DermNet NZ

Facts about the skin from DermNet New Zealand Trust. Topic index: A B C D E F G H I J K L M N O P Q R S T U V W X Y Z

Skin problems associated with thyroid disease

Overactivity and underactivity of the thyroid gland may result in alterations in skin, hair or the nails. This may be as a result of the abnormal level of thyroid hormone, or a consequence of an underlying condition.

Thyrotoxicosis (overactive thyroid gland)

Excess thyroid hormone (thyroxine) may be due to:

Thyrotoxicosis results in an increase in metabolic rate. This may result in:

Graves disease can be associated with other autoimmune conditions, including vitiligo.

Pretibial myxoedema
Pretibial myxoedema or thyroid dermopathy affects 5% of patients with Graves disease. It may appear before, during or after the thyrotoxic state and is sometimes associated with an underactive thyroid. Pretibial myxoedema presents with a swollen and lumpy appearance over the shins and sometimes also affects the feet. The skin may be discoloured pink or purple, with prominent hair follicles. This is known as ‘peau d'orange’ (orange-peel) appearance. It may instead look warty or ‘verrucous’.

Pretibial myxoedema is a form of diffuse mucinosis. The thickened and inelastic skin is filled with excessive hyaluronic acid and chondroitin sulphate. These are acid mucopolysacharides (glycosaminoglycans).

The same material is deposited behind the eyes resulting in protrusion and lid lag on movement of the eyeballs.

Pretibial myxoedema is thought to be caused by thyroid-stimulating immunoglobulin (autoantibodies) but this is not proven.

The name 'pretibial myxoedema' is misleading as although common in front of the tibea bone, it may occur in other sites, and it is not caused by mucus (myxoid tissue).

Pretibial myxoedema Pretibial myxoedema Pretibial myxoedema
Pretibial myxoedema

Hypothyroidism (underactive thyroid gland)

An underactive thyroid gland may be also be due to autoimmune diseases:

An underactive thyroid may result in:

Hypothyroid dry skin is prone to develop dermatitis (eczema craquelé - a crazy paving splitting of the surface layer).

Dry skin
Dry skin
Eczema craquele
Eczema craquelé

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