Hypothyroidism and Degenerative Spine Disease: A Literature Review

Hypothyroidism is an increasingly prevalent endocrine disorder, with recent U.S. estimates approaching 11.7%. While hypothyroidism has been suggested as a risk factor in spinal surgery outcomes, its prevalence and association with degenerative spine disease remain underexplored. To address this gap, we conducted a comprehensive literature review utilizing various databases from their inception through October 2024. Studies were selected if they documented a diagnosis of hypothyroidism or markers of thyroiditis in relation to patients with spine disease. A total of 647 titles were identified, of which 22 were included in the final analysis. A total of 647 titles were identified, of which 22 were included in the final review. Prevalence of hypothyroidism was reported from 5.4% to 31.5% in degenerative spine disease cohorts ( n = 12). Patients with hypothyroidism undergoing spine surgery were found to have increased length of stay ( n = 3), readmission rates ( n = 3), and rates of pseudoarthrosis ( n = 2). Hypothyroidism was found to correlate significantly with radiographic findings of spine disease ( n = 3). These findings suggest that hypothyroidism may be a clinically significant risk factor not only for postoperative complications following spinal surgery but also for the severity of underlying degenerative pathology. Thyroiditis has been found to be associated with spine disease independently, further supporting a potential immuno-inflammatory link. The increasing prevalence of hypothyroidism in aging populations, coupled with these associations, suggests a need to further investigate whether hypothyroidism plays a causal role in the pathogenesis or progression of spine degeneration. Future studies should examine whether optimization of thyroid hormone levels prior to surgical intervention could mitigate postoperative complications. Additionally, greater awareness among spine surgeons regarding thyroid function may allow for more tailored preoperative assessment and postoperative management, particularly in high-risk populations.