Thyroid Disorders on Adhesive Capsulitis: Examining the Role of IL-6 and CRP in Acute and Chronic Pain Stages

Objective: Thyroid dysfunction is a known risk factor for adhesive capsulitis (AC), but prior studies have relied on single-domain outcomes without formal inferential comparison between thyroid subtypes. No Indian study has examined, within one cohort using validated multidomain instruments, whether physical, psychological, and functional burden in thyroid-related AC differs by subtype. This study assessed prevalence and distribution of physical activity, sleep quality, psychological morbidity, kinesiophobia, functional disability, quality of life, pain, and irritability in patients with AC and co-existing hyperthyroidism or hypothyroidism, stratified by disease duration, and tested for association between subtype and each domain.
Methods: This was a single-centre, cross-sectional observational study conducted in patients aged 40 to 60 years with clinically diagnosed AC and co-existing thyroid dysfunction. A total of 46 patients were enrolled and form the study sample reported in the demographic and clinical summary. Thyroid-subtype classification (hyperthyroid n=23, hypothyroid n=20; total 43) was available for 43 of the 46 participants, and subtype-stratified analyses are based on these 43 participants. All outcome measures were collected at a single assessment visit; disease-duration strata (≤1, 2–4, ≥5 years) reflect the recorded duration of thyroid diagnosis at that visit rather than longitudinal follow-up. Validated instruments assessed each domain. Fisher's exact test evaluated subtype–outcome associations, appropriate given small cell sizes (as low as n=2 in some strata); duration-stratified comparisons remained descriptive. A post hoc sample-size and power appraisal is reported alongside the primary analysis, and a Bonferroni-adjusted significance threshold (p<0.00625 for eight comparisons) is applied alongside the conventional p≤0.05 threshold to contextualise the single significant finding.
Results: Physical inactivity, poor sleep, psychological distress, kinesiophobia, disability, pain, and irritability were prevalent throughout the cohort. Only poor sleep quality showed a significant subtype association, more frequent in hyperthyroid than hypothyroid participants (69.5% vs 30.0%; Fisher's exact p=0.015, odds ratio 5.33, 95% CI 1.45 to 19.67; risk difference 39.6 percentage points, 95% CI 12.1 to 67.1), a difference that was statistically significant under the conventional threshold but did not remain significant after Bonferroni correction for eight comparisons (adjusted threshold p<0.00625), and is therefore reported as a nominally significant, hypothesis-generating association rather than a multiplicity-robust finding. No significant associations emerged for the remaining seven domains (p=0.669-1.000), though descriptive differences were noted and are reported strictly as hypothesis-generating.
Conclusion: This cross-sectional, multi-instrument, formally tested characterisation of burden in Indian patients with adhesive capsulitis with co-existing thyroid dysfunction found that sleep quality alone showed a nominally significant association with subtype under the conventional threshold that did not survive Bonferroni correction, and is presented as a hypothesis-generating signal warranting clinical attention to sleep in hyperthyroid patients rather than a statistically robust, multiplicity-adjusted finding; other observed differences require confirmation in larger, adequately powered cohorts.