Is A Skin Rash A Symptom Of Hashimoto’s Disease?

Hashimoto’s disease can have a wide range of symptoms. Although this condition originates in the thyroid gland, it can affect the skin, nails, and hair. For that reason, it can be a dermatologist who first notices the signs of Hashimoto’s disease.

Keep reading to learn more about the connection between Hashimoto's disease and chronic skin rash/hives and the treatment plans available.

What is Hashimoto's disease?

Hashimoto's disease (or Hashimoto's thyroiditis) is an autoimmune disorder that affects the thyroid. This condition occurs when antithyroid antibodies attack and damage the thyroid gland, causing it to become underactive and produce fewer thyroid hormones than the body needs (known as hypothyroidism).

The thyroid gland is a small organ shaped like a butterfly, which sits at the front of the neck. It produces hormones responsible for regulating various essential body functions. For example, the hormones it produces influence:

• Heart rate

• Body temperature

• The central nervous system

• Growth and development

• Metabolism and weight

• Fertility.

Hashimoto's thyroiditis impacts approximately 1 -2% of people in the United States,¹ affecting more women than men. What’s more, hypothyroidism isn't the only risk Hashimoto’s disease poses. In some cases, the thyroid gland becomes inflamed and swells, forming a goiter. Treatment is necessary to improve symptoms and prevent the condition from worsening.

Hashimoto's hypothyroidism symptoms

If you do have Hashimoto’s thyroiditis, it is possible to go many years without experiencing any symptoms. Furthermore, when thyroid hormones are low, symptoms can seem minor or non-specific at first.

The most common symptoms include:

• Enlargement of the thyroid gland, known as a goiter

• Fatigue

• Cold skin

• Swollen hands and feet

• Thick and brittle nails

• Decreased sweating

• Irregular menstrual cycles or prolonged menstrual bleeding

• Slow heart rate

• Hair loss

• Thinning or brittle hair

• Infertility

• Face puffiness

• Weight gain

• Depression

• Non-specific muscle and joint aches and stiffness

• Dry skin

• Constipation

• Mental fogginess and forgetfulness

Hashimoto thyroiditis and hives

Hashimoto thyroiditis may come with bouts of hives (urticaria). In fact, in one study, 30% of people² who experienced chronic hives were found to have Hashimoto's disease.

The characteristics of chronic hives caused by Hashimoto's disease are similar to hives caused by other factors.

Chronic hives are those that repeatedly occur for at least six weeks. Their cause is not specific, but certain foods or other allergens often trigger them. 

However,  depending on the circumstances, Hashimoto's thyroiditis may be suspected, and if so, your doctor will run several tests to exclude Hashimoto’s disease first.

Chronic hives was also found to be significantly associated with³ some other autoimmune disorders such as type 1 diabetes, lupus, and rheumatoid arthritis.

The hives appear as swelling or welts, also known as wheals. They are pink and usually accompanied by an itching or burning sensation. They occur on the back, chest, buttocks, face, and neck.

Sometimes, hives may affect the arms or legs, especially the upper arms and thighs. They develop suddenly, reach their maximum size in a few hours, disappear within a few days, or stay longer than six weeks if they become chronic.

How does Hashimoto's disease cause a rash?

Studies have not identified exactly how Hashimoto’s disease and hives are linked.

So far, it has been suggested that neither condition causes the other and that they merely coexist due to the high likelihood⁴ of the patient developing autoimmune disorders. 

When to see a doctor

Talk to your primary healthcare provider if you are experiencing one or more of the above symptoms. While these symptoms may not necessarily mean that you have thyroid disease, your doctor can make a proper diagnosis by conducting a blood test and other assessments.

How to diagnose hypothyroidism

The correct diagnosis of Hashimoto's hypothyroidism depends on these factors:

• Symptoms: Your doctor will ask you about your symptoms, their intensity, and when they started.

• Medical and family history: Tell your doctor about your medical history, including previous surgeries and medications that you take now or in the past. Your doctor will also ask about your family history and whether anyone has been diagnosed with autoimmune or endocrine issues.

• Physical exam: Your healthcare provider will look for changes in your skin, like swelling, dry skin,  or slower reflexes, and they’ll check your thyroid gland.

• Blood tests: TSH (thyroid-stimulating hormone) and T4 tests are the two most commonly used blood tests in diagnosing hypothyroidism. The pituitary gland secretes TSH to stimulate the secretion of the thyroid hormones, and therefore, when thyroid hormones are low, TSH is secreted in higher amounts. When this is detected in addition to low T4, this indicates hypothyroidism.

• Antibody tests: Considering that hypothyroidism can be caused by diseases other than Hashimoto's thyroiditis, an antibody test (anti-TPO) is often required to confirm the diagnosis.

Treatment of Hashimotos’ disease-associated hives

The overall goal of treating hives is to relieve symptoms and prevent new ones from appearing. Healthcare providers use various approaches to treat the condition, focusing on the prevention of triggers. These triggers will vary from one person to another and usually include certain foods or substances that irritate the skin.

If the hives were found to be linked to undiagnosed Hashimoto's disease, your doctor would prescribe Levoxyl or levothyroxine, a thyroid replacement medication for treating hypothyroidism.

Often when the level of thyroid hormones normalize, the hives won’t appear as frequently or intensely as before, and in some cases, they stop happening altogether.

Some studies² have found that combining antihistamines, such as loratadine, with levothyroxine delivered the fastest and most effective relief from symptoms.

Other treatment options include topical corticosteroids.

The lowdown

Hashimoto's disease usually starts exhibiting symptoms in mid-adulthood but can appear earlier or later in life. The signs and symptoms often develop slowly over many months and years. These symptoms include weight gain, depression, fatigue, and chronic hives.

Early diagnosis and treatment can create a positive outcome. Regular blood tests and monitoring of symptoms can minimize the side effects and create a good long-term prognosis.