Cutaneous manifestations of thyroid disease
Introduction
Gross clinical manifestations of thyroid hormone (TH) imbalance are often first seen in the skin where TH plays an integral role in sustaining natural function. Thyroid hormone directly influences proteoglycan synthesis in the skin by stimulating fibroblasts. In addition, it plays a regulatory role in epidermal differentiation at least in part because of effects on keratinocytes. Finally, TH appears to be essential in hair formation and sebum production. As a result, the skin presents important external markers associated with thyroid disease that can signal dermatologists to investigate and diagnose thyroid disorder. This article will review the key cutaneous manifestations associated with hypothyroidism and hyperthyroidism.
Section snippets
Hypothyroidism
Hypothyroidism, or low levels of circulating thyroid hormone (TH), results from either primary thyroid disease or hypothalamic-pituitary disease. The most common cause of primary thyroid disease is a deficiency of dietary iodine, an essential component in the production of the two biologically active THs, thyroxine (T4) and 3,5,3′-triiodothryonin (T3). Although iodine deficiency is the most common etiology of hypothyroidism worldwide, it is rarely seen in the United States.1 More common causes
Hyperthyroidism
Hyperthyroidism, or excess of circulating thyroid hormone, results from a disturbance in any portion of the hypothalamic-pituitary-thyroid axis. Disruptive factors include TSH-secreting pituitary adenomas, a single toxic nodule of the thyroid, toxic multinodular goiters, Graves disease (GD), early non-Graves thyroiditis, and excessive thyroxine intake. Less common causes include molar pregnancy, struma ovarii, and metastatic follicular carcinoma. Hyperthyroidism is more commonly seen in women
Conclusions
There are multiple skin manifestations associated with an imbalance in circulating TH. Equipped with the knowledge of these various cutaneous manifestations, dermatologists may be able to diagnose a potential thyroid disorder, which can be definitively established with routine thyroid function studies. Although TH replacement often clears the skin manifestations associated with hypothyroidism, the skin manifestations associated with hyperthyroidism are classically cleared with treatment of the
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