Thyroid Disease and the Skin

Review Article

Annals Thyroid Res. 2014;1(2): 23-26.

Thyroid Disease and the Skin

Kasumagic-Halilovic E*

Department of Dermatovenerology, Sarajevo University Clinical Center, Bosnia and Herzegovina

*Corresponding author: Kasumagic-Halilovic E, Department of Dermatovenereology, Sarajevo University Clinical Center, 71 000 Sarajevo, Bosnia and Herzegovina

Received: September 17, 2014; Accepted: November 26, 2014; Published: November 27, 2014


Thyroid disease is associated with changes in the skin, which may sometimes be the first clinical sign. A variety of cutaneous findings may present in the setting of either a hyperthyroid or hypothyroid state. There may be evidence of the effect of altered concentrations of thyroxine on the skin, with changes in texture and hair growth. Associated increases in thyroid stimulating hormone concentration may lead to pretibial myxedema. Hair follicles are particularly sensitive to concentrations of thyroid gland derived hormones. The cells of the hair matrix, due to their high degree of metabolic activity, are most profoundly influenced by the deficiency or excess of thyroid derived hormones. There is convincing evidence of a significant association between thyroid autoimmunity and skin disorders. Most commonly reported cutaneous disorders related with thyroid disease are alopecia areata and vitiligo. This review constitutes a summary and update of the cutaneous manifestation of thyroid disease.

Keywords: Hypothyroidism; Hyperthyroidism; Thyroid autoimmunity; Skin disease; Thyroid dermopathy


The long-recognized “thyroid-skin conection” encompasses many layers of complexity, and it has become a hot frontier in dermatoendocrinology [1]. Thyroid disorders are known to involve all organ systems of the body and the skin is no exception. Cutaneous manifestations generally appear subsequent to the development of thyroid disease, but may be the first presenting sign or even precede the diagnosis by many years. Skin manifestations of thyroid dysfunction may be divided into two main categories: (I) direct action of thyroid hormone on skin tissues, and (II) autoimmune skin disease associated with thyroid dysfunction of autoimmune etiology.

Although there have been reports investigating the thyroid function tests, auto antibodies and thyroid diseases in various cutaneous disorders, the presence of cutaneous manifestations of thyroid diseases has been rarely discussed in the scientific literature. This article outlines the major skin findings in thyroid disease and summarizes recent studies and reports. A review was performed searching the electronic databases: Ovid MEDLINE and PubMed. No methodological search filters or limits were applied.

Direct thyroid hormone action on skin

It has been known for decades that thyroid disorders that lead to elevated or decreased thyroid hormone serum levels are associated with altered human skin and hair structure as well as function [2]. Available data suggest that thyroid hormone plays a pivotal role in embryonic development of mammalian skin as well as in maintenance of normal cutaneous function an adult skin. Direct thyroid hormone action has been demonstrated on cutaneous biology including on the epidermis, dermis, and hair. Thyroid hormone stimulates epidermal oxygen consumption, protein synthesis, mitosis, and determination of epidermal thickness [3]. In addition, thyroid hormone appears to be necessary for both the initiation and maintenance of hair growth and normal secretion of sebum.

Direct thyroid hormone action on skin is mediated through Thyroid Hormone Receptor (TR). All three widely recognized thyroid hormone binding isoforms of TR have been identified in skin tissues [4,5]. TRs have been detected in epidermal keratinocytes, skin fibroblasts, hair arrector pili muscle cells, sebaceous gland cells, vascular endothelial cells, and a number of cells types that make up the hair follicle [6]. The interaction of triiodothyronine (T3) with its receptors (TRa and TRß) affects epidermal differentiation and enhances its responsiveness to growth factors [5,7]. These effects of T3 are particularly important for the function of sebaceous, eccrine, and appocrine glands, growth of hair follicles and synthesis of proteo- and glycosaminglycans by dermal fibroblasts [8]. In tissue culture studies using surrogates for DNA expresion, T3 has been shown to stimulate growth of both epidermal keratinocytes and dermal fibroblasts [9,10]. Thyroxine (T4) stimulates the proliferation of hair follicle keratinocytes and T3 inhibits their apoptosis [11]. Thyroid hormones may also affect hair follicle stem cells, since T3 and T4 were found to induce differentiation and apoptosis, and inhibit clonal growth of hair follicle epithelial stem cells [12]. The demonstration of TR expression in hair follicle cells indicates that thyroid hormone can affect hair growth directly, rather than through an intermediate mechanism such as a general metabolic status [13]. In addition, investigators have identified elements of the hypothalamic-pituitary-thyroid hormone axis in human skin [1,14] and have determined that thyroid hormone receptors mediate skin proliferation and inflammation along with skin response to retinoids [15,16].

Both hypothyroidism (Table 1) and hyperthyroidism (Table 2) are known to cause skin change.

Citation: Kasumagic-Halilovic E. Thyroid Disease and the Skin. Annals Thyroid Res. 2014;1(2): 27-31.