Skin Changes and GI Problems Associated with Thyroid Disease

What is the thyroid gland?

The thyroid gland is a small, butterfly-shaped gland in the front of your neck just below your “Adam’s apple”. It consists of two lobes that sit on the right and left of your trachea and are connected by a bridge, called the isthmus. When the thyroid gland is normal in size you likely can’t feel it.

The pituitary gland in the brain produces a hormone called thyroid stimulating hormone (or TSH), that causes the cells in your thyroid gland to make thyroid hormones, thyroxine (T4) and triiodothyronine (T3). The thyroid gland secretes these hormones.

Thyroid hormones play a large role in metabolism. They influence the control of our body’s vital functions, including body temperature, heart rate, and blood pressure. They’re critical for skeletal and nervous system development, and play an important role in the development and functioning of the reproductive system.

 

What is Thyroid Disease?

If the thyroid gland doesn’t produce or release enough thyroid hormone: hypothyroidism (or an underactive thyroid) can result.

If the thyroid gland produces or releases too much thyroid hormone: hyperthyroidism (or an overactive thyroid) can result.

 

How common is thyroid disease?

Thyroid disorders are quite common. They’re more common in women than men, and your risk increases with age. It’s estimated that 1 in 8 women will develop a thyroid disorder over the course of her lifetime.

 

What causes Thyroid Disease?

The most common cause of hypothyroidism worldwide is iodine deficiency. The most common cause of hypothyroidism in the United States is Hashimoto’s thyroiditis.

Graves' disease, an autoimmune disorder where your immune system produces antibodies that stimulate your thyroid gland to produce too much T4, is the most common cause of hyperthyroidism in the U.S.

 

What are the Risk factors for Thyroid Disease?

Risk factors for hyperthyroidism include:

  • Being female
  • Over the age of 60
  • Recent pregnancy
  • Having a history of another autoimmune disorder (like celiac disease, rheumatoid arthritis, sarcoidosis, or lupus)
  • Having a family history of thyroid disease or autoimmune disease
  • Having a personal history of thyroid problems or thyroid surgery
  • Consuming significant amounts of iodine through food or medication

Risk factors for hypothyroidism include:

  • Being female
  • Over the age of 60
  • Being Caucasian or of Asian ethnicity
  • Having a personal history of another autoimmune disease
  • Having a family history of thyroid disease or autoimmune disease
  • History of radiation to the neck
  • History of prior thyroid surgery
  • Recent pregnancy
  • Personal history of lithium use
  • Personal history of certain chromosomal abnormalities like Down syndrome

 

What skin changes are associated with Thyroid Disease?

Thyroid disease can affect the hair, nails, and skin.

Hypothyroidism can be associated with:

  • Dry, rough skin
  • Carotenemia, a condition that causes the skin on the palms of the hands and soles of the feet to look yellow. It’s caused by an increased level of dermal carotene, and can easily be misdiagnosed as jaundice due to liver problems.
  • Acne: New or recurrent acne in older adults may be suggestive of hypothyroidism 
  • Swelling: Mild hypothyroidism may cause mild weight gain due to water retention. Severe hypothyroidism can cause the face and the extremities to swell as lymphatic drainage is compromised. This fluid retention can be dangerous and contribute to the development of congestive heart failure.
  • Hair loss, slow growing, dry, brittle, and/or coarse hair, and diminished body hair. Like most cells, hair follicles are regulated by thyroid hormone. Because hair follicles have stem cells that have a short lifespan and rapid turnover, they are more sensitive to low thyroid levels than other body tissues. Low thyroid hormone causes hair follicles to stop regenerating, resulting in hair loss. This will typically improve when the thyroid issue is treated. 
  • Loss of the lateral third of the eyebrows
  • Coarse, thin, and brittle nails that grow slowly
  • Poor wound healing
  • Abnormal lack of sweating

 

Hypothyroidism can be associated with:

  • Skin thinning, some people will say their skin feels like a baby’s skin
  • Fine, soft, brittle hair and/or excessive hair loss
  • Early graying (or the hair)
  • Redness of the face, elbows, and palms
  • Hives and itching
  • Plummer's nails: a concave contouring which raises the nails away from the nail bed.
  • Telangiectasias or spider veins: tiny blood vessels that cause threadlike red lines or patterns to appear on the skin
  • Abnormally excessive sweating especially on the palms and soles
  • A condition called “Pretibial myxedema” where the skin between the knees and ankles thickens and develops raised bumps. Tender, red-brown nodules occur on areas such as the shins, calves and feet.

 

How are skin problems associated with Thyroid disease treated?

The best way to correct any skin problem associated with underlying thyroid disease is to treat the thyroid disease. Once the thyroid dysfunction is addressed often the associated skin changes will resolve.

 

How is Thyroid disease related to GI disease?

In general, hyperthyroidism speeds up the GI tract and can inhibit proper nutrient absorption. Patients with hyperthyroidism may experience weight loss, frequent bowel movements, diarrhea, malabsorption of important nutrients, nutrient deficiencies, abdominal pain and fullness, belching, nausea, and/or vomiting, and sometimes increased hunger.

Hypothyroidism, on the other hand, delays stomach empting and slows movement through the entire GI tract. Food sits in the stomach and large intestine for a longer than normal period of time resulting in gas, bloating, reflux symptoms, and constipation. The longer waste sits in the large intestine, the more time there is for water to be reabsorbed back into the body. Stool becomes harder and drier and more difficult to pass. Hypothyroidism is classically associated with constipation, delayed gastric emptying, and gas and bloating aggravated by slowed digestion.

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