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Multiple Sclerosis (MS) and Hypothyroidism

Learn about the link between multiple sclerosis and hypothyroidism
Multiple Sclerosis (MS) and Hypothyroidism
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Multiple sclerosis and hypothyroidism are two distinct medical conditions. One affects the central nervous system; the other affects the thyroid. Research shows people with MS have a higher risk of developing thyroid disorders. Despite the research, the exact link between MS and thyroid disorders remains unknown.

In this article, learn more about the suspected link between these two health conditions.

What is multiple sclerosis?

Multiple sclerosis (MS) is a chronic autoimmune condition. It occurs when the immune system attacks the healthy cells of the brain and spinal cord. Together, the brain and spinal cord make up your central nervous system (CNS).

This attack targets myelin, the protective layer around the nerves. Myelin helps the brain and the rest of the body communicate. Without myelin, the brain has trouble communicating with the rest of the body, resulting in symptoms of MS.

Disease-modifying therapies are the mainstay treatment options for those with MS. These medications help lower or change the activity of the immune system. In turn, this helps manage MS symptoms and reduces relapse rates.

What is hypothyroidism?

Hypothyroidism occurs when the thyroid gland doesn’t produce enough thyroid hormone to meet the body’s needs. Thyroid hormone is essential for regulating metabolism, and nearly every cell in the body needs it to do its job properly.

The most common cause of hypothyroidism is Hashimoto’s thyroiditis. Hashimoto’s thyroiditis is an autoimmune condition where the immune system attacks the healthy cells of the thyroid. This attack destroys thyroid cells, leaving them unable to make thyroid hormone. Other less common causes of hypothyroidism include

  • Iodine deficiency
  • Certain medications, such as amiodarone or lithium
  • Surgical removal of part or all of the thyroid (thyroidectomy)
  • Radiation of the neck

Management of hypothyroidism involves restoring thyroid hormone levels. Thyroid hormone replacement medications, like levothyroxine, help achieve this goal. Lifestyle changes also play an essential part in managing hypothyroidism.

The connection between MS and hypothyroidism

Study results are conflicting when it comes to a link between MS and hypothyroidism. Some studies support a link, while others don’t.

A recent review conducted in 2023 supports the idea that MS and hypothyroidism are connected. The review found the incidence of thyroid conditions is significantly higher in people with MS compared to those without MS.

Here are three reasons experts believe these two health conditions are connected.

1. Autoimmune link

Uncontrolled inflammation in the body is a problem, so our bodies have built-in systems to keep inflammation in check and prevent it from getting out of control. For individuals with an autoimmune disorder, these natural checks and balances often don’t work as well. This dysregulation can lead to chronic inflammation. As a result, symptoms related to the autoimmune condition begin to appear.

Several studies found that autoimmune disorders tend to cluster together. This means if you have one autoimmune disorder, you are more likely to develop another one. As mentioned, there seems to be a higher co-occurrence of MS with hypothyroidism, including Hashimoto’s, compared to the general population.

Researchers believe that MS may trigger an autoimmune response in the thyroid gland. An autoimmune response is another way of saying the immune system begins to attack itself.

Another study hypothesizes that both MS and Hashimoto’s share similar development pathways. The link here may lie within the dysregulation of the anti-inflammatory processes. Because of this, having MS may make conditions in the body more favorable for developing Hashimoto’s.

2. Multiple sclerosis treatments

MS treatments focus on managing and preventing acute MS attacks and relieving symptoms. Some of these medication treatments may cause thyroid dysfunction.

One medication in particular, alemtuzumab (Lemtrada), can cause thyroid dysfunction. Alemtuzumab treats relapsing forms of MS and is generally prescribed after people with MS have tried at least two other MS medications. In a 2017 study of alemtuzumab-treated patients, approximately 20% of the patients studied developed thyroid disease within 18 months of the start of treatment. In 2023, another study found that nearly 35% of alemtuzumab-treated MS patients develop either hypothyroidism (not related to autoimmune disorder) or Hashimoto’s. Thyroid disorders often develop around three years after starting alemtuzumab but can happen anytime over the treatment course.

Interferon-beta-1 (Avonex, Betaferon, Rebeif) is another MS treatment that can also cause thyroid dysfunction. A recent study found that TSH levels increased while free T4 levels decreased. But, the clinical significance behind these changes is unknown.

3. Shared risk factors

Researchers are still trying to determine what causes the immune system to go rogue in both MS and Hashimoto’s. But, they believe a combination of factors listed below influence their development:

Genetics: One common risk factor for both autoimmune thyroid disease and MS is genetics. Research has shown that individuals with a family history of either disease are at a higher risk of developing the condition themselves. This suggests that a genetic component may predispose certain individuals to autoimmune diseases.

Gender: Another risk factor for both Hashimoto’s and MS is gender. Both hypothyroidism and MS are more common in those assigned female at birth. So it may not be surprising that those assigned female at birth with MS have a higher chance of developing a thyroid disorder compared to the other gender. Hormonal factors may play a role in this gender disparity, as fluctuations in estrogen levels have been linked to autoimmune conditions.

Environmental factors: Environmental exposures also play a significant role in the development of both Hashimoto’s and MS. Exposure to certain environmental toxins, infections, and stressors can trigger an autoimmune response in susceptible individuals. For example, smoking has been linked to an increased risk of both Hashimoto’s and MS, as it can disrupt the immune system and trigger inflammation.

Hormonal and immune system balances: Hormonal and other underlying immune system imbalances can also increase the risk of developing Hashimoto’s and MS. For example, individuals with other autoimmune diseases, such as lupus or rheumatoid arthritis, may be more susceptible to developing additional autoimmune conditions. Similarly, imbalances in thyroid hormone levels or vitamin deficiencies can contribute to developing Hashimoto’s thyroiditis.

Family history of autoimmune disease, MS, or Hashimoto’s: Having family members with a history of autoimmune disease, MS, or Hashimoto’s puts you at higher risk of both MS and Hashimoto’s. 

Vitamin D levels: Vitamin D levels may also play a role in the development of autoimmune disorders. Vitamin D helps regulate your immune response and your body’s inflammatory process. Experts believe low vitamin D levels may contribute to the dysregulation of anti-inflammatory processes. One study found vitamin D levels were lower in those with MS compared to healthy individuals and those with Hashimoto’s. A 2017 study found that low vitamin D levels contribute to developing Hashimoto’s. Thus, low vitamin D levels seen in MS may be a factor in the development of Hashimoto’s.

Symptoms of MS and hypothyroidism

While MS and hypothyroidism are two distinct medical conditions, they do share common symptoms.

Hypothyroidism symptoms that overlap with MS include:

  • Fatigue
  • Muscle weakness
  • Mood changes such as heightened anxiety
  • Tingling or numbness, especially in the extremities
  • Cognitive impairment or brain fog
  • Balance and coordination challenges

However, some symptoms are unique to each medical condition. Those with MS may present with changes in their vision and heat sensitivity.

In some cases, MS can lead to more severe complications such as mobility issues, bladder or bowel problems, and even paralysis. In contrast, hypothyroidism causes cold intolerance, weight gain, constipation, dry skin, and hair loss.

Diagnosing MS and hypothyroidism

Even though they share symptoms, healthcare providers can tell the difference between the two conditions based on specific diagnostic testing.

Your provider can test your thyroid function for hypothyroidism by measuring your thyroid biomarkers. Common thyroid biomarkers include:

Abnormal thyroid biomarkers may lead to a diagnosis of a thyroid condition. Providers can also check for thyroid peroxidase antibodies (TPOAb) -- also known as anti-thyroid antibodies --  in your blood to see if you have an autoimmune thyroid condition.

Unfortunately, there is no blood test for diagnosing MS. Diagnosing MS involves:

  • Thorough medical history with a focus on neurological symptoms
  • Imaging studies like magnetic resonance imaging (MRI)
  • Spinal tap

The process of diagnosing MS can be complex, as symptoms can vary widely from person to person and can mimic other conditions. A neurologist is usually the specialist responsible for diagnosing MS, and they will consider all relevant information before making a final diagnosis. Early and accurate diagnosis of MS is crucial in order to begin appropriate treatment and management of the disease.

A note from Paloma Health

Although some research suggests a possible link between MS and Hashimoto’s, just because you have MS doesn’t mean you will develop Hashimoto’s. If you live with MS, make sure to report any symptoms of hypothyroidism to your healthcare provider. They will advise you on the next best steps.

If you find yourself in need of a provider that specializes in hypothyroidism, consider partnering with Paloma Health. Our providers specialize in treating hypothyroidism. We work with you to develop a personalized treatment plan, often involving traditional medication therapy and holistic approaches. Schedule a free consultation call today.

Dealing with Hypothyroidism?  Video chat with a thyroid doctor

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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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