Skin signs of thyroid disease

Skin signs of thyroid disease

In the book Hypothyroidism: The Unsuspected Illness thyroid pioneer Dr. Broda Barnes wrote, “When thyroid function is low, circulation is reduced. In advanced cases of hypothyroidism, the skin, in fact, may receive as little as one-fourth to one-fifth the normal blood supply.”

I suspect I had undiagnosed hypothyroidism for most of my life. From a very young age skin conditions including dry itchy skin, itchy flaky scalp, dry frizzy hair, dry cracked heels, loss of the outer third of eyebrows, brittle nails, loss of eyelashes, pale colorless skin, and chronic eczema have been a constant in my life. I went through a period of rapid hair loss that devastated me so much that I spent over one year researching the causes of hair loss to save my own hair. Thankfully with optimal thyroid treatment many of my skin issues have improved and I have found solutions for my thyroid hair loss.

I wonder just how many people with hypothyroidism and hyperthyroidism are struggling with skin-related conditions. Do they know these skin issues may be a sign their thyroid condition is not optimally treated?

Written by Dr. Amanda Oakley, DermNet NZ

Skin problems can be significant in patients with thyroid disease. Not surprisingly, the signs of an underactive thyroid are quite different from those of an overactive thyroid.


Whatever its cause— iodine deficiency, autoimmune disease, treatment of hyperthyroidism or medications—the skin signs of inadequate thyroid hormone are similar.

The signs are rather non-specific, often subtle, and easily confused with other conditions or normality. In advanced hypothyroidism, the following symptoms may lead to a visit to the doctor and thyroid hormone testing.

  • Intolerance of cold conditions – needing to wear more clothing than previously
  • Dry skin
  • Dry, brittle, thinning hair
  • Dry, brittle, ridged or split nails

Dry Skin

Hypothyroidism Dry Skin

Copyright Waikato DHB and DermNet NZ (with permission)

Skin examination may reveal:

  • Cool, dry or waxy skin
  • Facial puffiness, especially eyelids
  • Thickened skin of lower legs with a pale or yellowish appearance
  • Thinned scalp, eyebrow, armpit and pubic hair that is coarse and dry
  • Dry, ridged or split nails

Skin swelling is myxoedema, due to the deposition of sugars called glucosaminoglycans.


Skin signs of thyroid disease - Vitiligo

Copyright Waikato DHB and DermNet NZ (with permission)

The thyroid autoimmune condition Hashimoto’s thyroiditis is associated with other autoimmune diseases, including vitiligo (white patches of skin) and alopecia areata (hair loss in which there are round bald patches).

Alopecia Areata

Skin signs of thyroid disease - alopecia areata

Copyright Waikato DHB and DermNet NZ (with permission)

With thyroid hormone replacement, the symptoms and signs of hypothyroidism gradually return to normal. Some patients may continue to have mildly dry skin even when blood tests indicate their thyroid hormone levels are optimal.

Thyroid hormone replacement should be undertaken gradually to avoid complications of treatment such as excessive flushing, sweating, and paradoxically, further hair loss. Hypersensitivity reactions are rare, but can include rash.


Excessive thyroid hormone leads to an increase in basal metabolic rate—body functions go faster than normal. For the skin, this often leads to:

  • Intolerance of hot conditions – needing to wear less clothing than previously
  • Increased perspiration and warm, moist skin, which can lead to sweat rashes in skin folds
  • Increased hair shedding
  • Rapidly growing nails that may lift off the nail bed (this is called onycholysis)

Graves’ disease is an autoaimmune disease often recognized by protruding eyes. About 2% of patients with Graves’ disease develop pretibial myxoedema. This often arises at sites of previous injury. It occurs more often in females than in males, and more often in patients over the age of 50 years than in younger people.

Signs of pretibial myxoedema are:

  • Red or brownish, thickened plaques with non-pitting oedema
  • Prominent hair follicles “like the skin of an orange”
  • Warty surface, increased hair and increased sweating
  • Distribution is usually on the shins, but sides and back of lower legs, thighs, arms and other sites may be involved

Pretibial myxoedema

Hyperthyroidism Pretibial Myxoedema

Copyright Waikato DHB and DermNet NZ (with permission)

Pretibial myxoedema can be itchy or painful and can persist after successful return of thyroid hormone status to normal levels.

As with Hashimoto’s thyroiditis, Graves’ disease is associated with other autoimmune diseases, including vitiligo (white patches of skin) and alopecia areata (hair loss in which there are round bald patches).

Treatment of hyperthyroidism is often with carbimazole or propylthiouracil. These occasionally cause an itchy rash, which is usually mild. Rarely, hypersensitivity vasculitis arises, which can present with purple non-blanching bumps (palpable purpura) on the lower legs and feet. Palpable purpura should be urgently investigated and the drug should be stopped.

About Dr. Amanda Oakley

Associate Professor Dr. Amanda Oakley is a dermatologist at Waikato Hospital in Hamilton, New Zealand. She is also the website manager and chief editor of DermNet NZ. DermNet NZ presents authoritative facts about the skin for consumers and health professionals in New Zealand and throughout the world. It is written and reviewed by dermatologists, other health professionals and medical writers.

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About Dana Trentini

Who knew that little butterfly-shaped thyroid gland at the base of my neck could affect my life so completely? I founded Hypothyroid Mom in memory of the unborn baby I lost to hypothyroidism. Winner of two 2014 WEGO Health Activist Awards: Health Activist Hero & Best In Show Twitter. *Hypothyroid Mom includes Affiliate links. Connect with me on Google+

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