Hypothyroid muscle and joint pain present in 30% to 80% of hypothyroid women patients, manifests in both congenital and acquired cases with generalized myalgias, muscle weakness, and muscle pain or stiffness. Thyroid hormone plays a vital role in metabolism, growth, and organ function and is a primary regulator of energy availability and consumption in the musculoskeletal system. Proximal muscles such as thighs, hips, shoulders, and neck are commonly involved, impacting activities such as stair climbing, rising from a seated position, and lifting objects. Severe or untreated hypothyroidism can prompt substantial muscle disease, leading to severe functional limitations. All patients diagnosed with hypothyroidism should be questioned about musculoskeletal symptoms. Rarely, severe hypothyroid myopathy can result in muscle necrosis, acute compartment syndrome, or respiratory failure.