Hypothyroidism and Musculoskeletal Injury Susceptibility in Athletes: A Narrative Review
DOI:
https://doi.org/10.12775/QS.2026.66.73913%20Keywords
hypothyroidism, athletes, musculoskeletal injury, skeletal muscle, tendon, thyroid hormones, exercise physiology, sports medicineAbstract
Background
Thyroid hormones are key elements regulating the body's metabolism, muscle function and connective tissue homeostasis. Therefore, hypothyroidism may affect exercise performance and regeneration processes. Its role as a factor increasing susceptibility to sports injuries remains insufficiently defined.
Objective
This narrative review aims to evaluate evidence regarding the impact of hypothyroidism on the musculoskeletal system and the risk of sports injuries with attention paid to the underlying physiological mechanisms.
Methods
Studies published from 1986–2026 were searched in the PubMed database. The literature was reviewed using the following keywords: hypothyroidism, skeletal muscle, tendinopathy, exercise performance, athletes, and musculoskeletal injuries. Additional papers were identified by reviewing references of relevant articles.
Results
Available evidence indicates that thyroid hormones regulate multiple processes relevant to musculoskeletal health, including oxidative metabolism, neuromuscular function, and extracellular matrix remodeling. Hypothyroidism has been associated with reduced aerobic capacity, impaired muscle strength, and delayed muscle regeneration after injury. Experimental data also suggest disturbances in tendon homeostasis, which may influence tissue adaptation to mechanical loading. Although these findings provide a plausible link between hypothyroidism and increased injury susceptibility, direct evidence in athletic population remains limited.
Conclusions
Current literature suggests an association between hypothyroidism and impaired musculoskeletal function that may contribute to increased susceptibility to sports-related injuries. Due to the lack of prospective studies in athletes, hypothyroidism should be considered a potential modifying factor rather than a risk factor for injury. Further sport-specific research is required to clarify its significance in injury prevention and athletic management.
References
1.Oliva F, Berardi AC, Misiti S, Maffulli N. Thyroid hormones and tendon: current views and future perspectives. Concise review. Muscles, Ligaments and Tendons Journal [Internet]. 2013 Aug 11;3(3):201. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC3838329/
2.Lankhaar JAC, Kemler E, Hofstetter H, Collard DCM, Zelissen PMJ, Stubbe JH, et al. Physical activity, sports participation and exercise-related constraints in adult women with primary hypothyroidism treated with thyroid hormone replacement therapy. Journal of Sports Sciences. 2021 Jun 24;39(21):1–10.
https://doi.org/10.1080/02640414.2021.1940696
3.Taylor DJ, Rajagopalan B, Radda GK. Cellular energetics in hypothyroid muscle. European Journal of Clinical Investigation. 1992 May;22(5):358–65.
https://doi.org/10.1111/j.1365-2362.1992.tb01474.x
4.Aguiari P, Villani V, Liu YY, Carraro G, Brent GA, Perin L, et al. Hypothyroidism impairs skeletal muscle regeneration after injury by altering myogenic and nonmyogenic pathways. JCI Insight. 2026 Mar 23;11(6).
https://doi.org/10.1172/jci.insight.197761
5.Leal ALRC, Albuquerque JPC, Matos MS, Fortunato RS, Carvalho DP, Rosenthal D, et al. Thyroid hormones regulate skeletal muscle regeneration after acute injury. Endocrine. 2014 May 6;48(1):233–40.
https://doi.org/10.1007/s12020-014-0271-5
6.Duhig TJ, McKeag D. Thyroid Disorders in Athletes. Current Sports Medicine Reports. 2009 Jan;8(1):16–9.
https://doi.org/10.1249/JSR.0b013e3181954a12
7.Abete M. Therapeutic use of hormones on tendinopathies: a narrative review. Muscles, Ligaments and Tendons Journal. 2016;
https://doi.org/10.11138/mltj/2016.6.4.445
8.Kjaer M. Role of Extracellular Matrix in Adaptation of Tendon and Skeletal Muscle to Mechanical Loading. Physiological Reviews. 2004 Apr;84(2):649–98.
https://doi.org/10.1152/physrev.00031.2003
9.Ljungqvist A, Schwellnus MP, Bachl N, Collins M, Cook J, Khan KM, et al. International Olympic Committee Consensus Statement: Molecular Basis of Connective Tissue and Muscle Injuries in Sport. Clinics in Sports Medicine. 2008 Jan;27(1):231–9.
https://doi.org/10.1016/j.csm.2007.10.007
10.Magnusson SP, Langberg H, Kjaer M. The pathogenesis of tendinopathy: balancing the response to loading. Nature Reviews Rheumatology. 2010 Mar 23;6(5):262–8.
https://doi.org/10.1038/nrrheum.2010.43
11.Harvie P, Pollard TCB, Carr AJ. Calcific tendinitis: Natural history and association with endocrine disorders. Journal of Shoulder and Elbow Surgery [Internet]. 2007 Mar 1;16(2):169–73.
https://doi.org/10.1016/j.jse.2006.06.007
12.Lee JW, Kim NH, Milanesi A. Thyroid Hormone Signaling in Muscle Development, Repair and Metabolism. Journal of endocrinology, diabetes & obesity [Internet]. 2014;2(3):1046.
13.De Stefano MA, Ambrosio R, Porcelli T, Orlandino G, Salvatore D, Luongo C. Thyroid Hormone Action in Muscle Atrophy. Metabolites [Internet]. 2021 Oct 25;11(11):730.
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Copyright (c) 2026 Łukasz Szkaradowski, Szymon Baranowski, Julia Lewańska, Krzysztof Bogdański, Zuzanna Kruszyńska, Anastasiya Aleshchyk, Michał Adamczak, Marcel Majewski, Bogumił Libura, Martyna Lazar
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