Less common findings include myalgia, arthralgia, and joint effusion. In the patient described here, a triathlete, interpretation of early signs and symptoms as typical tendinitis led to months of treatment failure. Considering hypothyroidism in the differential diagnosis for patients who have overuse syndromes can expedite treatment.
Definitive diagnosis rests on testing of serum thyroid hormone levels.
Treatment, which is usually quickly effective, consists of gradually adjusted thyroid hormone replacement. T he symptoms of hypothyroidism, like those of other diseases with nonspecific, insidious onset, can be interpreted in many ways by both patient and physician. Such was the case with the triathlete described here, whose symptoms were attributed to patellar tendinitis, shoulder impingement, lateral epicondylitis, and fibromyalgia before the correct diagnosis was made. His usual training regimen consisted of running 20 miles, biking 75 miles, and swimming 4 miles each week. For 3 months he had iced the knee and decreased his training distances without relief.