Thyroid disease: A checklist of skin, hair, and nail changes

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The thyroid is a butterfly-shaped gland in your neck that produces hormones, which play a key role in regulating your heartbeat, breathing, and many other functions.

Although your thyroid gland sits deep in your neck, your dermatologist may be the first doctor to notice signs of thyroid disease. That’s because many signs and symptoms of thyroid disease develop on the skin, hair, and nails.

You, too, may also be able to spot thyroid disease — and that’s important. Caught early, treatment can prevent complications. When thyroid disease goes untreated for years, it can lead to a dangerously slow (or fast) heartbeat, an injury that refuses to heal, or unrelenting pain. You may have gained or lost weight for no apparent reason.

To help you find early (and some not-so-early) signs of thyroid disease on your skin, hair, and nails, here’s a checklist.

How many of these signs and symptoms do you have?


Skin

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When eyes protrude, it’s often a sign of thyroid disease.

☐ Dry, pale, and cool skin
☐ Moist, velvety, and warm skin like a baby’s
☐ Dry skin with deep cracks and scale
☐ Deep, noticeable lines on your palms and soles
☐ Yellowish-orange color on your palms and soles
☐ Doughy and swollen face, especially on your eyelids, lips, and tongue
☐ Widening nose
☐ Slow-healing wounds
☐ Sweating less (or more) than before
☐ Goiter (swelling in the neck)
☐ Protruding eyes
☐ Flushing on your face and red palms
☐ Darker skin in the creases of your palms, on your gums, or elsewhere in your mouth
☐ Rashes, especially in the creases of your skin
☐ Painless lumps and patches of scaly, discolored skin, and the affected skin feels hard and waxy
☐ Reddish spots on the skin that come and go

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Lumps on discolored skin that feel hard and waxy can be a sign of thyroid disease.

Hair

☐ Thinning (or missing) eyebrows on the outer edge
☐ Coarse, dull, dry, and brittle hair that breaks easily
☐ Soft and fine hair with lots of shedding
☐ Thinning hair or balding patches
☐ Growing more slowly (or quickly)
☐ Dry, itchy scalp and dandruff
☐ Less hair on your legs, arms, and other areas

Nails

☐ Thick, dry, and brittle with visible ridges
☐ Soft, shiny, and easily crumble
☐ Growing more slowly (or quickly)
☐ Peel, crumble, or break easily
☐ Lift up
☐ Curved with swollen fingertip and thickening skin above the nail

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A swollen fingertip, curved nail, and thickening skin above a nail are often signs of thyroid disease.

Itch

☐ Itchy skin without a rash
☐ Untreatable and itchy hives

Existing skin disease

You have a higher risk of developing thyroid disease if you have one of the following:

☐ Vitiligo
☐ Hives
☐ Alopecia areata (autoimmune disease that causes hair loss)

When to contact your doctor

If you’ve checked off signs and are not feeling yourself, discuss this with your primary care doctor. These signs don’t necessarily mean that you have thyroid disease. By asking you about your symptoms, your doctor can decide whether you need a blood test to check for thyroid disease.


Images
Image 1: Getty Images
Images 2, 3, 4: Used with permission of the Journal of the American Academy of Dermatology: J Am Acad Dermatol. 2003 Jun;48(6):970-2.

References
Ai J, Leonhardt JM, et al. “Autoimmune thyroid diseases: etiology, pathogenesis, and dermatologic manifestations.” J Am Acad Dermatol. 2003;48(5):641-59.

Anderson CK, Miller OF. “Triad of exophthalmos, pretibial myxedema, and acropachy in a patient with Graves' disease.” J Am Acad Dermatol. 2003;48(6):970-2.

Bae JM, Lee JH, et al. “Vitiligo and overt thyroid diseases: A nationwide population-based study in Korea.” J Am Acad Dermatol. 2017;76(5):871-8.

Callen JP. “Dermatologic manifestations in patients with systemic disease.” In: Bolognia JL, et al. Dermatology. (second edition). Mosby Elsevier, Spain, 2008: 681-2.

Kalus AA, Chien AJ, et al. “Diabetes mellitus and other endocrine diseases.” In Wolff K et al. Fitzpatrick’s Dermatology in General Medicine (seventh edition).” McGraw Hill, China, 2008:1470-4.