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General signs and symptoms of low thyroid function include fatigue, weakness, cold intolerance, low morning axillary temperatures (normally 97.8F to 98.2F taken for 10 minutes before getting out of bed and averaged over a 5-day period), weight changes (usually weight gain), and depression.36 Common musculoskeletal signs and symptoms include muscle pain, stiffness, muscle cramping, muscle weakness, paresthesias, arthropathy, and sluggish deep tendon reflexes.37 Other reported musculoskeletal-related symptoms associated with hypothyroidism include adhesive capsulitis of the shoulders, proximal myopathy, carpal tunnel syndrome, and polyneuropathy that tends to be primarily sensory but some- times exhibits motor weakness as well.38,39 The incidence of musculoskeletal symptoms with hypothyroidism has been reported by Khaleeli, et al40 to be as high as 30% to 80%, depending on the special interests of the diagnosing physician

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