Thyroid Disease and Chronic Hives (Urticaria)

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If you have chronic hives, thyroid disease may be the cause. And if you have thyroid disease, especially Hashimoto's disease or hypothyroidism, you may develop hives. Up to 30% of people with chronic hives (also called urticaria) have an underlying autoimmune thyroid disease.

Treatment of chronic urticaria is based on relieving the symptoms when they occur as well as preventing symptoms whenever possible. But if thyroid disease is the cause of your urticaria, diagnosis and treatment of your thyroid condition may be the key to improving your skin condition.

Symptoms of Chronic Urticaria in Thyroid Disease

The symptoms of urticaria in thyroid disease are similar to the symptoms of hives due to another cause. You may experience patchy areas of swelling or welts (wheals) on your chest, back, neck, face, or buttocks. Sometimes they affect the arms or legs, and they are more likely to appear proximally (thighs and upper arms) rather than distally (hands and feet).

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Urticaria
 DermNet / CC BY-NC-ND

The skin lesions of urticaria may appear pink, and some feel itchy or may be characterized by a stinging or burning sensation. Hives often develop suddenly on your skin, rapidly reach their maximal size within a few hours, and then fade away within a few days. New skin lesions can appear as the old ones disappear.

Chronic urticaria is defined as hives that are present nearly every day for six or more weeks.

How Are They Connected?

Chronic urticaria may be tracked to a particular food allergy or to environmental allergens, like pollen. When there is no clear trigger, the condition is diagnosed as idiopathic urticaria. If this is the case, thyroid disease could be the cause.

Antithyroid antibodies, such as antithyroid peroxidase (anti-TPO) and antithyroglobulin (anti-Tg), are immune proteins that attack the thyroid gland, causing autoimmune thyroid diseases like Hashimoto's disease and Grave's disease.

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

It is unclear whether antithyroid antibodies play a causative role in the association between chronic urticaria and autoimmune thyroid disease, or whether they are just a sign of both conditions.

It is important to note that antithyroid antibodies can be elevated if you have subclinical thyroid disease, which is thyroid disease without symptoms. It's possible, then, that urticaria could be a tip-off to this underlying concern.

Subclinical thyroid disease is usually associated with mildly abnormal thyroid hormone test results. Over time, subclinical thyroid disease can progress, eventually causing symptoms. Early diagnosis may help prevent disease progression and complications.

Know, though, that urticaria is sometimes associated with elevated antithyroid antibodies without subclinical thyroid disease, and thyroid disease may never develop—even in the presence of antithyroid antibodies.

Treatment of Thyroid-Associated Urticaria

Urticaria can be treated with a few different approaches. The most important approach is to avoid triggers, such as food allergies and substances that irritate your skin. These exposures can trigger an attack of hives (whether you have thyroid disease or not), and side-stepping them to prevent outbreaks is far more effective than treating hives when they occur.

Of course, you can break out in hives without an obvious reason, but minimizing exposure to substances that have caused you to develop hives in the past is important.

Topical Creams

Topical (on the surface of the skin) anti-itch creams and anti-inflammatory creams can relieve hives, particularly if you have a few small lesions. Your doctor may recommend an over-the-counter antihistamine or hydrocortisone solution. If discomfort is more of a problem than the appearance of the welts, she may recommend a topical anesthetic, such as lidocaine cream or spray, which can reduce pain and itching.

Oral Medications

When the lesions are widespread throughout the body, it can be difficult to rub cream over many patches of skin, in which case oral medications may be preferred.

Antihistamines are the first line of therapy, especially modern second-generation antihistamines such as Allegra (fexofenadine), Claritin (loratadine), and Zyrtec (cetirizine). If these are not effective, your doctor may add additional, more potent antihistamines or drugs such as leukotrine receptor antagonists, H2-antagonists, or anti-inflammatory agents and immunosuppressants such as corticosteroids.

Keep in mind that oral steroids and antihistamines can suppress thyroid function, and your doctor may need to adjust your thyroid replacement medication dose while you are taking them.

Levothyroxine

Levothyroxine is a thyroid replacement medication used to treat hypothyroidism. Urticaria associated with autoimmune thyroid disease has been shown to improve for a longer duration of time with levothyroxine than with an antihistamine. Improvement of hives is noted even among people who have elevated thyroid antibodies without thyroid disease.

Levothyroxine treatment does not reduce thyroid antibody levels because it is a thyroid replacement medication, not a treatment for the autoimmune processes.

Beyond Hives

Other skin conditions related to thyroid disease include thyroid dermopathy, which is thickening of the skin associated with Grave's disease, and myxedema, which is swelling associated with severe hypothyroidism. These skin conditions do not appear to be related to urticaria.

It's best to have any skin issues evaluated by your thyroid doctor and a dermatologist to ensure a proper diagnosis.

A Word From Verywell

Chronic urticaria can be one of the symptoms of thyroid disease, although it does not affect everyone with thyroid disease. This condition is not usually the only sign of thyroid disease, but sometimes it can be one of the early signs, prompting thyroid hormone level tests and a diagnosis of thyroid disease.

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