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The thyroid gland produces hormones, which regulate basic body functions such as breathing, digestion, body temperature and heart rate. These hormones, however, also support the function of the skin, with the result that this is often the first part of the body where the disturbance of their levels becomes apparent.
It is a butterfly-shaped gland located in the throat. Its over-functioning and under-functioning are quite common. It is estimated that over the age of 12 one person in 100 has hyperthyroidism and five in 100 have hypothyroidism.
“Skin manifestations of thyroid gland dysfunction depend on the type of thyroid disease,” reports the Dermatologist – Venereologist Dr. Markos Michelakis, from EDOEAP. “In rough lines they can be divided into three categories: a) Those due to the direct effect of thyroid hormones on the skin and its appendages (hair, nails), b) those due to the effects of hormones on non-cutaneous tissues (e.g. in the nerves) and c) in the autoimmune skin manifestations, which are related to the autoimmune thyroid diseases”.
The most common skin manifestations of hyperthyroidism are warm, moist and soft (baby-like) skin. According to an earlier study, 85% of those suffering from the disease manifest this symptom. Increased heat manifests itself as a consequence of increased blood flow to the skin and peripheral vasodilation, which also cause reddening of the skin on the face, elbows and palms.
Hyperthyroidism can cause other symptoms as well. Hair, for example, becomes thin and soft. Sometimes their widespread loss (alopecia) or even premature graying is observed. Patients may also sweat profusely (hyperhidrosis), have generalized or localized hyperpigmentation (darkening of the skin, eg in the skin folds on the fingers) or white discoloration of the nails which may be a sign of onycholysis (the nails ” come off’ from their base).
Other possible manifestations of hyperthyroidism on the skin are telangiectasia (thin blood vessels in the face, neck, chest, etc. become visible due to leakage of blood, creating spider web-like patterns) and red-brown tender nodules to the touch that develop on the shins, calves, and soles of the feet.
Especially in patients with hyperthyroidism due to Graves’ disease, protibial myxedema can be observed. This disorder is characterized by thickening and redness of the skin on the shins, which is sometimes painful. It is estimated that it manifests in less than 5% of patients, within two years of the diagnosis of the disease.
Accordingly, hypothyroidism causes skin changes such as thickening, hyperkeratosis, diffuse scalp loss, and nail atrophy. In addition, the skin is cold, pale, wrinkled and very dry.
In fact, rough, tough, and dry skin is the most common skin manifestation of hypothyroidism. Studies have shown that most sufferers have it (eg, more than 70% of patients with Hashimoto’s thyroiditis, which is the most common cause of hypothyroidism).
Intense dryness is often due to reduced sweating or even its complete absence. In some cases, the consequence is a thickening of the skin of the palms and soles (the condition is called keroderma) or the creation of a “network” of fine lines on the skin that resemble a crystal cracked in many places (eczema craquelé). More than half of the patients, moreover, also manifest dryness in the mucous membranes (e.g. in the mouth or eyes).
Other manifestations of hypothyroidism on the skin are yellow discoloration of the palms and soles (carotenemia), coldness of the skin of the extremities (due to constriction of the skin’s vessels) and puckering (loss of eyebrows at their outer edge).
Hair and nails are also affected. Hair grows slowly, becomes brittle and rough, and may fall out. Hair growth on the rest of the body is also often reduced. And the nails grow at a slow rate, while they become thin, rough and fragile.
Finally, hypothyroidism can slow wound healing and cause myxedema, which is swelling (swelling) in certain areas of the skin from a build-up of substances around hair follicles and skin vessels.
“The term myxedema also describes severe hypothyroidism that can lead to coma and threaten life, but it is different from the skin manifestations of the disease,” clarifies Mr. Michelakis.
And he concludes: “The above are just some of the skin manifestations caused by thyroid diseases. Others may be seen, such as swelling of the face (mainly around the eyelids, lips and tongue), enlargement of the nose, swelling of the throat, protrusion of the eyes (exophthalmos), rashes (mainly in the folds of the skin), “redness ” on the skin that subside and then recur, pruritus (itching) for no apparent reason, etc. Anyone who has these types of symptoms should consult their doctor. It doesn’t mean that he definitely has a thyroid disease, but if he does, it’s good to know about it in time.”
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