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.


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

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.


  1. I’ve been experiencing pretibial myedema (Hashimoto’s) for several months and that, in addition to the overall pain I have, has made walking quite difficult. I am looking at an under desk elliptical due to the longer periods I am at my desk and wonder if this activity would affect the myxedema in either a positive or negative way. Any thoughts?

  2. I took Armour and Synthroid for about 40 years, now I take meds for T3 and T4 to combat brain-fog.

  3. Professor Donald N Hester says

    Forgot to tell you, I have taken citimel and synthroid for both T3 and T4 for about 40 years

  4. I was diagnosed with Hashimoto’s disease at age 17, now 78. I have lived “free” of any symptoms until a year ago. I was recently diagnosed with Vitiligo. For about a year I scratched itchy circles off my left arm, circles had a neutral color. My arm looks bad, but the itchy circles have stopped. When I was young, people did not burn like they do now, but I always wore a long sleeve shirt. Recently, I noticed my face has a pink patchy covering quite a bit of my face, both sides. And, I burn really fast on my neck, ears, and face. This sucks

  5. Jessica Tapper says

    I was recently diagnosed with under active thyroid, I had trouble getting pregnant for 5 years, had a miscarriage and one successful pregnancy, my daughter is 2 now, and we are trying for #2. I have suspected for years that my thyroid may be to blame. I also got vitiligo when I was 5, I’ve lost all of my pigment years ago. I’ve got patches of white hair and half my eyelashes on my right eye are white, which is kinda cool. My father had under active thyroid and had a grapefruit sized goiter removed. Auto immune disorders run in our family. As far as symptoms of hypothyroidism, only notable symptoms I’ve had is irregular periods and rapid weight gain after my daughter was born. And some small raised pimply bumps on my arms that I’ve been meaning to get checked out.

  6. Terrin Eichwald says

    Terrin. I have always had very dry ,flakey skin. Since menopause its worse, my metabolism has almost stopped, seems I just can’t loose the weight and I now have a skin condition called granuloma Aguilera. My thyroid (THyroid stimulating hormone ,t4,t3) tests keep coming back normal. I still feel this stuff is thyroid related because I also am tired all the time. What’s up with that? My hair is thinner but not balding.

  7. Lisa B. says

    I have been getting breakouts since I had my thyroid removed. Driving me crazy!

  8. I have had extreme itching under the skin since 1990. I was diagnosed with hypothyroidism at that time and put on thyroid medication. I already had vitiligo, for several years, but unaware of a thyroid problem. After taking the medicine for several months, I’ve developed a runny nose, “frog in my throat”, very itchy back (under the skin). I’ve tried several topical creams ( medicated as well) but nothing has helped. I’ve talked to two dermatologists, as well as several doctors. This is driving me crazy, continually every day.

    • I have been diagnosed with both Hashimoto’s and Grave’s disease i am going for a blood test tomorrow as they are looking for the underlying cause of itchy and sore lumps on my nipples, i scratch and they then get sore, i have the itchy bumps pop up randomly and then spread, my skin is very dry and heels cracking, i am losing about a hand full of hair most days and then this stops, my arms now have bllod blisters on them as if i have scraped them but i have not. This is all Hashimoto’s and graves disease symptoms, Has your doctor checked your BSL( Blood Sugar Levels, a fasting test it takes about 45 minutes where they take blood out of each of your fingers about every 3 minutes or so. I ahve also been treated with Radioactive Iodine the biggest amount they can give, it knocked out the thyroid and then, my problems returned within 1 month, the thyroid did not function at all, so pills to make it function again, then it was functioning way too much and i started having heart palpitations, so more meds to stop that and different Thyroid medication, i am seriously thinking of getting them to remove my Thyroid altogether but have been told there is no cure for Hashimoto’s and Graves it is a life long sentence, you do go into remission, but if nothing else takes your life it does in the end. It is sad in today’s world there is nothing full proof to combat this dangerous disease and not much talked about, There should really be a tour around the world warning Women especially about this life long fight with this disease and the need to investigate it, Hope all are feeling better i have read your symptoms and can say if you have not seen your doctor yet, please go urgently.

    • I know this is a little late but was just reading your post and had to check to make sure it wasnt written by me! I’ve got exactly same problem. I am itching in the same places, my nose keeps running, and I get that frog in the throat feeling. My TSH had gone up to 112 but now is still high at 64. I’m titrating up on my thyroid meds. Start 45mg of Armour tomorrow. How are you doing now?

  9. Hello!
    I just came across this article today through Pinterest. I was diagnosed with Hashimoto in 2015. I had chronic fatigue for the first two years of my diagnosis. I had to quit my job that I loved. I have not come across any one that has symptoms like me. I know that everyone with Hashimoto’s and Graves’ disease is different.
    My symptoms are if I get too stressed out or too tried, I start sweating badly, I turn white as paper my skin is clammy and wet. My blood pressure goes high. I can not take the heat and humidity. I was finally diagnosed with the intolerance to heat instead of the cold. My hands stay chap all the time and in the fall and winter time they are so dry my hands can crack open. I take two thyroid pills for 6 days then I take the lowest dose on 7th day.
    Does any one else have these symptoms with their hands?

    • I have severe dry skin on hands use lots of cream on them my fingers crack open and bleed unless I use cream after washing every time. I am hypothyroid after thyroid removal in 2012

  10. I’ve had extremely dry, rough, peeling and leathery skin on my chin for two months. I can’t even wear makeup anymore because it just cakes up on the dry skin. It feels as if I have ten extra layers of skin ( in other words if I scratch my chin I can’t even feel it.!) I’m waiting for bloodwork results from my doctor to find an underlying cause of this and my extreme fatigue. I went to a dermatologist who said it was an allergy but I haven’t changed any detergents, moisturizers or make up etc. so I know that’s not it. I’m embarrassed to even go anywhere. Just wondering if hypothyroidism could cause the skin to build up like that?

    • I wonder if any of you have tried the old remedy for thyroid diagnosis – Armour. It is made from pork thyroid. I have heard of a few people who couldn’t tolerate the artificial synthroid etc. They did well on Armour because it possibly replaced ALL the parts that may be affected. Your doctor should be able to prescribe it for you. You could try and see if any of those annoying/crappy/puzzling symptoms are taken care of.

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