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Hypothyroidism and Surgical Implants, Fillers, and Joint Replacements

Explore how surgical implants, cosmetic procedures, and intrauterine devices affect those with hypothyroidism and Hashimoto's.
Hypothyroidism and Surgical Implants, Fillers, and Joint Replacements
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Thinking about getting a knee replacement? Or maybe you finally made an appointment for your first Botox injections or lip filler. But, now you are unsure. Not because you don’t want them but because you recently heard these procedures may not be wise for someone with autoimmune Hashimoto's thyroiditis or hypothyroidism.

Surgical implants, cosmetic procedures, and intrauterine devices (IUDs) introduce foreign material into your body. Because of this, some researchers believe these materials may cause your immune system to go into overdrive. This could result in new onset or worsening of a pre-existing autoimmune disorder.

Let’s look at these three types of procedures and explore if having hypothyroidism or an autoimmune condition may affect their outcome. If you are considering any of these procedures, be sure to talk to your healthcare provider about their risks and benefits.

Surgical implants

Surgical implants are made from various materials, such as metal, ceramic, or plastic. Some implants are permanent, like a joint replacement. While others, such as surgical screws, are removed when no longer needed.

Metal joint replacement and surgical screws

Limited evidence suggests that metals used in surgical joint replacement and bone repairs can trigger or worsen autoimmune disorders in some individuals. These metals include:

  • Cobalt-chromium
  • Titanium
  • Zirconium
  • Nickel

Studies and case reports show that individuals with metal implants can develop hypersensitivity or an allergic reaction to the metal. When this occurs, the body's immune system may be reacting to metal particles released from the joint replacement or surgical screws. This may trigger an immune response that can worsen or even cause a new autoimmune disease.

So, while there may be a risk, this risk appears low. But, we need more research to understand the relationship between metal exposure and autoimmune disease.

Breast implants

Breast implants are made of silicone or saline, and limited research links them to various autoimmune conditions, including Hashimoto's, a thyroid autoimmune disease.

One study published in 2018 found autoimmune thyroid disease was more common in those with breast implants than those without them. But, this study was unable to determine a time-related relationship between breast implants and the autoimmune disorder diagnosis.

The exact link between breast implants and Hashimoto's is not entirely understood. Some researchers suggest silicone leakage from breast implants could trigger an immune response. Others propose it is the stress of surgery and the inflammatory response after.

In both scenarios, immune system activation could trigger an autoimmune disorder. But, the overall risk of developing Hashimoto's or other autoimmune diseases appears relatively low in individuals with breast implants.

How do surgical procedures, in general, affect hypothyroidism?

Surgery does not have a direct impact on hypothyroidism. But, having hypothyroidism can affect the recovery process and may increase the risk of complications.

Individuals with hypothyroidism may have slower healing rates. This is because thyroid hormones play a crucial role in metabolism and energy production, which are necessary for tissue repair and wound healing.

Hypothyroidism can also weaken the immune system, making you more susceptible to infection following surgery.

This doesn’t mean you should avoid surgery. You will just need to take extra precautions before and after surgery.

Cosmetic procedures

Most cosmetic procedures involve injecting foreign material into certain body areas to improve your appearance. Let’s look at three common cosmetic procedures.

Facial fillers

Facial fillers contain synthetic or natural materials such as collagen or hyaluronic acid (Juvederm). Your immune system may overreact to these materials, causing an autoimmune response. This can lead to inflammation and damage to surrounding tissues.

Those with autoimmune disorders who receive Juvederm are at a higher risk of inflammatory nodules (bumps under the skin). It is unclear if these nodules are due to hyaluronic acid or the additives in the injection. But, the risk of adverse reactions to facial fillers in individuals with autoimmune diseases is still relatively low.


Botox is an injection that reduces the appearance of wrinkles. It has a similar structure to thyroid autoantigens. So, in theory, it could trigger an immune reaction in those with Hashimoto’s. But, very few studies support this concept.

In fact, most studies have not found a significant increase in adverse reactions to Botox in people with autoimmune diseases. Some studies even suggest Botox may have anti-inflammatory effects which could benefit individuals with certain inflammatory autoimmune disorders.

Buttock augmentation

Buttock augmentation, commonly called a butt lift, involves moving fat from one area of your body into the tissues of your buttocks.

This procedure is relatively safe for those with an autoimmune disorder. Some have reported formation of tiny nodules. But this might be due to the injection technique, not the autoimmune disorder.

Copper IUDs and autoimmunity

The copper intrauterine device (IUD) known by its brand name Paragard is a form of contraception placed into the uterus for up to 10 years. The copper IUD doesn't contain hormones like other IUDs. Instead, it works by creating an inflammatory response in the uterus that limits the survival of sperm.

Researchers suggest that the inflammatory response created by copper IUDs could trigger an immune response that contributes to the development of autoimmune diseases such as rheumatoid arthritis. But, the evidence is limited.

An animal study showed that high-dose copper injections were safe with limited systemic copper toxicity. The amount of copper in these injections was much higher than in copper IUDs. But, this study did show an increase in leukocytes (a type of white blood cell) which may need further investigation.

Based on the limited data, the risk of developing an autoimmune disease in individuals with copper IUDs appears low.

A note from Paloma Health

Hypothyroidism may make you think twice before undergoing surgical or cosmetic procedures or getting a copper IUD. But don’t let that stop you.

Work closely with your thyroid specialist to manage your thyroid condition before and after these procedures. This is key to avoiding thyroid-related complications. You may need to:

  • Adjust your thyroid medication dosage
  • Check your hormone levels more often
  • Take steps extra steps to prevent infections

Don’t have a thyroid specialist? Set up an appointment with a top Paloma Health thyroid expert today.

Dealing with Hypothyroidism?  Video chat with a thyroid doctor

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Center for Devices and Radiological Health. Implants and Prosthetics. U.S. Food and Drug Administration. Published 2019. Accessed April 3, 2023.

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Emilie White, PharmD

Clinical Pharmacist and Medical Blogger

Emilie White, PharmD is a clinical pharmacist with over a decade of providing direct patient care to those hospitalized. She received her Doctor of Pharmacy degree from Massachusetts College of Pharmacy and Health Sciences. After graduation, Emilie completed a postgraduate pharmacy residency at Bon Secours Memorial Regional Medical Center in Virginia. Her background includes caring for critical care, internal medicine, and surgical patients.

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