Link Between Frozen Shoulder and Thyroid Disease Understanding the symptoms and treatment options of frozen shoulder and thyroid disease is crucial for individuals dealing with these conditions. Frozen shoulder, characterized by shoulder pain, stiffness, and decreased mobility, can be accompanied by thyroid disorders such as hypothyroidism, hyperthyroidism, or thyroid cancer. These two conditions intersect in ways that are still being explored and understood by medical professionals.
Diagnosing frozen shoulder and thyroid disease involves a series of medical tests and evaluations to confirm the presence of these conditions. Treatment options for both frozen shoulder and thyroid disease may include physical therapy, medication, and other interventions aimed at managing symptoms and improving overall condition.
Furthermore, we will discuss the importance of rehabilitation and exercises in restoring shoulder mobility and reducing pain for individuals experiencing frozen shoulder and thyroid disease. Managing symptoms and lifestyle factors play a crucial role in the overall well-being of those affected, and we will provide practical tips and advice on pain management, stress reduction, and maintaining a healthy lifestyle.
We will also address the long-term outlook and prognosis for individuals dealing with both frozen shoulder and thyroid disease, highlighting potential complications and emphasizing the importance of ongoing management. Finally, we will touch upon the future research and advances in the understanding and treatment of these conditions, showcasing the ongoing studies and potential breakthroughs in these fields.
Frozen Shoulder: Causes, Symptoms, and Treatment
Frozen shoulder, also known as adhesive capsulitis, is a condition that causes shoulder pain, stiffness, and reduced mobility. It typically develops gradually and progresses through three stages: freezing, frozen, and thawing. Understanding the causes, symptoms, and treatment options for frozen shoulder is crucial in managing this condition effectively.
Causes of Frozen Shoulder
The exact cause of frozen shoulder remains unknown. However, certain risk factors have been identified that may increase the likelihood of developing the condition. These include:
- Age: Frozen shoulder commonly affects individuals between the ages of 40 and 60.
- Gender: Women are more susceptible to developing frozen shoulder compared to men.
- Underlying medical conditions: Individuals with diabetes, thyroid disease, or heart disease have a higher risk of developing frozen shoulder.
Symptoms of Frozen Shoulder
The primary symptoms of frozen shoulder include:
- Shoulder pain that worsens with movement
- Stiffness in the shoulder joint
- Limited range of motion in the shoulder
These symptoms can significantly impact daily activities and can even disturb sleep patterns. It is essential to seek medical attention if you experience these symptoms to receive a proper diagnosis and appropriate treatment.
Treatment Options
The treatment of frozen shoulder generally involves a combination of non-surgical interventions, such as physical therapy, medication, and home exercises. Physical therapy plays a crucial role in restoring shoulder mobility and reducing pain. Shoulder exercises, specifically designed to improve flexibility and strength, are an integral part of the rehabilitation process.
In more severe cases, a physician may recommend corticosteroid injections to decrease inflammation and alleviate symptoms. In rare cases where conservative treatments are ineffective, surgery may be considered to release the tightness in the shoulder joint capsule.
Shoulder Exercises for Frozen Shoulder
Regular shoulder exercises can help improve shoulder mobility and alleviate symptoms associated with frozen shoulder. While it is crucial to consult a healthcare professional before starting any exercise regimen, here are a few commonly recommended exercises:
- Pendulum swings: Gently swing your arm in circular motions while leaning over and supporting yourself with the unaffected arm.
- Passive stretching: Use your unaffected arm or assistive devices to help move the affected shoulder through its range of motion.
- Wall climbs: Stand facing a wall and use your fingertips to slowly climb up the wall, elevating your arm while maintaining contact with the wall.
- External rotation: Hold a resistance band or a towel with both hands and pull the band or towel away from your body while keeping your elbow close to your side.
These exercises should be performed under the guidance of a qualified healthcare professional or physical therapist to ensure safety and effectiveness.
| Treatment Options | Description |
|---|---|
| Physical Therapy | Physical therapy focuses on exercises and manual techniques to improve shoulder mobility and reduce pain. |
| Medication | Nonsteroidal anti-inflammatory drugs (NSAIDs) may be prescribed to alleviate pain and reduce inflammation in the shoulder joint. |
| Corticosteroid Injections | Injections of corticosteroids into the shoulder joint can help decrease inflammation and provide temporary relief from pain and stiffness. |
| Surgery | In severe cases, surgery may be recommended to release the tight capsule and regain shoulder mobility. |
Thyroid Disease: Overview and Types
Thyroid disease is a common condition that affects the thyroid gland, a small butterfly-shaped gland located in the front of the neck. This gland plays a crucial role in regulating various bodily functions, including metabolism, growth, and development. When the thyroid gland malfunctions, it can lead to thyroid disorders such as hypothyroidism, hyperthyroidism, or thyroid cancer.
Hypothyroidism
Hypothyroidism occurs when the thyroid gland fails to produce enough thyroid hormone. This condition can lead to a slowdown in bodily functions and metabolism, causing symptoms like fatigue, weight gain, and sensitivity to cold. It is often caused by an autoimmune disease called Hashimoto’s thyroiditis, but can also be a result of certain medications or iodine deficiency.
Hyperthyroidism
Hyperthyroidism, on the other hand, is characterized by an overactive thyroid gland that produces excessive amounts of thyroid hormone. This condition can accelerate the body’s metabolism, leading to symptoms such as weight loss, rapid heartbeat, and increased irritability. Graves’ disease is the most common cause of hyperthyroidism, but nodules in the thyroid gland or certain medications can also trigger this condition.
Thyroid Cancer
Thyroid cancer is a relatively rare form of cancer that affects the thyroid gland. It usually has a high survival rate when detected and treated early. The most common types of thyroid cancer are differentiated thyroid cancer (papillary and follicular) and medullary thyroid cancer. While the exact cause of thyroid cancer is unknown, certain genetic mutations and exposure to radiation may increase the risk.
Thyroid Symptoms
Thyroid disorders can present a wide range of symptoms that vary depending on the specific condition. Some common symptoms associated with thyroid disease include:
- Fatigue
- Weight changes
- Dry skin and hair
- Muscle weakness
- Irregular menstrual periods
- Depression or anxiety
- Trouble sleeping
- Swelling in the neck (goiter)
| Thyroid Disease | Common Symptoms |
|---|---|
| Hypothyroidism | Fatigue, weight gain, sensitivity to cold |
| Hyperthyroidism | Weight loss, rapid heartbeat, increased irritability |
| Thyroid Cancer | Swelling in the neck, voice changes, difficulty swallowing |
It’s important to note that these symptoms can be attributed to various illnesses, so it’s crucial to consult with a healthcare professional for an accurate diagnosis if you suspect a thyroid disorder.
Understanding the Relationship between Frozen Shoulder and Thyroid Disease
When it comes to the relationship between frozen shoulder and thyroid disease, there is ongoing research exploring the underlying mechanisms that may link these two conditions. While the exact connection is not fully understood, several potential factors contribute to their coexistence.
Firstly, hormonal imbalances associated with thyroid disease could play a role in the development of frozen shoulder. The thyroid gland produces hormones that regulate various functions in the body, including metabolism and musculoskeletal health. An imbalance in thyroid hormone levels can affect the structure and function of the shoulder joint, leading to shoulder pain, stiffness, and limited mobility.
Additionally, inflammation may be another common underlying mechanism. Both frozen shoulder and thyroid disease have been linked to chronic inflammation in the body. Inflammatory processes can contribute to the thickening and tightening of the joint capsule in the shoulder, causing the characteristic symptoms of frozen shoulder.
Furthermore, there may be an autoimmune component involved in the relationship between frozen shoulder and thyroid disease. Autoimmune conditions, such as Hashimoto’s thyroiditis and Graves’ disease, can lead to inflammation and tissue damage not only in the thyroid but also in other parts of the body, including the shoulder joint.
It is important to note that while the link between frozen shoulder and thyroid disease has been observed, not all individuals with thyroid disease will develop frozen shoulder, and not all cases of frozen shoulder are related to thyroid dysfunction. Other factors, such as age, gender, and previous shoulder injuries, may also contribute to the development of frozen shoulder.
In summary, the relationship between frozen shoulder and thyroid disease is a complex area that requires further investigation. While hormonal imbalances, inflammation, and autoimmune processes are potential underlying mechanisms, more research is needed to fully understand how these conditions intersect. By gaining a deeper understanding of this relationship, healthcare professionals can develop more effective strategies for diagnosing and managing both frozen shoulder and thyroid disease.
Frozen Shoulder as a Symptom of Thyroid Disease
One of the lesser-known symptoms of thyroid disease is the development of frozen shoulder. Frozen shoulder, also known as adhesive capsulitis, is a condition characterized by pain, stiffness, and limited range of motion in the shoulder joint. This condition often arises due to the thickening and tightening of the capsule surrounding the shoulder joint.
So, how exactly does thyroid disease contribute to the development of frozen shoulder? The key lies in hormonal imbalance. The thyroid gland plays a crucial role in regulating the body’s metabolism by producing hormones. When the thyroid gland is underactive (hypothyroidism) or overactive (hyperthyroidism), hormonal imbalance occurs. These hormonal imbalances can affect various tissues and structures in the body, including the shoulder joint.
Research has shown that hormonal imbalances associated with thyroid disease can lead to inflammation and changes in the connective tissues around the shoulder joint. This can result in the development of frozen shoulder. Additionally, these hormonal imbalances can contribute to increased pain sensitivity and decreased shoulder mobility, further exacerbating the symptoms of frozen shoulder.
Understanding the Connection
While the exact mechanisms linking thyroid disease and frozen shoulder are still being studied, it’s clear that there is an intricate relationship between these two conditions. To further explore this connection, let’s take a look at the underlying factors:
- Hormonal imbalance: Thyroid hormones directly impact the body’s metabolism and tissue function. Hormonal imbalances associated with thyroid disease can disrupt the normal functioning of the shoulder joint and lead to the development of frozen shoulder.
- Inflammation: Thyroid disease can trigger chronic inflammation in various parts of the body, including the shoulder joint. This inflammation can promote the thickening and tightening of the shoulder capsule, resulting in frozen shoulder.
- Impaired tissue healing: Hormonal imbalances can interfere with the body’s natural healing processes. In the case of shoulder injuries or trauma, impaired tissue healing may contribute to the development of frozen shoulder.
It’s important to note that not everyone with thyroid disease will develop frozen shoulder, and not everyone with frozen shoulder will have an underlying thyroid condition. However, being aware of this potential connection is crucial to ensure accurate diagnosis and appropriate treatment.
| Frozen Shoulder as a Symptom of Thyroid Disease | Factors Contributing to Development |
|---|---|
| Hormonal imbalance | Disruption of shoulder joint function |
| Inflammation | Thickening and tightening of shoulder capsule |
| Impaired tissue healing | Delayed recovery from shoulder injuries or trauma |
Diagnosing Frozen Shoulder and Thyroid Disease
Accurate diagnosis of both frozen shoulder and thyroid disease is essential for timely and effective treatment. Healthcare professionals employ various medical tests and evaluations to confirm these conditions and guide appropriate management strategies.
Frozen Shoulder Diagnosis
Diagnosing frozen shoulder typically involves a comprehensive evaluation of the patient’s medical history, physical examination, and imaging tests. The healthcare provider will inquire about symptoms such as persistent shoulder pain, stiffness, and limited range of motion. They may also assess any previous injuries or underlying medical conditions. During the physical examination, the doctor will perform specific maneuvers to evaluate shoulder mobility and identify characteristic signs of frozen shoulder, such as decreased range of motion and pain with movement.
Imaging tests, such as X-rays or magnetic resonance imaging (MRI) scans, may be ordered to rule out other shoulder conditions and confirm the diagnosis of frozen shoulder. These imaging techniques can provide a detailed view of the shoulder joint, helping to identify any structural abnormalities or inflammation.
Thyroid Disease Diagnosis
Diagnosing thyroid disease involves a comprehensive approach that may include blood tests, physical examination, and imaging studies. Blood tests are typically the first step in the diagnostic process. These tests measure thyroid hormone levels, including thyroid-stimulating hormone (TSH), T3, and T4. Abnormal hormone levels can indicate an underactive (hypothyroidism) or overactive (hyperthyroidism) thyroid gland.
Physical examination may involve palpation of the thyroid gland to check for any enlargement or lumps. In some cases, imaging studies like ultrasound or thyroid scans may be performed to provide a detailed view of the thyroid gland and identify any structural abnormalities or nodules.
Integrated Diagnosis Approach
Since frozen shoulder can occur as a symptom of underlying thyroid disease, it is crucial for healthcare professionals to have a holistic approach to diagnosis. They may consider the patient’s medical history, physical examination findings, and the presence of other symptoms related to thyroid dysfunction.
By integrating the diagnosis of both frozen shoulder and thyroid disease, healthcare professionals can develop a comprehensive treatment plan that addresses the underlying causes and provides optimal management strategies.
Treatment Approaches for Frozen Shoulder and Thyroid Disease
When it comes to managing frozen shoulder and thyroid disease, a variety of treatment approaches are available to alleviate symptoms and improve overall condition. These treatment options include physical therapy, medication, and other interventions that can help individuals regain mobility and reduce discomfort.
Treating Frozen Shoulder
Frozen shoulder, also known as adhesive capsulitis, is a condition characterized by shoulder pain, stiffness, and limited range of motion. To address these symptoms, a combination of physical therapy and medication is often recommended.
Physical therapy plays a crucial role in the treatment of frozen shoulder. Therapists work with patients to improve shoulder mobility through targeted exercises and stretches. These exercises help strengthen the muscles surrounding the shoulder joint and increase flexibility.
Additionally, medications such as nonsteroidal anti-inflammatory drugs (NSAIDs) or corticosteroid injections may be prescribed to reduce pain and inflammation. These medications can provide short-term relief and allow patients to engage more effectively in physical therapy.
Managing Thyroid Disease
Thyroid disease encompasses various conditions, including hypothyroidism, hyperthyroidism, and thyroid cancer. The treatment approach for thyroid disease depends on the specific diagnosis and its severity.
For individuals with hypothyroidism, medication in the form of synthetic thyroid hormones is typically prescribed to restore hormone levels in the body. This medication helps alleviate symptoms such as fatigue, weight gain, and muscle weakness.
Hyperthyroidism, on the other hand, may require different treatment options. Antithyroid medications help regulate the production of thyroid hormones, while radioactive iodine therapy and thyroid surgery may be recommended in more severe cases.
Intersection Between Treatment Approaches
Given the potential overlap between frozen shoulder and thyroid disease, a comprehensive treatment plan that addresses both conditions may be necessary. The physical therapy exercises prescribed for frozen shoulder can still be beneficial for individuals with thyroid disease by improving overall shoulder strength and mobility.
Furthermore, maintaining optimal thyroid hormone levels through medication can potentially enhance the effectiveness of physical therapy in managing frozen shoulder symptoms. By addressing both conditions simultaneously, individuals can experience improved shoulder function and better overall quality of life.
Below is a table summarizing the treatment approaches for frozen shoulder and thyroid disease:
| Treatment | Frozen Shoulder | Thyroid Disease |
|---|---|---|
| Physical Therapy | ✔ | |
| Medication | ✔ | ✔ |
| Corticosteroid Injections | ✔ | |
| Synthetic Thyroid Hormones | ✔ | |
| Antithyroid Medications | ✔ | |
| Radioactive Iodine Therapy | ✔ | |
| Thyroid Surgery | ✔ |
Rehabilitation and Exercises for Frozen Shoulder and Thyroid Disease
In the management of frozen shoulder and thyroid disease, rehabilitation and targeted exercises play a crucial role in improving shoulder mobility and reducing pain. These interventions can significantly enhance the overall quality of life for individuals facing the challenges of these conditions.
To address the specific needs of frozen shoulder and thyroid disease, a comprehensive rehabilitation program should focus on:
- Shoulder Mobility: Restoring and enhancing the range of motion in the shoulder joint to alleviate stiffness and improve flexibility.
- Muscle Strengthening: Strengthening the muscles surrounding the shoulder joint, enhancing stability, and supporting the rehabilitation process.
- Pain Management: Alleviating pain associated with frozen shoulder and thyroid disease through targeted exercises and pain-relieving techniques.
Below are some examples of exercises that can be beneficial for individuals dealing with frozen shoulder and thyroid disease:
1. Pendulum Exercises
Pendulum exercises involve gently swinging the arm in various directions to alleviate shoulder stiffness and improve mobility. These exercises can be performed by standing and leaning forward with the unaffected arm resting on a table or chair for support.
2. Shoulder Rolls
Shoulder rolls help in loosening the muscles and increasing the range of motion in the shoulder joint. Simply stand or sit upright, relax the shoulders, and perform gentle backward and forward rotations.
3. Wall Climbs
Wall climbs are effective in gradually improving shoulder mobility. Stand facing a wall with the fingertips touching the wall, and slowly climb the fingers up the wall while maintaining contact and control. Repeat this exercise several times.
4. Resistance Band Exercises
Resistance band exercises can be used to strengthen the muscles around the shoulder joint. Wrap a resistance band around a sturdy object and hold the other end with the affected arm. Perform controlled movements such as shoulder abduction, flexion, and external rotation to work the targeted muscles.
| Exercise | Description |
|---|---|
| Pendulum Exercises | Gently swing the arm in various directions to alleviate shoulder stiffness and improve mobility. |
| Shoulder Rolls | Loosen the muscles and increase the range of motion in the shoulder joint by performing gentle backward and forward rotations. |
| Wall Climbs | Gradually improve shoulder mobility by climbing the fingers up a wall while maintaining contact and control. |
| Resistance Band Exercises | Use a resistance band to strengthen the muscles around the shoulder joint by performing controlled movements like abduction, flexion, and external rotation. |
It is important to consult a healthcare professional or a certified physical therapist before attempting any new exercises, especially if you have existing medical conditions or injuries. They can provide personalized guidance and ensure that the exercises are appropriate for your specific needs.
By incorporating rehabilitation and exercise into your comprehensive treatment plan, you can enhance shoulder mobility, reduce pain, and improve your overall well-being while managing frozen shoulder and thyroid disease.
Managing Symptoms and Lifestyle Factors
When dealing with frozen shoulder and thyroid disease, effectively managing symptoms and considering lifestyle factors is crucial for overall well-being. By adopting a proactive approach, individuals can take steps to mitigate pain, reduce stress, and improve their quality of life. Here are some practical tips to help manage these conditions:
1. Pain Management Strategies
Pain management is key when dealing with frozen shoulder and thyroid disease. Consider the following strategies to help alleviate discomfort:
- Hot and cold therapy: Applying hot or cold packs to the affected shoulder can provide temporary relief.
- Over-the-counter pain relievers: Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen can help reduce pain and inflammation.
- Topical creams: Topical creams containing menthol or capsaicin may be effective in relieving localized pain.
2. Stress Reduction Techniques
Stress can exacerbate symptoms of frozen shoulder and thyroid disease. Managing stress can help improve overall well-being. Consider the following techniques:
- Deep breathing exercises: Practice deep breathing techniques to promote relaxation and reduce stress levels.
- Mindfulness and meditation: Engaging in mindfulness practices or meditation can help calm the mind and reduce stress.
- Regular exercise: Engaging in regular physical activity can help reduce stress and improve mood.
3. Healthy Lifestyle Choices
Adopting a healthy lifestyle can support the management of frozen shoulder and thyroid disease. Consider the following lifestyle factors:
- Balanced diet: Consume a nutritious diet rich in fruits, vegetables, whole grains, and lean proteins to support overall health.
- Adequate sleep: Establish healthy sleep habits and aim for 7-9 hours of quality sleep per night.
- Regular exercise: Incorporate regular exercise into your routine to improve shoulder mobility and promote overall well-being.
By proactively managing symptoms and considering lifestyle factors, individuals can empower themselves to lead fulfilling lives despite the challenges posed by frozen shoulder and thyroid disease.
| Management Strategies | Frozen Shoulder | Thyroid Disease |
|---|---|---|
| Pain Management | – Hot and cold therapy | – Medication for pain relief |
| Stress Reduction | – Mindfulness and meditation | – Stress management techniques |
| Healthy Lifestyle Choices | – Regular exercise for shoulder mobility | – Balanced diet for overall health |
Long-Term Outlook and Prognosis
Understanding the long-term outlook and prognosis for individuals with frozen shoulder and thyroid disease is crucial for managing these conditions effectively. Both frozen shoulder and thyroid disease can present unique challenges, but with proper treatment and ongoing management, individuals can experience improved quality of life.
It is important to note that the long-term outlook can vary significantly depending on the severity of the conditions and individual factors. While some individuals may experience complete resolution of symptoms over time, others may require ongoing management to maintain shoulder function and thyroid health.
For individuals with frozen shoulder, the prognosis often depends on early diagnosis and appropriate treatment. Physical therapy plays a vital role in improving shoulder mobility and reducing pain. In some cases, corticosteroid injections or surgical intervention may be necessary to achieve the best outcome. With diligent rehabilitation and adherence to treatment plans, many individuals experience significant improvement in shoulder function.
Thyroid disease, on the other hand, requires long-term management to achieve optimal health. Hypothyroidism and hyperthyroidism can be effectively controlled with medication, regular monitoring, and lifestyle adjustments. In cases of thyroid cancer, early detection and treatment play a critical role in prognosis and overall survival rate.
Complications and Ongoing Management
While many individuals with frozen shoulder and thyroid disease respond well to treatment, there are potential complications that can impact the long-term outlook. Adhesive capsulitis, a severe and prolonged form of frozen shoulder, may lead to permanent limitations in shoulder mobility if not promptly addressed. Similarly, untreated or poorly managed thyroid disease can result in significant health complications, including cardiovascular issues, weight fluctuations, and mental health concerns.
That is why ongoing management and regular follow-up care are essential. It is crucial for individuals to work closely with their healthcare providers to ensure that treatment plans are adjusted as needed. Regular monitoring of thyroid hormone levels, shoulder function, and overall well-being can help prevent complications and enhance long-term outcomes.
Proactive Lifestyle Measures
In addition to medical treatment, individuals can take proactive steps to promote better long-term outcomes. This includes maintaining a healthy lifestyle with regular exercise, a balanced diet, and stress management techniques. These lifestyle measures can help support overall well-being and support the body’s natural healing processes.
Summary
| Frozen Shoulder | Thyroid Disease |
|---|---|
| Acknowledge the importance of early diagnosis and treatment | Ensure proper medication and regular monitoring |
| Physical therapy, corticosteroid injections, or surgery when necessary | Lifestyle adjustments and medication for optimal thyroid health |
| Potential complications: limited shoulder mobility | Potential complications: cardiovascular issues, weight fluctuations, mental health concerns |
| Ongoing management and regular follow-up care | Regular monitoring of thyroid hormone levels |
| Maintaining a healthy lifestyle with exercise, diet, and stress management |
By understanding the long-term outlook and prognosis for frozen shoulder and thyroid disease, individuals can take proactive steps towards better health and well-being. With proper management and ongoing care, it is possible to minimize complications and achieve an improved quality of life.
Future Research and Advances
The field of healthcare is constantly evolving, and ongoing research is paving the way for advancements in the understanding and treatment of frozen shoulder and thyroid disease. Researchers are focusing on uncovering further insights into the intricate relationship between these conditions, exploring the underlying mechanisms that connect them.
Future research endeavors aim to delve deeper into the potential genetic, hormonal, and environmental factors that contribute to the development and progression of frozen shoulder and thyroid disease. This knowledge can pave the way for more targeted and personalized treatment approaches, tailored to individual patients’ needs.
Advances in technology and imaging techniques also hold promise for improved diagnosis and monitoring of these conditions. Non-invasive methods, such as ultrasound and advanced imaging technologies, may provide more accurate assessments of shoulder function and thyroid gland activity.
Furthermore, emerging treatment modalities, including regenerative medicine techniques and innovative drug therapies, are being explored as potential avenues for managing frozen shoulder and thyroid disease more effectively. These advancements have the potential to enhance symptom relief, restore shoulder mobility, and improve the overall quality of life for individuals affected by these conditions.
FAQ
Is there a link between frozen shoulder and thyroid disease?
Yes, there is a potential link between frozen shoulder and thyroid disease. While more research is needed to fully understand this relationship, studies have shown a higher prevalence of frozen shoulder in individuals with thyroid disorders.
What are the symptoms of frozen shoulder?
Common symptoms of frozen shoulder include shoulder pain, stiffness, and limited range of motion. These symptoms usually develop gradually, and the condition typically progresses through three stages: freezing, frozen, and thawing.
What are the symptoms of thyroid disease?
The symptoms of thyroid disease can vary depending on the specific condition. Common symptoms of hypothyroidism (an underactive thyroid) include fatigue, weight gain, depression, and sensitivity to cold. Hyperthyroidism (an overactive thyroid) may cause symptoms such as weight loss, rapid heartbeat, anxiety, and heat intolerance.
