Thyroid Disease and Chronic Hives (Urticaria)

Thyroid disease can sometimes cause repeated bouts of an itchy skin reaction known as hives. In fact, up to 30% of people with chronic hives (also known as chronic urticaria) have underlying autoimmune thyroid disease.

Chronic hives are especially common in people with Hashimoto's thyroiditis, an autoimmune disease that causes hypothyroidism (an underactive thyroid gland).

This article looks at the connection between chronic hives and thyroid disease. It also discusses the various tests and treatments used to diagnose and manage this recurrent skin condition.

common symptoms of urticaria

Verywell / Nusha Ashjaee

Symptoms of Chronic Hives With Thyroid Disease

Hives associated with thyroid disease are similar to hives from other causes. They tend to develop rapidly and resolve in a relatively short period of time.

With that said, some forms of urticaria are chronic, meaning that they last for more than six weeks and recur frequently over the course of months or years.

Symptoms of chronic urticaria include:

  • Patches of raised red or skin-colored welts (known as wheals), often on the chest, back, neck, face, and buttocks
  • Wheals that can change in shape and size, sometimes fading and later reappearing
  • Itching, sometimes severe, and/or a stinging or burning sensation

Hives associated with autoimmune thyroid disease are most often chronic.

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

Urticaria
 DermNet / CC BY-NC-ND

Cause of Hives With Thyroid Disease

Autoimmunity is thought to be one of the most common causes of chronic hives.

Autoimmune diseases are those in which the body's immune system mistakenly attacks its own cells and tissues. It does so with immune proteins called autoantibodies that cause chronic or recurrent attacks known as flares.

In the case of autoimmune thyroid disease, the thyroid gland is the target of the assault.

During an autoimmune flare, the spontaneous release of autoantibodies can trigger the release of another protein known as immunoglobulin E (IgE). IgE is the antibody responsible for allergic reactions, such as hives or rash.

Not all autoimmune diseases trigger an IgE response. Those that do produce autoantibodies that target a specific protein—called a high-affinity IgE receptor—found in tissues under the skin. The autoantibodies "turn on" these receptors, triggering the production of IgE and the chain of events that lead to allergies.

Hashimoto's thyroiditis is one of several autoimmune diseases closely linked to chronic urticaria. Others include lupus and rheumatoid arthritis (RA).

Chronic hives may occur in tandem with an autoimmune flare or when the disease is subclinical (meaning active but without overt symptoms). During subclinical episodes, even low levels of autoantibodies can trigger an IgE response.

While Hashimoto's thyroiditis may increase the risk of chronic hives, not everyone who has Hashimoto's will get hives. This suggests that other environmental or genetic factors may contribute to the risk.

How to Treat Thyroid-Associated Hives

Hives are often one-off events that will clear on their own without treatment, never to be seen again. Those that recur should generally be treated, particularly if they are severe or persistent.

Regardless of the cause of hives, the goals of treatment are the same, namely to relieve symptoms and prevent a recurrence. 

The first and arguably most important goal is to avoid any triggers that instigate hives. These vary from one person to the next. They may include food allergies, strenuous exercise, sudden changes in temperature, and even stress.

Other treatment options include topical anti-itch creams, oral antihistamines, and thyroid hormone replacement.

Topical Anti-Itch Creams

Topical creams and sprays used to reduce itch and inflammation may be useful in managing the symptoms of hives, particularly if the hives are not widespread.

Over-the-counter options include:

Antihistamines and Related Drugs

If hives are widespread, oral antihistamines may be a better option. These drugs block a chemical called histamine that is involved in allergic reactions.

Antihistamines are the first line of treatment for moderate to severe hives. These include second-generation antihistamines that do not cause drowsiness.

Over-the-counter antihistamines used to treat hives include:

If the itchiness or burning are interfering with your sleep, first-generation antihistamines like Benadryl (diphenhydramine) are mildly sedating and may help you sleep.

Other drugs may be prescribed if oral antihistamines fail to provide relief, including:

Oral antihistamines and corticosteroids can interfere with the function of your thyroid gland. Your healthcare provider may need to adjust your thyroid hormone dose if you are taking either of these.

Levothyroxine

Levothyroxine, sold under the name Synthroid, Levoxyl, and others, is a synthetic thyroid hormone used to treat hypothyroidism. It does not treat the underlying autoimmunity that causes Hashimoto's thyroiditis but can normalize hormone levels so that you are less likely to experience hypothyroid symptoms.

Levothyroxine has been shown to work better than antihistamines in relieving hives related to autoimmune thyroid disease. It also tends to work for a longer period of time.

Are There Tests to Diagnose the Cause of Chronic Hives?

If you have chronic hives and Hashimoto's disease, it may seem reasonable to assume that they are both related. This may or may not be true.

Chronic hives can occur as a result of autoimmunity. But, it can also occur independently of thyroid disease for any number of reasons, including:

  • Food allergies and intolerance
  • Exposure to cold (cold urticaria)
  • Stress (stress-induced urticaria)
  • Sunlight (solar urticaria)
  • Exercise (exercise-induced urticaria)
  • Pressure on the skin, such as from a tight waistband (pressure urticaria)
  • Scratching (dermatographism)

In some cases, there may be no apparent reason for a recurrent outbreak. This is referred to as chronic idiopathic urticaria (CIU).

Hives can usually be diagnosed by their appearance. Identifying the underlying cause is a different issue and often involves a process of elimination to narrow the possible causes.

This may involve blood tests and skin biopsies to rule out infectious or inflammatory conditions (like vasculitis). Skin-prick tests and food challenges may be used to rule out specific types of allergies or food intolerances.

If autoimmune thyroid disease is suspected, your healthcare provider may order tests to help confirm the diagnosis, including:

  • Autologous skin serum test (ASST), a procedure used to measure your autoimmune reactivity to histamine injected beneath the skin
  • Thyroid hormone tests, a blood test used to measure the level of the thyroid hormones TSH, T3, and T4
  • Autoimmune thyroid tests, a blood test used to detect thyroid autoantibodies such as anti-TSH, anti-TPO, and anti-Tg

When to See a Healthcare Provider

Hives are often short-lasting and non-severe. Even so, there may be times when hives are an indication of a severe, whole-body allergy known as anaphylaxis.

Anaphylaxis is a medical emergency that can lead to shock, coma, heart, or respiratory failure, and death if left untreated.

Call 911 or go to your nearest emergency room if you experience the signs of anaphylaxis, including:

  • A sudden outbreak of hives or rash
  • Difficulty breathing, including shortness of breath and wheezing
  • Abnormally rapid heartbeat
  • Lightheadedness or fainting
  • Swelling of the lips, face, or throat
  • Sudden clammy skin
  • A feeling of impending doom

Generally speaking, any time that an outbreak of hives is sudden, rapid, and severe, you should seek immediate medical attention.

Summary

Hives (urticaria) are skin reactions that cause raised, itchy welts. Those that are chronic (meaning lasting for more than six weeks or recurring over months or years) may be the result of an autoimmune disease like Hashimoto's thyroiditis.

Hives can be treated with topical anti-itch creams or oral antihistamines. If autoimmune thyroid disease is involved, a synthetic thyroid hormone called levothyroxine may help prevent or treat a hives outbreak.

A Word From Verywell

Chronic hives can be uncomfortable, unsightly, and aggravating. If you are unable to treat them with over-the-counter antihistamines or anti-itch creams, ask your doctor for a referral to a skin specialist known as a dermatologist or an allergy specialist known as an allergist.

If you suspect you may have thyroid disease, the best person to see is an endocrinologist who specializes in the diagnosis and treatment of hormonal disorders, including thyroid disease.

Frequently Asked Questions

  • How common are chronic hives in people with autoimmune disease?

    Some studies suggest that half of all cases of chronic hives (urticaria) occur as a direct result of autoimmune diseases. Anywhere between 0.5% to 5% of the general population is thought to have chronic hives.

  • What types of autoimmune diseases cause chronic hives?

    Numerous autoimmune diseases have been linked to chronic hives. These include lupus, polymyositis, dermatomyositis, rheumatoid arthritis, Sjögren syndrome, celiac disease, type 1 diabetes, and autoimmune thyroid disease.

  • What skin conditions can autoimmune thyroid disease cause?

    Pretibial myxedema is a skin condition that can occur with autoimmune thyroid diseases like Hashimoto's thyroiditis and Graves' disease. It causes deposits of a natural lubricating fluid called hyaluronic acid under the skin, causing pink or purplish nodules on the lower legs or feet.

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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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