How to Identify and Treat Thyroid Rashes

The thyroid is a butterfly-shaped gland that wraps around the trachea just about at the collarbone. This gland produces several hormones, mainly triiodothyronine (T3) and thyroxine (T4), that regulate different vital functions in your body like breathing, metabolism, and heart rate.

When the amounts of these hormones are out of balance or your thyroid gland is not working properly, you could have one of several types of thyroid disease. Hypothyroidism is the term for when your body doesn't make enough thyroid hormones, and hyperthyroidism is the term for when you have too much thyroid hormone.

Skin, hair, and nail changes are common results of thyroid disease. This article will describe a specific rash known as myxedema (thyroid dermopathy) that can develop, especially with a form of hyperthyroidism called Graves' disease. Keep reading to learn about this and other rashes you may see with thyroid disease.

Types of Thyroid Rashes

A rash is a generic term for an area of irritated skin. This irritation can take many forms, including redness, swelling, itching, and dryness.

Pretibial Myxedema

This is a rash that was once a hallmark sign of Graves' disease, a type of hyperthyroidism. Thanks to earlier diagnoses and treatment of thyroid diseases, this rash is now considered a rare symptom.

The pretibial myxedema rash, also known as thyroid or Graves' dermopathy, usually develops on the shins and the tops of the feet. It can occur with autoimmune thyroid diseases and develops in up to 4% of people with thyrotoxicosis, a condition that occurs when there is too much thyroid hormone circulating in your body. It's most common in people with Graves' disease, though, occurring in up to 15% of people with Graves’ ophthalmopathy.

The appearance of this rash can vary but usually appears with some form of redness or discoloration on raised patches of skin that can take on a texture similar to that of an orange peel (peau d’orange). In severe cases, areas of this rash can grow extremely large, growing into nodules, plaques, or elephantiasis-type lesions.

Chronic Hives

Red, raised, and itchy skin can also be a sign of thyroid disease. Hives (urticaria) that come and go or become chronic can signal a thyroid imbalance. If you have hives that keep coming back with no obvious cause and they are difficult to treat, talk with your healthcare provider. Additional testing and examination will be necessary to diagnose the cause of the hives and determine whether hyperthyroidism or hypothyroidism could be to blame.

Other Skin Conditions

There are several other skin symptoms that can come with thyroid disease. Although your skin can give you clues as to what the problem is, your healthcare provider will need to perform blood testing to confirm a diagnosis of hyperthyroidism or hypothyroidism and guide treatment.

Some common skin symptoms that appear with hyperthyroidism—in particular, those aside from the myxedema rash—include:

• Flushing of the face
• Redness on the palms of your hands
• Excessive sweating on the palms of your hands and/or the soles of your feet
• Thin, soft, and sometimes shiny skin

Hypothyroidism, on the other hand, usually leads to skin symptoms like:

• Mottling or discoloration
• Cold hands and feet
• Dry, coarse texture
• Cracking of the skin
• A waxy, puffy appearance (also known as myxedema)

What Do Thyroid Rashes Look Like?

Thyroid rashes can take on several appearances, but puffy, shiny skin that is red or discolored is common. Skin can also appear dull, flaky, dry, or rough, depending on your level of thyroid dysfunction.

Your healthcare provider may suspect a thyroid disease or a lack of control of your thyroid condition based on the appearance of your skin, but blood testing is necessary to confirm a diagnosis or guide treatment.

Diagnosis

The symptoms of thyroid diseases can overlap with those of a number of other conditions, so your doctor may perform different kinds of tests to confirm a thyroid disorder or rule out other problems that can cause a rash. They may examine your rash closely, or even take a skin sample to view under a microscope. Blood testing, however, is the only way to conclusively diagnose the presence and severity of a thyroid disorder.

Treatment

Pretibial myxedema can be difficult to treat, and there are no official guidelines. Corticosteroid injections are one option, but topical medications or other anti-inflammatory medications may also help.

The most effective treatment for thyroid-related skin disorders is to get your thyroid imbalance under control. For a pretibial myxedema rash in particular, the underlying hyperthyroidism or Graves' disease must be treated with:

• Anti-thyroid medications such as Tapazole (methimazole), PTU (propylthiouracil), and Neo-Mercazole (carbimazole)
• Beta-blockers like Inderal (propranolol)
• Radioactive iodine
• Surgical ablation or partial removal

These treatments help to suppress or reduce the overproduction of thyroid hormones.

Rashes caused by hypothyroidism are treated with medications that replace thyroid hormones. Your healthcare provider will prescribe you one or more thyroid hormone replacement medications, testing your hormone levels from time to time and adjusting doses as needed. Some examples of thyroid hormone replacements include:

• Levothyroxine, a synthetic form of T4 (Synthroid, Levoxyl, Unithroid, and Tirosint)
• Liothyronine, a synthetic form of T3 (Cytomel)
• Natural desiccated thyroid

When to See a Healthcare Provider

If you have thyroid disease, you will need to be under the regular care of a healthcare provider or endocrinologist. You should not try to treat thyroid disease on your own. Delaying or avoiding medical treatment for thyroid disease can lead to serious complications, such as an irregular heartbeat.

Summary

There are a number of skin symptoms that can appear with thyroid diseases. Changes in color or skin texture that produce a rash are not unusual with thyroid disease, although certain varieties—like a pretibial myxedema rash—are not common. Talk to your doctor if you have a rash and you suspect your thyroid could be to blame.

A Word From Verywell

If you have thyroid disease and develop a rash, it's important to talk to your healthcare provider. Rashes can be a normal symptom of most thyroid diseases, but they could also signal a need for more intense treatment. Treating your underlying thyroid disease should improve rashes and help you avoid more serious complications.