Increased Prevalence of Hypothyroidism Among Patients with Scoliosis

Introduction: A possible direct relationship between hypothyroidism and scoliosis has not been previously studied. Here, we evaluate whether there is an increased prevalence of scoliosis in a population of patients with hypothyroidism.

Methods: Electronic medical records were used to perform a retrospective analysis of patients at CHI Creighton University Medical Center - Bergan Mercy in Omaha, Nebraska who were 65 years of age or older and had an MRI lumbar spine with “scoliosis” indicated in the report (2013-2023). Within that cohort, hypothyroidism was defined as patients with a hypothyroidism diagnosis and/or on thyroid replacement medication.

We also reviewed the literature utilizing “hypothyroidism and scoliosis” on PubMed. Animal model studies or those not pertaining to degenerative spine disease were excluded.

Results: 974 patients were identified as having an MRI lumbar spine with scoliosis and included in the retrospective analysis. 29.0% (N=282) of those patients were found to have hypothyroidism; 81.9% (N=231) had both a hypothyroidism diagnosis while concurrently taking Levothyroxine, 11.0% (N=31) had a hypothyroidism diagnosis alone, and 7.1% (N=20) were taking Levothyroxine without a formally listed diagnosis. 4.8% (N=47) had no formal diagnosis or thyroid replacement medication but had a “high” TSH value (greater than 4mU/L).

The literature search revealed that no direct relationship has been established between hypothyroidism and scoliosis. Rather, symptoms within different disease processes would occasionally report the two occurring individually or simultaneously.

Conclusion : Our study describes an increased prevalence (29.0%) of hypothyroidism in patients with adult scoliosis which may be higher given undiagnosed hypothyroidism (4.8%) in our cohort. The prevalence is higher than previously reported values in the adult population (11.7% amongst adults, 6.9% amongst those at least 65 years of age). Further studies are required to establish a causative relationship.