Table 9-7Manifestations of hypothyroidism in the musculoskeletal system.

Clinical Symptoms and Signs• Myalgia, muscle weakness, stiffness, cramps, fatigue• Delayed reflex relaxation (e.g. prolonged Achilles tendon reflex relaxation time)• Arthralgias, joint stiffness, joint effusions• Carpal tunnel syndrome• Delayed linear bone growth in children
Laboratory• Normal ionized calcium, phosphate, and bone density• Increased serum PTH and 1,25 (OH) 2 -vitamin D 3, normal 25-OH vitamin D 3• Reduced urine calcium, hydroxyproline, serum alkaline phosphatase, osteocalcin, and IGF-1• Epiphyseal dysgenesis or delayed ossification in children

From: Adult Hypothyroidism

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