Thyroid Disease and Chronic Hives (Urticaria)

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Your thyroid produces important hormones that play a role in your metabolism. When you have thyroid disease, your thyroid doesn't produce the right amount of these hormones.

Thyroid disease can sometimes cause repeated bouts of hives. Another name for hives is urticaria. Up to 30% of people with chronic urticaria have an underlying autoimmune thyroid disease.

Chronic hives are especially common for people with Hashimoto's disease or hypothyroidism. Hashimoto's disease is an autoimmune disease in which the immune system mistakenly attacks thyroid cells. Hypothyroidism is when your thyroid doesn't make enough thyroid hormone.

If you have undiagnosed chronic hives, see a healthcare provider. If your hives are caused by thyroid disease, it is important to get diagnosed and treated. This could be the key to improving your skin condition.

This article looks at the connection between hives and thyroid disease. It also discusses treatment options.

common symptoms of urticaria

Verywell / Nusha Ashjaee

Symptoms of Chronic Urticaria in Thyroid Disease

Hives in thyroid disease are similar to hives from other causes. You may have patchy areas of swelling or welts, called wheals. They may appear on your chest, back, neck, face, or buttocks. 

Sometimes hives affect the arms or legs. If they do, they are more likely to appear on your thighs and upper arms than on your hands and feet.

This photo contains content that some people may find graphic or disturbing.

Urticaria
 DermNet / CC BY-NC-ND

Hives may appear pink. Some feel itchy or cause a stinging or burning sensation.

Hives often develop suddenly. They may reach their maximum size within a few hours, then fade away within a few days. New hives can appear as the old ones disappear.

Hives that are present nearly every day for six or more weeks are considered chronic.

How Are Hives and Thyroid Disease Connected?

Chronic hives may be caused by a food allergy. They may also be caused by allergens like pollen. If there is no clear trigger, they are called idiopathic urticaria. Sometimes, thyroid disease causes them.

Antithyroid antibodies are immune proteins that attack the thyroid. These include antithyroid peroxidase (anti-TPO) and antithyroglobulin (anti-Tg). These antibodies cause autoimmune thyroid diseases like Hashimoto's disease and Graves' disease.

People who have chronic hives are far more likely to have thyroid disease and elevated thyroid antibodies than people who don't.

It is unclear if antithyroid antibodies cause chronic hives, or if hives are just a sign of the condition.

Antithyroid antibodies can be high if you have subclinical thyroid disease. This is thyroid disease without symptoms. It's possible that hives could be a sign of this condition.

People with subclinical thyroid disease usually have mildly abnormal thyroid hormone test results. Over time, the disease can progress. Eventually, it may cause symptoms. Early diagnosis can help prevent progression and complications.

Hives sometimes occur with high antithyroid antibodies but without subclinical thyroid disease. Thyroid disease may never develop.

Treatment of Thyroid-Associated Hives

The goal of chronic urticaria treatment is to relieve symptoms and prevent new symptoms whenever possible. 

Urticaria can be treated a few different ways. The most important way is to avoid triggers. Triggers vary from person to person and can include things like food allergies and substances that irritate your skin.

Triggers can cause hives whether you have thyroid disease or not. Avoiding them is far more effective than treating hives when they occur.

You can also break out in hives without an obvious reason. Sill, limiting your exposure to things that gave you hives in the past is important.

Topical Creams

Topical anti-itch creams and anti-inflammatory creams are applied directly to the skin. These may relieve hives, particularly if you have only a few small spots.

Your healthcare provider may also recommend an over-the-counter antihistamine or hydrocortisone medication. A topical anesthetic like lidocaine cream or spray can reduce pain and itching. This is a good choice if you are more concerned about discomfort than appearance.

Oral Medications

If you have a lot of hives all over your body, it can be hard to apply cream to all of them. In this case you may need an oral medication.

Antihistamines are the first line of therapy. These include modern second-generation antihistamines like Allegra (fexofenadine), Claritin (loratadine), and Zyrtec (cetirizine). If these don't help, your healthcare provider may add additional, more potent antihistamines.

Other drugs that may help include:

  • Leukotriene receptor antagonists
  • H2 antagonists
  • Anti-inflammatory agents and immunosuppressants like corticosteroids

Oral steroids and antihistamines can interfere with the normal function of your thyroid. Your healthcare provider may need to adjust your thyroid replacement medication dose while you are taking them.

Levoxyl (levothyroxine)

Levoxyl (levothyroxine) is a thyroid replacement medication. It is used to treat hypothyroidism.

Levoxyl tends to work better than antihistamines for hives related to autoimmune thyroid disease. It has been shown to improve hives for a longer period of time. This is true even for people who have elevated thyroid antibodies without thyroid disease.

Levoxyl does not reduce thyroid antibody levels. This is because it is a thyroid replacement medication. It does not treat the autoimmune processes.

Recap

Treatment of chronic hives starts with avoiding triggers. Hives can also be treated with topical creams or oral medications like antihistamines. The thyroid replacement medication Levoxyl (levothyroxine) may help hives related to thyroid disease.

Other Thyroid-Related Skin Conditions

Other skin conditions related to thyroid disease include:

These skin conditions do not appear to be related to urticaria.

Have your skin issue evaluated by your thyroid specialist or a dermatologist. This will help ensure a proper diagnosis.

Summary

Hives are areas of swelling or welts on the skin. They may itch or cause a burning sensation.

Chronic hives may be related to thyroid disease. If you have undiagnosed chronic hives, see your healthcare provider.

If your hives are caused by triggers like food or other allergens, the best way to avoid them is to avoid your triggers. Hives can be treated with topical creams or oral medications.

In many cases, treating the thyroid disease will cause an improvement in hives.

A Word From Verywell

Chronic hives can be one of the symptoms of thyroid disease. Hives don't affect everyone with thyroid disease, though.

This condition is not usually the only sign of thyroid disease. Still, it can sometimes be one of the early signs. Chronic hives may be the first clue that leads to thyroid hormone level tests and a diagnosis of thyroid disease.

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6 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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