoga or tai chi (gentle movement)
    Slow, controlled movements with breathing, as in yoga or tai chi, can improve flexibility, balance, and mental calmness. The purpose is to rebuild confidence in your body with low-impact exercise. The mechanism is combining mild strengthening with nervous system relaxation to reduce tremor and stiffness.

17. Energy-conservation strategies
    Planning the day, grouping tasks, using tools like trolleys or backpacks, and sitting when possible reduce muscle overload. The purpose is to help you do important activities without collapsing from fatigue. The mechanism is smart distribution of limited muscle energy across the day.

18. Education about disease and self-monitoring
    Learning to notice early warning signs (new weakness, rapid heart rate, shortness of breath) helps you seek help sooner. The purpose is early intervention and prevention of severe myopathy or thyroid storm. The mechanism is empowering patients to act quickly when symptoms change, before major muscle damage happens.

19. Regular follow-up and lab monitoring
    Keeping scheduled visits and blood tests (TSH, free T4, free T3) lets doctors adjust treatment before muscles are badly affected. The purpose is to maintain a stable “euthyroid” (normal) state. The mechanism is tight control of hormone levels so the muscle sees fewer swings between overload and under-activity.MSD Manuals+1

20. Management of other medical problems
    Conditions like diabetes, vitamin B12 deficiency, or other autoimmune diseases can worsen weakness. Treating these alongside hyperthyroidism supports better muscle recovery. The purpose is a holistic approach to health. The mechanism is removing extra stressors that also damage nerves and muscles, so recovery from hyperthyroid myopathy is faster and more complete.

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Drug treatments for hyperthyroid myopathy

Important: Drug names, doses, and schedules are general information, mainly for adults. Never start, stop, or change any medicine without a doctor, especially if you are a minor.

1. Methimazole (Tapazole, generic)
   Methimazole is the main antithyroid drug in many countries. It blocks the thyroid from making new hormone, so muscle over-stimulation slowly settles. Typical adult doses start around 10–30 mg per day, divided, then reduced as labs normalize, always adjusted by a doctor. It belongs to the thionamide class. Side effects can include rash, joint pain, liver problems, and rare low white blood cells, so blood checks are essential.FDA Access Data+2FDA Access Data+2

2. Propylthiouracil (PTU)
   PTU is another thionamide antithyroid drug. It blocks thyroid hormone production and also conversion of T4 to active T3 outside the thyroid. It is usually reserved for patients who cannot take methimazole or for early pregnancy because of serious liver risk. Typical adult doses are 50–150 mg three times daily at first, then less. Side effects include liver injury, rash, joint pain, and low blood counts, so it must be used with close monitoring.FDA Access Data+3FDA Access Data+3FDA Access Data+3

3. Propranolol (Inderal and generics)
   Propranolol is a non-selective beta-blocker. It does not fix hormone levels but quickly eases tremor, fast heart rate, and anxiety, which improves exercise tolerance and muscle comfort. Typical oral doses can be 10–40 mg three to four times daily, adjusted to heart rate and blood pressure. Side effects include low heart rate, low blood pressure, tiredness, and can worsen asthma, so it must be prescribed carefully.MSD Manuals+5FDA Access Data+5FDA Access Data+5

4. Atenolol
   Atenolol is a selective beta-1 blocker often given once daily, which makes it convenient. It reduces palpitations, tremor, and exercise-induced breathlessness in hyperthyroidism, helping muscles feel steadier. Typical adult doses range from 25–100 mg once daily. Side effects are similar to other beta-blockers: low heart rate, low blood pressure, dizziness, and fatigue. It may be preferred when once-daily dosing is needed and in patients who cannot tolerate propranolol.

5. Metoprolol
   Metoprolol is another beta-1 selective blocker. By slowing the heart and lowering blood pressure, it reduces the strain on weak muscles during activities. Usual doses are 25–100 mg twice daily in tablet form, individualized. Side effects can be tiredness, dizziness, and cold hands or feet. Its main role is symptom control while antithyroid medications or radioiodine are working.Medscape eMedicine+1

6. Nadolol
   Nadolol is a long-acting non-selective beta-blocker that can often be taken once daily. It is used to control rapid heart rate and tremor in some hyperthyroid patients. Doses might range from 20–160 mg daily, adjusted by a clinician. Because it also blocks beta-2 receptors, it can worsen asthma and peripheral circulation, so it requires careful selection and monitoring.

7. Esmolol (intravenous beta-blocker)
   Esmolol is an ultra-short-acting beta-1 blocker given by IV infusion in hospital, especially for severe thyrotoxicosis or thyroid storm with very high heart rate. It allows very rapid control and quick stopping if side effects appear. The mechanism is short-term blockade of heart beta-1 receptors. Side effects can be low blood pressure or heart block, which is why it is used in intensive care with continuous monitoring.MSD Manuals+1

8. Diltiazem
   Diltiazem is a calcium-channel blocker sometimes used if beta-blockers are not tolerated (for example, in people with asthma). It slows the heart rate and can help palpitations and breathlessness from hyperthyroidism. Typical doses vary (for example 120–360 mg per day for sustained-release forms) and are set by a doctor. Side effects include ankle swelling, headache, and low blood pressure.

9. Cholestyramine
   Cholestyramine is a bile-acid binding resin that can bind thyroid hormones in the gut and increase their loss in stool. It is sometimes added in severe hyperthyroidism to help lower hormone levels faster. Doses are usually several grams per day divided with meals. Side effects can include constipation, bloating, and interference with absorption of other drugs.

10. Potassium iodide / Lugol’s solution
    High doses of iodide for a short time can “shut down” the thyroid’s release of hormone (the Wolff–Chaikoff effect). This can be used before thyroid surgery or in thyroid storm together with other drugs. It is usually given as drops for a limited number of days. Side effects can be rash, swelling of salivary glands, metallic taste, and rarely iodide-induced swelling of the thyroid.

11. Glucocorticoids (e.g., prednisone, hydrocortisone)
    In severe thyrotoxicosis or when thyroid eye disease is present, glucocorticoids may be used. They reduce inflammation and lower the conversion of T4 to T3. They can help muscle pain and swelling in some autoimmune thyroid cases. Doses vary widely and are always specialist-guided. Side effects include weight gain, high blood sugar, infections, and bone loss if used long term.MSD Manuals

12. Radioactive iodine (I-131) therapy
    Radioiodine is swallowed as a capsule or liquid. The over-active thyroid cells take it up and are slowly destroyed, leading to a more normal or under-active thyroid. This often stabilizes or improves hyperthyroid myopathy over time as hormone levels normalize. It is not used in pregnancy. Side effects include neck discomfort, temporary worsening of hyperthyroid symptoms, and eventual hypothyroidism needing replacement.

13. Levothyroxine (after over-treatment)
    If aggressive treatment causes the thyroid to become under-active, levothyroxine (synthetic T4) replaces the missing hormone. Proper replacement prevents hypothyroid myopathy and allows muscles to function normally. Doses are usually once daily, adjusted by weight, age, and labs. Side effects mainly come from too high a dose (palpitations, tremor) or too low a dose (fatigue, muscle cramps).

14. Carbimazole
    Carbimazole is converted to methimazole in the body and used as an antithyroid drug in many countries. It works like methimazole by blocking thyroid hormone synthesis. Doses and side effects are similar: rash, liver issues, and rare agranulocytosis (severe drop in white blood cells). Blood counts and liver tests are important when using this medicine.

15. Sedatives for severe insomnia (e.g., short-term benzodiazepines)
    In selected adults with extreme insomnia and anxiety from hyperthyroidism, short-term sedatives may be prescribed while thyroid treatment starts to work. They help restore sleep, which supports muscle recovery. These drugs act on brain GABA receptors to calm the nervous system. They can cause dependence, drowsiness, and falls, so they are used carefully and for short periods only.

16. Analgesics (paracetamol/acetaminophen, limited NSAIDs)
    Simple pain relievers can help muscle and joint aches during the early phase of hyperthyroid myopathy. They do not change the disease but improve comfort and allow gentle exercise. Doses must follow package or doctor instructions to avoid liver or kidney damage, and NSAIDs must be used carefully in people with heart, kidney, or stomach problems.

17. Bisphosphonates (for bone protection in severe hyperthyroidism)
    Long-standing hyperthyroidism can weaken bones. In adults with high fracture risk, a doctor may add bisphosphonates like alendronate. These drugs slow bone breakdown, indirectly supporting muscle function by reducing pain and fractures. They are usually taken weekly or monthly, with strict instructions about posture and timing. Side effects can include stomach upset and rare jaw bone problems.

18. Insulin or diabetes medicines (if hyperthyroidism unmasks diabetes)
    High thyroid hormone can worsen blood sugar control. If diabetes appears or becomes uncontrolled, proper treatment with insulin or oral diabetes drugs protects nerves and muscles from further damage. These medicines lower blood sugar and reduce glucose-related injury to tissues, but they must be managed by a specialist.

19. Anticoagulants (for atrial fibrillation)
    Hyperthyroidism can trigger atrial fibrillation, a very fast irregular heartbeat that increases stroke risk. If this occurs, blood thinners like warfarin or newer anticoagulants may be prescribed. They do not treat myopathy directly but prevent clots that could cause major disability. The mechanism is blocking clotting factors, and side effects include bleeding.

20. Other beta-blockers (bisoprolol, nebivolol – chosen case-by-case)
    In some patients, other selective beta-blockers may be chosen for heart-rate control. They all reduce the heart’s response to adrenaline, easing tremor and breathlessness. Dose, timing, and choice depend on heart function, blood pressure, and other illnesses. All share similar side effects such as low heart rate, low blood pressure, and fatigue, and must be prescribed by a physician.Medscape eMedicine+2PubMed+2

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Dietary molecular supplements

Supplements can interact with medicines. A doctor or dietitian should review all products, especially in young people.

1. L-carnitine
   L-carnitine moves fatty acids into cell “power plants” (mitochondria) and may be depleted in hyperthyroidism. Studies show 2–4 g per day helped reverse hyperthyroid symptoms and muscle weakness and may improve bone health.Consensus+4PubMed+4PubMed+4 The functional effect is better energy handling in muscle and partial blocking of thyroid hormone action inside tissues, not at the thyroid gland itself.

2. Selenium
   Selenium is part of enzymes that activate and deactivate thyroid hormones and reduce oxidative stress. In Graves’ disease and eye involvement, selenium supplementation has been associated with improved quality of life and slower disease progression.New England Journal of Medicine+3PMC+3Frontiers+3 Typical doses in studies are around 100–200 micrograms per day, but long-term excess is harmful, so medical guidance is vital.

3. Vitamin D3 (cholecalciferol)
   Vitamin D deficiency is common in Graves’ disease and is linked to weaker muscles and poorer quality of life. Supplementation, often 1000–2000 IU daily or tailored higher doses, may help restore muscle performance and support immune balance.MDPI+4PMC+4Pak J Med Dent+4 The mechanism is improved calcium balance, muscle fibre function, and modulation of immune responses that contribute to autoimmune thyroid disease.

4. Omega-3 fatty acids (EPA/DHA)
   Omega-3 fats from fish oil have anti-inflammatory and possible immunomodulatory effects. They may help joint and muscle pain and support heart health in hyperthyroid patients. Common supplemental doses are 500–1000 mg combined EPA/DHA daily, adjusted individually. They act by changing cell membrane composition and reducing pro-inflammatory signalling molecules, which can indirectly support muscle recovery.

5. Magnesium
   Magnesium is essential for nerve transmission and muscle contraction. Low levels can worsen cramps, tremor, and fatigue. Supplemental doses often range from 200–400 mg elemental magnesium per day, depending on kidney function. It works as a co-factor in hundreds of reactions related to energy metabolism and helps stabilize excitable tissues like muscle and heart.

6. Coenzyme Q10 (CoQ10)
   CoQ10 is a key component of mitochondrial energy production and an antioxidant. Hyperthyroidism places heavy demand on mitochondria; CoQ10 supplementation (for example 50–200 mg/day) may support energy production and reduce oxidative stress in muscle. The functional mechanism is improved electron transport in the mitochondrial chain and scavenging of harmful free radicals.

7. B-complex vitamins (especially B1, B6, B12)
   B vitamins help convert food into energy and support nerve health. Deficiency can worsen fatigue, neuropathy, and muscle weakness. Balanced B-complex supplements provide multiple B vitamins at physiological doses; exact dosing should follow product labels and professional advice. They function as co-enzymes in energy pathways and neurotransmitter synthesis, which supports muscle control and endurance.

8. Protein or branched-chain amino acids (BCAAs)
   If appetite is poor or weight loss is severe, protein powders or BCAA supplements may help provide enough building blocks for muscle repair. They supply essential amino acids like leucine that trigger muscle protein synthesis. Dose depends on overall diet; often 10–20 g of extra protein per day under dietitian supervision is used rather than very high intakes.

9. Vitamin C
   Vitamin C supports collagen formation, immune function, and antioxidant defence. It may help limit oxidative damage in muscles and blood vessels during hypermetabolism. Common supplement doses are 200–500 mg per day from diet and tablets combined. It works by neutralizing free radicals and helping regenerate other antioxidants such as vitamin E.

10. Alpha-lipoic acid
    Alpha-lipoic acid is an antioxidant that works in both water and fat environments and may support nerve and muscle health. Typical supplemental doses are 100–300 mg per day, but this should be individualized. It helps recycle other antioxidants and improve mitochondrial energy metabolism, which might ease fatigue and neuropathic symptoms in some patients.

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Regenerative and immune-modulating drugs

There are no stem cell or “immunity booster” drugs specifically approved for hyperthyroid myopathy. The options below describe general immune-modulating approaches used in some autoimmune or experimental settings. They are specialist-only and often research-level.

1. Rituximab
   Rituximab is a monoclonal antibody that targets CD20 on B cells, reducing autoantibody production. It has been explored in some autoimmune thyroid-related eye diseases but is not standard for hyperthyroid myopathy. It is given by IV infusion at specialist centres, with dosing cycles months apart. It can increase infection risk and cause infusion reactions, so strict monitoring is needed.

2. Intravenous immunoglobulin (IVIG)
   IVIG is pooled antibodies from donors and is sometimes used in severe autoimmune muscle diseases. In rare, complex cases with overlapping autoimmune myopathy and thyroid disease, it may be considered. Doses are high (for example 2 g/kg spread over several days) under hospital supervision. It works by modulating immune responses and blocking harmful autoantibodies, but it is expensive and not routine for hyperthyroid myopathy alone.

3. High-dose pulse corticosteroids (e.g., IV methylprednisolone)
   Short courses of high-dose IV steroids can rapidly suppress inflammation in severe thyroid eye disease or overlapping inflammatory muscle disease. Doses and schedules vary (for example weekly pulses), always decided by specialists. They act by strongly blocking inflammatory gene expression. Side effects are significant, including mood change, high blood sugar, and infection risk, so they are reserved for carefully selected cases.

4. Experimental mesenchymal stem cell (MSC) therapies
   Mesenchymal stem cells from bone marrow or fat are being studied in many autoimmune diseases for their potential to reset immune tolerance and support tissue repair. At present, MSC therapy for Graves’ disease or hyperthyroid myopathy is experimental only, offered mainly in clinical trials. Doses and regimens are not standardized, and long-term safety is still under investigation. Patients should avoid unregulated commercial “stem cell clinics.”

5. Recombinant growth factors (e.g., IGF-1 in research settings)
   Insulin-like growth factor-1 and other anabolic agents can stimulate muscle protein synthesis, but they are not approved treatments for hyperthyroid myopathy. Their use outside strict research protocols can cause serious side effects like low blood sugar, swelling, and possible tumour growth. For now, the safer way to rebuild muscle is proper thyroid control, nutrition, and physiotherapy.

6. Future targeted immune therapies
   New biologic drugs that target specific immune pathways in autoimmunity (such as co-stimulation blockers or cytokine inhibitors) are being studied in other diseases. They might one day be used in severe, refractory thyroid autoimmunity but are not standard for hyperthyroid myopathy. For now, they belong to research and not routine care, and any use should be inside formal clinical trials only.

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Surgeries and interventional procedures

1. Total or near-total thyroidectomy
   In this operation, most or all of the thyroid gland is removed. It is done when medicines fail, cannot be tolerated, or when there is a large goitre or suspected cancer. Removing the over-active gland stops excess hormone production, which over time helps muscle strength recover as you become euthyroid or mildly hypothyroid and start replacement therapy.

2. Subtotal thyroidectomy
   Here, surgeons leave a small part of the thyroid. This is less commonly used now but may be chosen in some centres. The goal is to reduce hormone output significantly while leaving a little tissue. Some patients still become hypothyroid and need replacement; others may stay euthyroid. The benefit for myopathy is similar: more stable hormone levels help muscles heal.

3. Minimally invasive or endoscopic thyroid surgery
   For selected patients, surgeons can remove the thyroid through smaller cuts using special instruments, sometimes with robotic help. The purpose is the same as open surgery but with smaller scars and possibly quicker recovery. As with other thyroid surgeries, careful nerve and parathyroid preservation are crucial. Muscle recovery depends on achieving stable thyroid hormone levels after surgery.

4. Orbital decompression surgery (for severe Graves’ eye disease)
   Some patients with Graves’ disease have very severe eye involvement that pushes the eyes forward and threatens vision. Orbital decompression removes some bone or fat from around the eye to make more space. While it mainly protects sight, easing eye pain and pressure can also improve overall function and quality of life for patients who also have myopathy.

5. Orthopaedic or tendon surgeries for fixed deformities (rare)
   In very long-standing muscle disease, some people may develop fixed contractures or spine deformities. Rarely, orthopaedic surgery to release tendons or correct deformities may be needed. This is not specific to hyperthyroid myopathy and is usually considered only after thyroid control, rehabilitation, and bracing have failed to keep function.

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Prevention of hyperthyroid myopathy

1. Treat hyperthyroidism early and follow medical advice closely.

2. Attend regular follow-up visits and blood tests to keep thyroid levels in the normal range.

3. Avoid self-adjusting thyroid medication doses without professional guidance.

4. Do not use over-the-counter “thyroid boosters” or high-iodine supplements like kelp.

5. Maintain a balanced diet with enough protein, calories, vitamin D, and selenium.PMC+2Frontiers+2

6. Stop smoking and limit alcohol to support immune and muscle health.

7. Start gentle exercise early, under guidance, to keep muscles active but not overloaded.

8. Manage other conditions such as diabetes, vitamin deficiencies, and autoimmune diseases.

9. Learn early warning signs of relapse (new tremor, weight loss, rapid heart rate, new weakness).

10. Seek care quickly if symptoms worsen rather than waiting for months.

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When to see a doctor

You should see a doctor as soon as possible if you notice new or worsening muscle weakness, especially in your thighs and shoulders, such as trouble climbing stairs, lifting your arms, or getting up from a chair. Seek urgent help for fast or irregular heartbeat, chest pain, shortness of breath at rest or lying flat, difficulty swallowing, sudden weight loss, or severe tremor. Any sudden change in vision, double vision, or severe eye pain in someone with known hyperthyroidism is also an emergency. If you already have hyperthyroid myopathy and suddenly feel much weaker, fall frequently, or cannot perform basic daily tasks, you need rapid review, as thyroid levels may be very off or another serious problem could be present. If you are a teenager, always involve a parent or guardian and a doctor before making any changes to medicines or supplements.

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What to eat and what to avoid

1. Eat: balanced meals with lean protein (fish, eggs, beans, poultry) to support muscle repair.

2. Eat: plenty of fruits and vegetables for vitamins, antioxidants, and fibre.

3. Eat: foods rich in calcium and vitamin D (fortified milk, yogurt, small fish with bones) to protect bones and muscles.PubMed+1

4. Eat: whole grains like brown rice and oats for steady energy instead of sugary snacks.

5. Eat: small, frequent meals if appetite is poor to prevent weight and muscle loss.

6. Avoid: very high-iodine foods and supplements (kelp tablets, large amounts of seaweed) unless your endocrinologist specifically allows them.

7. Avoid: excessive caffeine from coffee, tea, cola, and energy drinks, as they can make tremor and palpitations worse.

8. Avoid: highly processed junk foods high in sugar, salt, and unhealthy fats, which do not support recovery.

9. Avoid: crash diets or fasting, which can further weaken muscles and disturb hormone balance.

10. Avoid: alcohol binge drinking, which stresses muscles, heart, and liver and may interact with medications.

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Frequently asked questions

1. Can hyperthyroid myopathy go away completely?
   Yes, in many people muscle strength improves greatly or returns close to normal once thyroid hormone levels are controlled and you follow a proper rehab and nutrition plan. Recovery is usually gradual, over weeks to months, and is best when treatment starts early and other health problems are also managed.

2. How long does it take for muscles to feel better after starting treatment?
   Some symptoms like tremor and palpitations may improve within days to weeks once beta-blockers and antithyroid drugs are started.PubMed+1 Muscle strength often improves more slowly, usually over several months, as the body rebuilds muscle protein and adapts to normal thyroid levels again.

3. Will exercise make my muscle weakness worse?
   Very hard or unplanned exercise can worsen fatigue and cause injury, but a gentle, supervised program usually helps. Starting with low-intensity activities and slowly increasing under guidance is generally safe. Physical therapists are trained to find the right balance between rest and activity in hyperthyroid myopathy.

4. Is hyperthyroid myopathy dangerous for the heart?
   Hyperthyroidism itself stresses the heart and can lead to rhythm problems like atrial fibrillation.Cleveland Clinic+1 Weak respiratory and heart-supporting muscles can add to breathlessness. This is why early diagnosis, beta-blocker use when appropriate, and careful heart monitoring are important parts of treatment.

5. Can teenagers or young adults get hyperthyroid myopathy?
   Yes. Graves’ disease and hyperthyroidism can affect teenagers and young adults. Muscle weakness, weight loss, and anxiety may be mistaken for stress. Any young person with unexplained tremor, fast heartbeat, and difficulty climbing stairs should be checked by a doctor, not just told to “exercise more.”

6. Are antithyroid drugs safe to use long term?
   Methimazole and PTU are very helpful but can have serious side effects like liver problems and very low white blood cells in rare cases.FDA Access Data+3FDA Access Data+3FDA Access Data+3 Regular blood tests and quick reporting of fever, sore throat, or jaundice are essential. Your endocrinologist will weigh the risks and benefits and may later switch to radioiodine or surgery for lasting control.

7. Do supplements like L-carnitine and selenium replace standard treatment?
   No. Evidence suggests L-carnitine and selenium may support symptom control or quality of life in some patients, but they do not replace antithyroid drugs, radioiodine, or surgery.Frontiers+3PubMed+3OUP Academic+3 They should only be added after discussion with your doctor to avoid overdose or interactions.

8. Can diet alone cure hyperthyroid myopathy?
   Diet is very important for muscle repair and general health, but it cannot switch off an over-active thyroid gland by itself. Good nutrition works together with medical treatment and physical therapy. Think of it as one leg of a three-legged stool: all three (medicine, rehab, and nutrition) are needed for best results.

9. Will I always need medicine after surgery or radioiodine?
   Many people become hypothyroid after definitive treatment and then take levothyroxine for life. This may sound worrying, but a stable replacement dose often gives smoother hormone levels than an over-active thyroid. With proper dosing, muscles and energy usually feel much better and more stable than before.

10. Is weight training safe with hyperthyroid myopathy?
    Heavy weight training is not recommended early on. Later, when thyroid levels are stable and basic strength has improved with light exercise, your therapist may add light resistance bands or small weights. This should be done carefully to avoid joint strain, high blood pressure spikes, or heart rhythm problems.

11. Can hyperthyroid myopathy come back after it improves?
    Yes, if hyperthyroidism relapses or if thyroid medication is stopped without proper follow-up, symptoms can return. This is why long-term monitoring and adherence to treatment are key. Early warning signs like new tremor, weight loss, or heat intolerance should prompt a check-up.

12. Is it safe to play sports with hyperthyroid myopathy?
    High-intensity competitive sports are usually not advised until thyroid levels and heart rhythm are well controlled. Once you are stable and your doctor clears you, you can slowly re-introduce sports, starting with low-intensity activities and always paying attention to symptoms like chest pain or severe breathlessness.

13. Do all people with hyperthyroidism get myopathy?
    No. Some people mainly have heart or eye symptoms, others have strong muscle involvement, and some have a mix. Risk depends on how high and how long thyroid hormone has been elevated, age, general health, and genetics. Good control of thyroid disease reduces the chance and severity of myopathy.

14. Can hyperthyroid myopathy affect breathing muscles?
    Yes, in more severe cases the muscles that help you breathe can weaken. This may appear as shortness of breath climbing stairs, difficulty lying flat, or waking gasping at night. Any sign of breathing difficulty is serious and needs prompt medical review to avoid respiratory failure.

15. What is the most important step for recovery from hyperthyroid myopathy?
    The single most important step is achieving and maintaining normal thyroid hormone levels with appropriate treatment plus regular monitoring. Alongside this, gentle exercise, good nutrition, and avoiding harmful substances like tobacco and high-iodine supplements give your muscles the best chance to heal and stay strong.

Disclaimer: Each person’s journey is unique, treatment plan, life style, food habit, hormonal condition, immune system, chronic disease condition, geological location, weather and previous medical  history is also unique. So always seek the best advice from a qualified medical professional or health care provider before trying any treatments to ensure to find out the best plan for you. This guide is for general information and educational purposes only. Regular check-ups and awareness can help to manage and prevent complications associated with these diseases conditions. If you or someone are suffering from this disease condition bookmark this website or share with someone who might find it useful! Boost your knowledge and stay ahead in your health journey. We always try to ensure that the content is regularly updated to reflect the latest medical research and treatment options. Thank you for giving your valuable time to read the article.

The article is written by Team RxHarun and reviewed by the Rx Editorial Board Members

Last Updated: December o3 , 2025.