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

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. Kary Wagner says:

    I was diagnosed with Hashimoto’s 4 years ago. I have never experience any hair loss but do suffer from very painful red skin rashes on my fingers. What causes this??

    • Just had my blood work done and my TSH is finally in the normal range, but I’m still experiencing symptoms.
      Especially the dry, red, flaky skin on my face. I wish I knew how to control this?

  2. Just came across this website. I have hypo and my levels are perfectly normal. I live a healthy and completely active lifestyle. I noticed a couple weeks ago I added carrots more often to meals then my preferred broccoli. Have any you experienced orangish palms and feet by eating to many carrots? Feeling great so no other issues aside. LOL I’m going back to broccoli for awhile and reduce carrot intake. Any advice.? Thanks

  3. I was diagnosed July 2004 with Hashimotos bc I had a newborn (in april) and a toddler and was always so exhausted I couldn’t take care of my kids…in addition to gaining 3-4 pant sizes in 2-3 weeks….I have found that Synthroid is the only med that keeps my levels somewhere near normal and have been on every dose from 88-175. I have experienced pretty much every symptom over the years and within the last few months, am now having swelling and itching over my whole body…I’m miserable 🙁 my last bloodwork also showed liver enzymes roughly 3 times normal and thyroid was way way low…so now im waiting to get bloodwork done again to see if both are normal now. With all of this being said, I can deal with the aches/cold intolerance/weight fluctuations/etc , but this whole body itching (literally head to toe…hands, arms,head,chest,back) is just driving me nuts….lotion helps some (short term). Does anyone have any suggestions? I just turned 37 and swear im gonna go insane with this itching.

    • I have been dealing with Hashimoto’s hypothyroidism for 14 years, including thyroid cancer last year. Most of that time has been on synthroid. The itching was making me crazy too, especially since the thyroïdectomie and radiation. I just switched to tirosint last month after researching the inactive ingredients in all the different thyroid pills. I realized I was allergic to two of synthroid’s inactive ingredients! A month into the new pill the itching has stopped and I feel much better overall. I feel more like my old self and have energy again. I wish I had figured it out sooner! The only problem is tirosint is expensive. 🙁

      • Also forgot to mention I’ve lost 7 pounds on the new thyroid meds in a month! I’m eating and exercising the same (I’ve been trying to lose weight since May of 2017!). On synthroid I couldn’t lose a pound, and had gained 40 pounds since my thyroidectomy and radiation. Everyone is different, but Tirosint seems to be the better medication for me. I wish I hadn’t wasted 14 years before getting desperate enough to research the inactive ingredients. Best of luck to finding on that works for you. 🙂

    • Elevated liver levels can cause very itchy skin.

  4. 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.

  5. 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.

    • Paula, I’m sos sorry to hear all that’s happening with your skin. As you read in this guest post that I included at Hypothyroid Mom, low thyroid affects the skins in all sorts of ways. This may be your red flag that your hypothyroidism is not being well treated. If you are on a T4 only levothyroxine medication like Synthroid, the first step is to read about the other options. Here’s an article:

      https://hypothyroidmom.com/which-is-the-best-thyroid-drug-for-hypothyroidism/

      • Just came across this website. I have hypo and my levels are perfectly normal. I live a healthy and completely active lifestyle. I noticed a couple weeks ago I added carrots more often to meals then my preferred broccoli. Have any you experienced orangish palms and feet by eating to many carrots? Feeling great so no other issues aside. LOL I’m going back to broccoli for awhile and reduce carrot intake. Any advice.? Thanks

    • Methotrexate is serious stuff. I wouldn’t take it. Try grandpas pine tar soap let the lather sit on the rash for a few mins. Hope this helps.

  6. Janice Larkin says:

    What about rash on face not in scalp??

  7. 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.

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