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.

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

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

Dana Trentini M.A., Ed.M., founded Hypothyroid Mom October 2012 in memory of the unborn baby she lost to hypothyroidism. This 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 including the Amazon Services LLC Associates Program.

Comments

  1. I feel everyone’s pain here, but I need everyone to be aware … Stay on top of these Drs. Get tested frequently. I am 49 hrs old acquired hypo at age 19 after a hard pregnancy. I wasn’t taking my meds and water filled the outer sac of my heart. I had to be life flighted for emergency surgery, they thought my heart would stop in traffic. I started out on 250 mcg. Please, please don’t let these Drs. not test enough. Your thyroid will take your life if you’re not careful. As for pain, wow. So much pain in so many places, I had no idea it was thyroid related. Right now I’m on Norco because I can’t even pick up my cell phone without excruciating pain. My prayers are with everyone. IF YOUR WITH A DR. YOU’RE NOT SURE YOU TRUST …. FIND ANOTHER

  2. I was diagnosed with Hypo right after I had my daughter. I was immediately placed on meds and slowly upped to 200mcg.
    About a year ago, I went to an East meta West Dr. he took 22 viles of blood and tested for everything. He told me I had Hashimotos and I should go 80% gluten free.
    I went home and started reading up on Hashimotos. It basically said you are diagnosed with Hashimotos when there isn’t anything else to call what you have.
    I do not have about 50% of the symptoms.
    I am tired a lot, weight gain, some dry skin. My nails are clear but I have ridges and no moons(which I did not know was a symptom)

    I have beautiful long hair and long eyelashes

    I don’t believe I have Hashimotos, what do I have?

  3. This says that Vitiligo is associated with Hashimoto’s. Does that mean if I have Vitiligo I can assume I have Hashimoto’s even if my lab work doesn’t show elevated antibodies?

  4. I had the right side of my thyroid removed over 30 years ago due to a large goiter pressing on my esophagus. For two years after I took a low dose of synthroid. We moved to a new state and the new doc discontinued the meds. Since that time I have dealt with extreme fatigue, cold intolerance, dry skin, dry, brittle hair and nails. I recently had a PET scan which revealed my remaining thyroid is extremely enlarged and has a goiter. My hair is falling out and I now have developed a horrible rash. Yet my bloodwork is always fine. I often wonder if it has anything to do with being a redhead. Redheads have a defective gene which requires to receive more pain meds such as numbing at the dentist among other things. Not sure if that defective gene affects blood tests or not. Something to ponder.

    • make sure you dr is testing FREE T3 FREE T4 AND TSH and antibodies…..AND REVERSE T3 OR you can be undermedicate especially on t4 only meds. Make sure you are not low normal in d3, b12, ferritin or iron

  5. I’ve been taking 100mcg thyroxine for about 40 years ,I fall asleep most afternoons ,I don’t just feel tired…it’s sheer exhaustion,I can’t keep my eyes open. my eyebrows are getting so thin, but everytime I have my blood tests, it always comes back with the same result….normal range. I have developed dry red patches on my upper arms that no cream or ointment will shift.I don.t know if that’s caused by the thyroid or not I eat a healthy diet but can’t seem to loose weight. the skin on my face isn’t dry , but I have red marks all over my cheeks. the cold doesn’t bother me…but I find I can’t stand the heat…

    • Have you checked to see if you have lupus?

    • YOU MAY have LOW FREE T3 ,MANY people do not convert their t4 meds into the active free t3 your body uses and they either need t3 added or need to use a natural thyroid supplement like armour, nature throid , etc that has t1 t2 t3 t4 in it to feel better…

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