Q. I have painful cramps in my calf and thigh with twitching. What could it be?

Answered by
Dr. Hitesh Kumar
and medically reviewed by Dr. Preetha J
This is a premium question & answer published on Nov 04, 2020

Hi doctor,

I have painful cramps in my calf and thigh, mostly intermittently, for around three months. The twitching started about two months ago in the same leg long before I was anxious about it. I have been to the GP. I am going completely mad with worry over ALS and cannot get it out of my head as I have read that it can begin with these symptoms alone without any muscle weakness or atrophy. I am not coping well, and the GP knows that. She checked over my whole body for any changes, but all are fine. She tested all muscle strength in arms and legs, did reflexes, and the Babinski test came back fine. I feel that I am now just waiting for something to fail as most on here say twitch and cramp come after weakness, and one thinks it can take six months to notice weakness from the onset of twitching or cramps. I am not sure what to think. My blood came back with a slightly low vitamin D but nothing concerning. Can you help with some reassurance as I cannot stay worried waiting for something else to happen? I still run and exercise.



Welcome to

I would like to know some details about your symptoms:

1. What is your age?

2. Is your body weight is 30.39 kg with a height of 5.4 feet, or it is the wrong entry in the query?

3. Since when you have hypothyroidism and taking Levothyroxine, and in what dose are you taking it?

4. In which body parts you have twitching?

5. Have you noticed trigger factors or situations when these twitchings are more?

6. What exactly happens during a painful cramp?

  • Which body parts involved in that?
  • How long does one cramp last?
  • How it subsides?
  • Is it getting it better by local massage?

7. Do you have any neck pain or lower back pain?

8. Do you have any difficulty in the control of urine?

9. How is your sleep in a routine?

  • Do you get sleepy soon after lying in bed?
  • Or it takes a long time?
  • Once got sleepy, do you have frequent awakenings during sleep?
  • Do you feel fresh on awakening from sleep in the morning?

10. How is your usual mood in day-to-day activities? Happy or toward the sad side (thinking about past events) toward the worried side (thinking about future things or irritable or something else)?

11. How is your appetite?

12. Do you had you any significant weight loss in recent times?

13. Have you undergone any other test (apart from blood work), like MRI (magnetic resonance imaging) brain or spine, NCV (nerve conduction velocity), EMG (electromyography), etc.? If yes, please send it here as an attachment.

It is good that your muscle power is good, and reflexes are normal.

Also, are you able to run and do exercises?

Such cramps and twitching can happen in many conditions like anxiety or benign fasciculation syndrome or benign cramps or hypocalcemia or hypoparathyroidism, or some hormonal imbalance.

Regarding follow up:

Please revert to the above-mentioned information for better understanding and further judgment and also send your investigation reports as attachment.

Thank you, doctor, for your reply.

I am 53 years old, and my weight is 60.3 kg. I am taking Thyroxine 75 mcg for the past 28 months. I have twitching in the calf and thighs. When I am anxious, the twitchings are more. I will have cramps at night or rest and not while moving mainly in the calf, which lasts for a few minutes and goes by stretching or walking. I do not have any neck or back pain, and I do not have any difficulty controlling urine. My sleep routine is broken only during a cramp. My mood in the morning is usually happy, but not at the moment when I am very low and anxious. I did lots of research on the internet, which gave me the symptoms of ALS. My appetite is fine, but I feel sick as I am worried. I recently do not have any weight loss. Only blood work has been done. I usually run, do yoga, circuit training, and sometimes get cramp in yoga positions. The doctor gave a clinical examination. The cramps have been going on for three months, and the twitching or pulsating came later.



Welcome back to

As per your description, it seems that you are very anxious, maybe some underlying anxious personality, and superadded by current thoughts of ALS (Amyotrophic lateral sclerosis).

Such twitching (fasciculation) in body parts can happen due to many reasons like anxiety, or hyperthyroidism, or benign fasciculation syndrome, or cramp fasciculation syndrome, or ALS, etc. Cramps are also very common symptoms, can happen in anxiety or low calcium state or even can happen without a known cause. In your case, as you mentioned that there is no weakness or thinning of any limb and reflexes are fine, I would like to consider the possibility of :

1. Anxiety disorder.

2. Benign fasciculation syndrome.

3. Cramp fasciculation syndrome.

There are no conclusive investigative tests available, which can rule out or confirm it. Diagnosis of ALS is a clinical diagnosis after the patient's clinical findings fulfill the diagnostic criteria for it is diagnosis. ALS is a rare progressive disease, and symptoms and signs can develop with time. But it is inappropriate to have the anxiety of getting ALS just due to twitching and cramp, which are very frequent in other common conditions. However, you can get some investigations to rule out some other organic cause of these symptoms.

Investigations to be done:

T3 (Triiodothyronine), T4 (thyroxine), TSH (thyroid stimulating hormone).
NCV (Nerve conduction velocity), and EMG (electromyography) all four limbs.
MRI (magnetic resonance imaging) screening of the whole spine.
Serum ionic calcium.
Serum vitamin D3.
Serum PTH (parathyroid).
Serum anti-VGKC (voltage-gated potassium channel) antibodies.

Differential diagnosis:

1. Anxiety disorder.
2. Benign fasciculation syndrome.
3. Cramp Fasciculation syndrome.
4. Neuromyotonia.

Treatment plan:

Can first undergo suggested investigations, if they come out to be normal, can meet a psychiatrist, and start with anti-anxiety medication.
If I find some abnormalities in tests, we will decide according to it.

Regarding follow up:

Revert with above mentioned reports.

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