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.

Hypothyroidism

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.

Vitiligo

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.

Hyperthyroidism

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

I founded Hypothyroid Mom October 2012 in memory of the unborn baby I lost to hypothyroidism. Hypothyroid Mom is for informational purposes only and should not be considered a substitute for consulting your physician regarding medical advice pertaining to your health. Hypothyroid Mom includes affiliate links to favorite resources including the Amazon Services LLC Associates Program. Connect with me on Google+

Comments

  1. I geel so gross. My scalp is scaley and itchy. I have tried oils and zinc shampoos..
    Nothing seems to help. Its terrible and I’m going crazy. Does anyone have suggestions! I feel like I can’t handle this anymore.

    • Maria Modod says:

      The only solution to thyroid related problems involving skin conditions is to change the diet. No gluten and no sugar and no processed food. Fruits are okay. You will see the difference in a month. Go as natural as possible. Avoid commercial store bought creams and lotions. So far i only liked Eucerin. If possible choose organic skin care line. Drink filtered water and even better if you can get filter i stalled in your shower faucet. Good luck and dont lose hope. You are not alone in this…. Take care

    • Have you tried tar products? Shampoo as well as cream.

    • There is this YouTube video https://www.youtube.com/watch?v=DsU1tCcAxLw&t=982s I don’t know if you have psoriasis, but the treatment seems to help a lot of people. Worth a try?

    • I have found an Aveda scalp product that helps – pramàsana. I trialled it at my hairdressers but is also available at Aveda stores.

    • Lynette R says:

      Clobetasol Propionate works WONDERS!! I HIGHLY recommend it!!!

      • I use that stuff off and on, whenever I get desperate. It does help but only temporarily. It’s NOT a cure and does have side effects of its own.

    • Elizabeth says:

      try 50% Apple cider vinegar mixed with 50% water. Mix in spray bottle. Apply completely to your scalp. Pop on a shower cap leave on 20-60 minuets depends on how much you have. Then wash out. My daughters will get so bad she scratches it till it bleeds. This is the only thing that works for her. You will need to do at least once a week I have to do every other day with her.

    • Mine does sound different than yours but this is worth a try. I had bumps on top and on one side of head which was painful. My scalp was gritty with bumps. They felt a little pointy. Being a crazy OILer, I tried many but found two testimonials. Crazy but they used Thieves home cleanser. You only need a very little amount to clean the house. At first I dabbed my bumps with it, let it sit 15 minutes & washed hair. The next night I thought what the heck, so I took a full capful maybe two and saturated the scalp where the bumps were, did it two more nights and they were gone. I finally got into the dermatologist – she said my scalp was really clean but with two bumps. Long story short. She said what I had some young people get but mostly older folks like me. They try prescription after prescription but nothing every totally works. She told me to do whatever I was doing but it worked and she was going to look into it for her own patients. I HOPE you find what works for you. I think we have toxins and bacterial in our body which causes a whole host of problems.

    • Neutrogena tar shampoo…works like a charm

    • Kittifer says:

      I tried massaging coconut oil into my scalp and it helped. I was worried about having greasy hair but it seemed to look thicker. I was pleased as it had been thinning. 🙂

    • Jenny Turner says:

      I used to treat my mums scaley scalp with a diluted sulution of Dettol, worked wonders, so try rinsing hair with a jugful of this every so often.

  2. Judith Dominguez says:

    Hi guys I’m 57 years old. I had thyroid cancer in 2006 now I had 17 neck nodules removed of 13 cancerous. Before this I had Congestive Heart . Had pacemaker defribulator inserted and they told me it was due to a viral infection. I was very thin prior to my last daughter in 2001 I had an emergency cesarean done. Since then I went down hill. I have been tested fir Hashimoto and tested positive. Now they said I still have papillary cancer but not to worry. Had surgery to remove my nodules and my voice still hasn’t returned. Ugh thus sucks!!!

  3. Verna Hebert says:

    I have symptoms of both hypo and hyper . I can’t tolerate heat in summer and cold in winter . The heat in summer is more severe because I live in south Louisiana . If I get too hot I start throwing up and want to pass out ! I am careful where i go . In winter if I get cold I am shaking so hard I look like I’m having a seizure !!!! I was in my 50’s before I was diagnosed . The endo said he thought I had this as a child and it was overlooked . I have had many symtoms and problems . I had my thyroid removed in 2005 and had RAI . It is horrible to live this way ! I am now 69 !

    • I also have symptoms of hypo and hyper and of course my work ups always show the opposite of whatever state I happen to be in. I had one thyroid
      Removed in my late 40’s and was diagnosed with Hashimotos then, now I’m 62 and my mental and physical health is really starting to take its toll. I’m going to switch to Armour when I get back home as I have some friends and family who have found relief going this route, you might want to look into it as an option.

    • Patricia my heart goes out to you. Gulp is that my future.

  4. So… like… any advice right now would be helpful. I have been monitoring my thyroid because my previous doctor said she was concerned about weird levels (always ‘within acceptable parameters,’ but off). I have recently been reconnecting with my mom and her family (they weren’t really a part of my life) and things have been stressful. I have PTSD, and I started vomiting like… all the time recently. I assumed it was stress, as I have had that reaction before… but not like this. I have lost like 20 lbs. I also just found out that my biological mom and maternal grandmother have Grave’s Disease. I immediately scheduled an appointment with a doctor (I had been putting it off when I just thought it was psychosomatic) and the doctor immediately referred me to a psychiatrist. He refused to prescribe an anti emetic. I held onto hope that the psychiatrist would take me seriously, but he was so dismissive of what I was saying that he sent the prescription he gave me (for an ssri? I think? he rushed through the whole appointment) to a pharmacy that I had just told him (more than once) was no longer anywhere near where I lived. I also have a prolonged QT interval, which was discovered by the same doctor who told me to keep an eye on my thyroid levels, because she was going to prescribe me citalopram and she wanted to make sure I didn’t have an underlying condition (citaloptram can prolong qt interval). Like. I simultaneously feel like a crazy person because doctors keep dismissing things, but I decided to try and inform myself and… like… I have the symptoms that folks talk about. And I don’t know what to do. They did a thyroid test (which the psychiatrist dismissed and the original doctor almost didn’t order) so hopefully that will help? I am just so confused about all of this, and I only just got insurance back. Like. When I went in to the doctor, I just asked him to help me with the vomiting and run the test. I’m not like… totally convinced I have this or anything…… I just am really scared, because I am losing weight so fast, and I just feel so depressed. If this isn’t just PTSD, I can’t deal with it like it is.
    To be clear, I have round patches on my head. I always assumed they were scars from cigarette burns (I have those in other places). I have reddish purple… bumps? What I would refer to as eczema (because that’s what the doctor said it was) on my shin, the top of one foot, knees, and elbows. The skin flakes sometimes, but it never goes away. My skin isn’t dry, though, it’s oily, which is why the patches are so weird.
    Sometimes my hands and feet hurt so much I have difficulty walking or holding things. I always assumed it was a side effect of the muscle spasms I have.
    I guess my point is, I have a long history of weird medical things, and the more I read about Grave’s, the more that makes sense. I just don’t know how to advocate for myself with these doctors.

    • I have to pretend that I am advocation for someone else… becasue I will go to bat for others bt I feel not so easy formy self

    • E. Richardson says:

      You sounds like you have Hashimotos Hyperthyroid. You need an intergrative approach doctor. Also get the book 90 day protocol Dr. Wentz. You will find that all of your symptoms are related, and also find very helpful strategies to get you well. Your Graves D. was probably caused by your thyroid or vice verse. It is very common to get additional autoimmunes with Hashimotos.

    • Have you gotten any answerss? I am working with an amazing immunologist/allergist to get a diagnoses of what is going on with me. If you haven’t gotten answers…don’t give up! Switch doctors and get some referrals to docs recommended in your area

    • Keri R says:

      If you have PTSD, it may be the cortisol that’s making your thyroid out of order. My thyroid seems hyper one month then hypo the other.
      I’m no expert but I’ve looked at PTSD and thyroid and there are reports of it really messing things up.
      Have you looked up cortisol and thyroid?
      It may raise more questions than answers. It seems like that doctor you told you about watching your levels may be the best to deal with it. She seems to know more than the other, IMO.

  5. REANNA BROWN says:

    I hope this is still an active feed. I was recently diagnosed with hyperactive thyroid. It started several months ago after I gave birth to my second child. It started with a long very heavy and dark period that lasted almost 4 months. Then in as little as 2 short weeks I lost over 25 pounds. I finally was diagnosed. I’ve been taking this medication but have now noticed my face and hands starting to peel and crack. I’m miserable, constantly exhausted and irritable. My doctor has not discussed any of these symptoms with me at all. Actually I only received a phone call 2 days after they drew my blood. I was told over the phone that I had this and was told to pick up a prescription. I see my doc on the 1st and hope she can give me the answers I need. Looking for some guidance here as well.

    • Jean Settle says:

      Look into subacute, or De Quervain’s, thyroiditis. I developed hyperthyroid symptoms and lost a lot of weight in the months after my baby was born. By the time the doctor concluded it was not a true Graves disease, I was starting to improve. He never gave me thyroid meds, just told me to take aspirin. I recovered after a few months. But 15 yrs later I started having hypothyroid symptoms, and have been on levothyroxine and liothyronine for a long time now. Still have skin problems but otherwise feel pretty good. I’m going to experiment with some of the other suggestions I’ve seen here, including cutting out some foods. – while still taking the Rx I’ve been using.

  6. Reanna,

    I can’t give you guidance, but I just want you to know that I wish you well in what must be a horrible situation. Your experience with doctors is a very common one ( I’ve experienced it myself) and it’s hard to not start doubting yourself. You know yourself and your body best, and don’t be intimidated/discouraged from seeking any tests or treatment you think you might need. Good luck!

  7. My head looks like the person in the picture.im bald in one area with a clump of hair in the middle.what can I do to grow it back?

    • I have the dry skin, the cracked heels, and am recovering from the alopecia due to trial and error. Try making a little bay rum, massaging into scalp, covering then rinsing for couple days, then moisturize like black people (I am) with natural moisturizers.

      Lessen sugar and gluten like other people have mentioned. It helps. Eat seaweed snacks.

      Now all I need help with is the joint pains I didn’t have until this started. Suggestions appreciated.

  8. And the white eyelashes.

  9. I was diagnosed with Hashimoto’s in June of 2016. It took a year and a half to get my synthroid at the right dose and now my face looks 20 year’s older than I am (my doctor thought I was my sister’s mother, she is 5 years’s older than me) my skin is so saggy and puffy aroung my jowels and cheeks. Is there anyway to tighten my skin?

    • Have you found out anything about skin yet , I have noticed a drastic aging in last yr. now my hair super dry and falling out rapidly

  10. Mary williams says:

    Hello. My daughter has graves disease. Her blood count is high. The medication s working, but not fast enough for the Doctor. She wants my daughter to have the surgery. From what I have read it’s not good. I want to help her but don’t know what to do.

  11. Treona L Willard says:

    Ketaconazol shampoo helped my daughter. It is available otc and you can also get a script for it. It’s a little pricey but insurance usually will pay for it.

  12. Janice Larkin says:

    What about rash on face not in scalp??

  13. Paula Shank says:

    I had thyroid out 30yrs ago and have been on thyroid medicine since. Now apparently part of thyroid has grown back and with it 7 nodules. For the last 10 months have been dealing with chronic skin rash over the whole body. I was on steroids for 9 months but still rash continued. Then my face swelled and b ot rashy. I’m going nuts because I itch all over…nothing relieves it. Now I’m on methotrexate. ..which is a lose dose chemo pill…I take once a week for last 5 weeks and I’m still breaking out with rash and itching all over. HELP…any suggestions? I am 66 yrs old and this is miserable. The Dr said it is an autoimmune problem and methotrexate will suppress immune system but so far it hasn’t helped..it just makes me sick for a few days and I’m still itching and getting the rash. Any suggestions will help.

  14. Dorleen Lastra says:

    Wow! This has been the best site for me. I’ve struggled with skin problems since 1990. I am humbled and will contact my doctor to put me back on it. The Levothyroxine was too strong. I was going thru Chemo and radiation treatment too. It’s been close to 2 years without Levothyroxine. 4 years cancer free 😇so glad I found you. God bless you all!

    • Hello Dorleen, 4 years cancer free! So wonderful but I can only imagine what a toll this has all taken on you emotionally and physically. Good to have you at Hypothyroid Mom.

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