Elsevier

Clinics in Dermatology

Volume 26, Issue 3, May–June 2008, Pages 283-287
Clinics in Dermatology

Cutaneous manifestations of thyroid disease

https://doi.org/10.1016/j.clindermatol.2007.10.020Get rights and content

Abstract

The diagnosis of thyroid disease can often first be identified by recognizing various cutaneous manifestations associated with an imbalance of circulating thyroid hormone. This article reviews the pathophysiology of thyroid disease, characteristic cutaneous findings of the hypothyroid and hyperthyroid states, and cutaneous conditions associated with 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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