A low functioning thyroid can cause many symptoms. That is because the thyroid is involved in practically every aspect of your body. In this post, I am going to talk about ways to help hair loss from thyroid and other hormonal imbalances.
Hair loss from hypothyroid is from the root. You will find full-length pieces of hair everywhere. In hypothyroid you will find hair thinning all over but particularly the top and hairline. Also, the eyebrows really take a beating in hypothyroid. There will be patches of hair missing throughout the eyebrows and the tail ends will disappear. Even body hair will reduce in hypothyroid. I had a patient that hadn’t shaved in years. And once we treated her hypothyroidism, she had to start shaving her legs again.
Other Common Symptoms of Hypothyroid:
- Weight gain
- Dry skin and terrible nails
- Irregular periods / bad PMS
- Mood issues: Thyroid slows everything down, even your mood. Many people report once their thyroid is treated their mood improves.
- Blood work out of range: Hypothyroid can disrupt blood sugar, raise cholesterol and increase inflammatory markers.
While having concerns over hair loss might seem superficial, it is not. It is disturbing to be losing hair and worrying if it will ever stop.
I’ve had patients who:
- Cry in my office because they don’t know how to stop the hair loss.
- Bring in hair that was lost in a little baggie or tissue.
- Send me pictures of the hair they are losing.
- Spend extraordinary amounts of money on special shampoos, conditioners, products for thinning hair.
- Spend money on low-level laser hats and steroid scalp injections
- Get their temples tattooed, so the hair loss is not so noticeable
- get blown off by their primary care or general provider because of their hair loss concerns.
It is important to understand hair loss is not a “disease,” it is not going to kill you. Unfortunately, many doctors are not interested in your hair loss concerns. Because they are jaded by dealing with people that have illnesses like diabetes, cancer, heart disease. I have had patients tell me that their primary care doctors tell them there is nothing that can be done.
One patient told me, her doctor told her to buy a wig. They are told hair loss is a consequence of thyroid, hormones, getting old and to just deal with it. But this is a very distressing concern, especially for women. For men, it is more socially acceptable to have thinning hair or baldness compared to women. With that said, I would like to provide you with some ideas to help with hair loss from hypothyroid and other hormonal imbalances.
Thyroid medication: If your thyroid is underactive, taking thyroid medication will help improve the overall function. If you are having symptoms of hypothyroid and excessive hair loss, have a blood test to check your thyroid. If you are interested in the different types of thyroid medication click on the link to listen to our podcast Episode 021.
Thyroid Testing: If you are interested in thyroid testing, click on the link to our podcast Episode 019 that is all about thyroid labs.
Raise T3: Bear with me as I try not to bore you with the physiology of thyroid hormones. This is going to be short and sweet and will not include every detail of how the thyroid functions. The brain releases TSH (thyroid stimulating hormone). The TSH monitors overall thyroid hormones. The thyroid releases mainly T4 (thyroxine). Thyroxine (T4) converts to T3 (triiodothyronine). T4 has a long half-life and doesn’t have much activity other than converting to T3, which is the active form of thyroid. You can have all the T4 in your body, but if you do not have T3, then you will have symptoms of hypothyroid. The goal here is to raise your T3 or raise the conversion of T4 to T3. The TSH is not an accurate measure of thyroid function. To accurately measure thyroid, you want to include a Free T4 and a Free T3.
Ways to Raise T3:
Reduce exercise: Excessive cardiovascular exercise will decrease your conversion of T4 to T3. If you over exercise or do a high volume of intense cardiovascular exercise, you are putting a heavy burden on your thyroid and adrenal glands. Intense cardio will dramatically increase your cortisol levels which impact your T3 levels.
Liver function: Your liver is the main converter of T4 to T3. If your liver is burdened or not functioning well, it cannot convert T4 to T3. Thereby reducing your T3 levels in your bloodstream.
A burdened liver can come from:
- Excessive caffeine intake
- Too much alcohol
- High intake of sugar especially fructose (high fructose corn syrup)
- Certain medications like statins (cholesterol-lowering medication)
- Taking a lot of medications
- Taking a lot of Tylenol or medicines with acetaminophen
- Fatty-liver disease (NAFLD)
Improve liver function by:
- Avoiding too much alcohol, sugar, fructose and restricting medications, especially meds with acetaminophen.
- Reduce coffee/caffeine consumption
- Take a liver supplement with herbs and vitamins to improve liver function
- Regular bowel movements, reduce constipation
No starvation/caloric restriction (dieting): Restricting your calories dramatically reduces your T3 levels. Part of your T3’s function is to keep your metabolism moving at a healthy pace. If your body thinks it is starving, it will do anything to try and preserve body mass. Automatically your T3 levels drop to reduce metabolism. I remember a young teen patient that was referred to me by a colleague to address her thyroid levels. She came in with her mom and grandmother as they were concerned about her hypothyroid symptoms. She was always tired and it was starting to affect her grades, family and social life. Her TSH was in range and even looked like she was HYPER-thyroid. Her T4 levels were normal. But she has very low levels of T3. I had seen her a couple years before and noticed that she had lost a considerable amount of weight.
In fact, she was incredibly thin. And she was on a restricted diet for her food allergies. But when we talked some more she started crying that she was fat and did not want to get “fatter”. She wanted to be on thyroid medication for her energy and metabolism. I am not a eating disorder practitioner. And I will be the first to say, I am not a expert in eating disorders. But it turned out she was anorexic. And privately I gave her grandmother a name of a eating disorder therapist, which she eventually, continues to see. What I am trying to say here, dieting in any manner that reduces caloric intake is going to drop your T3 levels. We all should endeavor to eat healthy. But caloric restriction will not help your hair loss and ultimately will not maintain weight loss.
Chronic Ketosis: A keto diet is a great way to lose weight (especially belly fat) and balance insulin and cortisol. Being in ketosis for an extended amount of time is hard on the thyroid and causes a drop in T3. This is why many people complain the keto diet caused their hair to fall out. Because they were in ketosis too long and needed to cycle in carbs every once in a while. Also, ketosis reduces appetite, so you have to be careful not to drop calories too much. If you are going to do a keto diet, make sure it is properly managed. You can download our free guide to healthy ketosis and carb cycling which we call, The Keto-Carb-Cycling-Program.
Sleep: Sleep deprivation can cause hair loss. Make sure you are getting at least 6 hours up to 8 hours a night. Not getting enough sleep is hard on the adrenal glands. The adrenal glands will end up releasing elevated levels of cortisol. These high levels of cortisol will reduce thyroid function which can cause hair loss.
High Reverse T3 levels: High levels of reverse T3 (RT3) can cause hair loss. Reverse T3 is inert and has no activity. Sometimes T4 will convert to RT3 instead of free T3. Higher levels of RT3 and lower levels of free T3 can cause symptoms of hypothyroid and hair loss. This is common when people are taking higher doses of T4 medication like Synthroid or levothyroxine. If you are taking Synthroid/Levothyroxine and your TSH is normal, but you still feel like you are hypothyroid. Check your Free T3 and Reverse T3 levels to make sure your medication is not converting to RT3.
Other contributing factors to your hair loss:
These factors may not be a direct influence from hypothyroid, but they are relevant to unexplained hair loss. I have had many patients convinced their hair loss is from their low thyroid. But in reality, it is a combination of thyroid and other factors. Or their hair loss is completely unrelated to their thyroid.
Low Iron levels: Having low blood iron/anemia can cause hair loss. Make sure to have your iron levels checked if you are having hair loss. For females, they might be losing too much blood during their periods. This will cause anemia and hair loss. Giving a iron supplement (non-constipating one) will help replenish the iron. And balancing hormones so that the blood loss from the periods is resolved will help prevent anemia. When testing for iron levels, most doctors will order a complete-blood-count (CBC). A CBC will show levels of red blood cells, the hemoglobin and hematocrit. If the hemoglobin and hematocrit are low then that points to anemia or low iron levels.
If the red blood cells are low, that too means anemia. But often times a person’s CBC is normal. Which is why checking ferritin levels are important when someone is having unexplained hair loss. Ferritin is not iron, but it is a protein that binds to iron. It helps us find out if the iron storage levels are low. It can be common for someone to have normal red blood cells, normal hemoglobin and hematocrit, but low levels of ferritin. Low levels of ferritin can cause hair loss. People also report having fatigue and a chronic low level headache with low ferritin. If you are worried about hair loss, make sure you have your ferritin levels tested as well as a CBC. If your doctor will not order a ferritin level for you, order it yourself on our website.
High Androgens in Females: Having high levels of DHEA or testosterone can cause hair loss. Usually, with high androgens, you will notice hair loss in temples and top of the head. People with Polycystic Ovarian Syndrome (PCOS) make excess testosterone causing hair loss. But I have many patients that do not have PCOS, yet they have higher than normal levels of testosterone.
If you do not have PCOS but have hair loss, get your testosterone and DHEA levels tested. There are ways to reduce the testosterone levels. Spironolactone is a medication that is often given to women with high levels of testosterone. Spironolactone will reduce testosterone levels quite effectively. Bioidentical progesterone can balance the testosterone levels to help with hair loss. Many doctors give birth control pills to reduce testosterone levels, although this would not be my first option for hair loss. Taking saw palmetto in some cases can reduce a female’s testosterone levels as well.
Exogenous Androgens: This is VERY common. If you are a female and taking testosterone or DHEA that can very well cause hair loss. Testosterone can be given for many reasons. Testosterone is often given as part of hormone replacement. But it can also be used for libido or building muscle. DHEA is a precursor to testosterone. Many women and men take DHEA supplements because it is helpful for raising testosterone levels and can be beneficial for aging. Either way, if you are taking testosterone or DHEA, be sure to test the levels. If they are too high for you, that will cause hair loss.
One time I was at my gynecologist’s office talking with the office manager. She was concerned because all the hair in her temples had fallen out. I told her that she needed to talk to her doctor and have him/her reduce the amount of testosterone in her hormone replacement. She was shocked and said, ‘how did you know I was on testosterone??’. Because that is one of the main symptoms, you will see if the testosterone is too high for that individual.
‘Lisa’, my trainer is a great example. I noticed she was having some pretty bad acne on her cheeks all of a sudden. I didn’t say anything, but she mentioned that she was losing her hair. I didn’t want to state the obvious but asked how long has it been going on and has she noticed any other changes, like “skin issues”. Lisa said she had been breaking out in cystic acne on her face and back recently. And her hair was coming out in handfuls. She was really worried that something serious was wrong with her. I asked her if she started any new medications or supplements of recent. Lisa said, “not really, but I am taking a new vitamin that helps with weight training and building lean muscle”. Turns out this supplements was very popular around the gym and a lot of trainers were taking it. And it happen to have 50 mg of DHEA in it. That high level of DHEA was causing acne and hair loss. A man should be able to tolerate 25-50 mg of supplemental DHEA. But for us ladies, taking that level would instantly cause hair loss, acne and feeling irritable (“testy”). Most women cannot tolerate more than 15 mg of DHEA, and even that can be too high. Usually DHEA in levels of 5-10 mg is the common dosage for a woman.
Another example is my patient, “Joan.” Joan came to her appointment and was concerned because her hair was falling out. I noticed she was breaking out on her face and she also mentioned she was very irritable. Her levels of testosterone were three times the normal level. And I did not have her on any testosterone or DHEA. But it clicked right away. I asked Joan if her husband was using a testosterone cream to increase his levels. She said that he was, but he was careful not to get it on her. I told her to go home and ask him if he was applying the cream to his bum. Testosterone is absorbed well in an area of fat tissue, like the bum or inner thigh. Joan’s husband was putting his testosterone cream on the back of his leg and bum. Because of this, the testosterone cream was getting on the toilet seat and transferring to Joan when she would use the bathroom. This actually happens a lot. Men taking testosterone creams or gels to treat Low T and inadvertently getting on another member of the household or even pets.
Perimenopause and Menopause: When the hormones drop in perimenopause or cease altogether in menopause that can cause hair loss. Estrogen and progesterone are great for hair, so when they decline the hair can thin, fall out or change in texture. Also when the estrogen and progesterone are low, that makes normal levels of testosterone seem falsely elevated. This can also cause hair loss. Balancing the hormones can help with hair loss in perimenopause and menopause. Bioidentical hormone replacement can help with hair loss. But not everyone is a candidate for BHRT. Evening primrose oil can be helpful in perimenopause and menopause for hair loss.
Hopefully, this post has been helpful for you. If you have any questions, please feel free to leave a comment below or send an email to [email protected]
- What is overmedication?
- Signs and symptoms of overmedication
- How do you become overmedicated?
- What is the treatment for overmedication?
- Is Thyroid Disease Causing Your Hair Loss?
- How Thyroid Hormones Cause Hair Loss
- Symptoms of Thyroid Disease
- Treating Thyroid Disease and Hair Loss
- Hypothyroidism & Hair Loss
- 10 Tips to Reverse Thyroid Hair Loss
- 1. Make Sure Your Labs Are Optimal
- 2. Make Sure You’re On the Right Type and Dose of Supplemental Thyroid Hormone
- 3. Optimize Your Diet
- 4. Take a High-Quality Multivitamin
- 5. Increase Your Iron
- 6. Add in Collagen Protein
- 7. Check for Low Stomach Acid
- 8. Balance Your Hormones
- 9. Balance Your Blood Sugar
- 10. Address Adrenal Fatigue
- Reverse Chronic Illnesses So You Can Take Back Your Health!
- Hyperthyroidism, Hypothyroidism and thyroid hair loss
Thyroid causing hair loss?
Q&A with Dr. Manny: If you lose your hair from a thyroid condition, will it grow back after treatment?
Believe it or not, you can tell a lot about a person’s health by looking at his or her hair.
We recently received this email from a viewer:
Hi Dr. Manny,
If you lose your hair from a thyroid condition, will it grow back after treatment?
Hair cells are some of the fastest growing cells in the body. So when your body is under stress from illness, hair cells can shut down to redirect the energy elsewhere to help heal what ails you.
According to the Academy of Dermatology, almost half of the American population experiences thinning hair by the age of 40, but people with certain thyroid conditions may start to lose their hair even earlier and more quickly.
“The good news is that your doctor can prescribe thyroid hormone medication to help your hair grow back,” said Dr. Jennifer Landa, chief medical officer for BodyLogicMD. “The first thing that you’ll notice is a slowing of the hair loss, and then the hair will start to grow back, and ultimately it will grow thicker and stronger. But this can take several months.”
Landa added that if a patient has been on thyroid hormone medication for an extended period of time and is not seeing results, he or she should ask for a free T3 test – which measures for a specific thyroid hormone called triiodothyronine.
“Most medication that we get for thyroid is T4 (thyroxine), and most patients do very well on that,” she said. “But there are many patients that would benefit from the addition of some T3 into their thyroid hormone regimen to help them grow back hair longer and stronger.”
Do you have a health question for Dr. Manny? Please send it to [email protected]
Are you hypothyroid and taking a thyroid hormone replacement drug like levothyroxine (Synthroid, Levoxyl, Tirosint), liothyronine (Cytomel), or natural desiccated thyroid (Nature-throid, Armour Thyroid)? If so, there’s a strong likelihood that at some point you will become overmedicated. How do you end up getting overmedicated and what are the signs, symptoms, and treatment for overmedication? Let’s take a look.
What is overmedication?
Overmedication means that you are suffering symptoms as a result of taking too much thyroid hormone replacement medication. This may be supported by blood tests that show your thyroid stimulating hormone (TSH) level is suppressed, or in the low end of the reference range, i.e., below 0.5. Your free thyroxine (Free T4) and free triiodothyronine (free T3) may also be elevated, or on the high end of the reference range. Overmedication typically causes symptoms — usually symptoms of hyperthyroidism — although when overmedicated, you may have symptoms like fatigue or weight gain that are more commonly associated with hypothyroidism.
Signs and symptoms of overmedication
Some of the most common signs and symptoms of overmedication include the following:
- An elevated pulse rate
- Elevated blood pressure
- Heart palpitations or rhythm changes
- Anxiety, nervousness, panic attacks
- Tremors in your hands
- Feeling angry or irritable
- Racing mind, difficulty concentrating
- Sleep problems, insomnia
- Excessive sweating
- Feeling overheated; feeling hot when others feel cold; heat intolerance
- Diarrhea or loose stools
- Weight loss despite no change to exercise or diet, or less commonly, weight gain
- An increased appetite and hunger, or loss of appetite
- A stable weight or weight loss, despite increased food intake
- Craving sugar and carbohydrates and/or eating more sugary foods
The brand-name levothyroxine drug Synthroid also lists as its “side effects” – essentially, the effect of taking too much of the medication – the following symptoms:
- Chest pain or shortness of breath
- Muscle weakness
- Impaired fertility
- Decreased bone density
- Changes in menstrual periods
- Leg cramps
How do you become overmedicated?
If you are taking thyroid hormone replacement medication prescribed by your doctor, how can you become overmedicated? There are several ways that this can happen.
Your doctor prescribed a dose that is too high. Especially when you are first diagnosed, or when your dosage is being increased, your healthcare provider may overestimate the dose you need, and accidentally overmedicate you.
Your doctor made a mistake. There are times when doctors write down incorrect dosage or prescribing instructions on a prescription pad, or enter the wrong information in an automated system. Even a small difference in pill size, or a mistake that has you taking two pills a day instead of one, can be enough to quickly make you overmedicated.
The pharmacy made a mistake. Pharmacies frequently make errors, including:
- Filling your prescription with the wrong medication
- Filling your prescription with pills at the wrong dosage, or providing incorrect dosage instructions (i.e., “take two per day,” instead of one)
- Substituting a brand name drug with a generic, without approval
You should always check your medication carefully when receiving it from your pharmacy. Verify that you have the correct medication at the correct dosage. (It’s also a good idea to count the pills to make sure you’re not shorted.)
You are taking generic levothyroxine. Generic levothyroxine can vary in potency, depending on its manufacturer. As a result, when you get a refill of generic levothyroxine, you may get more potent pills, even at the same dosage, which can result in overmedication.
Your non-prescription supplements contain actual thyroid hormone. Research has shown that some over-the-counter supplements include measurable levels of thyroid hormone in them. When added to your intake of prescription thyroid hormone medication, this can push your thyroid hormone levels high enough to make you overmedicated. Watch out for supplements that are labeled as “thyroid support” or “thyroid glandular.”
You are overdoing it on iodine. Iodine is a building block for thyroid hormone. If you still have a thyroid gland and are overdoing it with iodine supplements or supplements that contain iodine — like seaweed, bladderwrack, or kelp — this can increase your thyroid hormone levels. When added to your prescription medication, you can become overmedicated.
Your absorption has changed. There are many factors that can cause you to better absorb the thyroid medication you are taking, causing overmedication. Some of the causes of better absorption include:
- You switched to Tirosint from a tablet form of levothyroxine to Tirosint liquid gel-caps, or Tirosint-SOL liquid levothyroxine, both of which are better absorbed than tablets.
- You reduced the amount of fiber in your diet, or you stopped eating a high-fiber diet.
- You stopped drinking coffee within an hour of taking your thyroid medication.
- You stopped taking iron or calcium supplements, or started taking them more than three hours apart from your thyroid medication.
- You stopped taking estrogen. Estrogen can bind/block absorption of thyroid hormone, so stopping hormone replacement therapy or birth control pills can sometimes trigger overmedication.
Your post-partum thyroid disease has resolved. Some women become hypothyroid after childbirth – known as post-partum thyroiditis. This condition can resolve over time. If you are continuing to take thyroid hormone medication, this can result in overmedication.
You have Hashitoxicosis. Patients with Hashimoto’s thyroiditis sometimes go through periods when the thyroid goes into overdrive, and shifts into a period of hyperthyroidism. If you are already taking thyroid hormone medication, these shifts can result in periods of overmedication.
You’ve lost weight. Thyroid dosage is somewhat weight-dependent, so if you lose more than a few pounds, your current dosage may end up being too high. This can cause overmedication.
What is the treatment for overmedication?
The treatment for overmedication is clear: Your healthcare practitioner will reduce your dosage of thyroid hormone replacement medication. You should also review and discuss any medications, vitamins, or supplements that may be affecting your thyroid, and determine whether to continue taking them.
After a dosage decrease, make sure that you are frequently tested until your overmedicated state is resolved and your levels return to the reference range. Once stabilized, you can return to your regular schedule of monitoring your thyroid levels.
See more helpful articles:
You Might be Hyperthyroid If…
The Risks for and Symptoms of Hyperthyroidism
Is Your Thyroid in the Normal Range, but Not Optimal?
It is a well-established fact that endocrine disorders such as hypothyroidism, hyperthyroidism, and parathyroid disorders can cause hair loss. In thyroid dysfunction, other than scalp hair, hair on other parts of the body may also be affected, such as eyebrows and body hair. Diffuse hair loss is sometimes the presenting symptom of hypothyroidism. It is well-known that thyroid hormone is essential for the development and maintenance of the hair follicle. Trichograms from the parietal and occipital areas in a study showed increased dysplastic and broken hairs strengthening the view that alopecia in thyroid disease is not caused by changes within hair cycle, but probably by impaired hair quality.
Although, there are many studies relating to thyroid and hair loss they are all based on a univariate analysis. Here, we have attempted to study multiple variables of alopecia with relation to thyroid disorder.
All patients who attended the clinic from December 2007 to December2009 (25 months) with the complaints of hair loss of any part of the body were seen and classified into diffuse alopecia, alopecia areata, androgenetic alopecia, cicatricial alopecia, alopecia totalis, alopecia universalis, madarosis, diminished facial hair (moustache and beard), and diminished body hair based on clinical diagnosis. They were again categorized sex wise and age wise and the relationship of each group to thyroid disorder was studied. Any associated clinical condition with each type of alopecia was noted and again their relation to thyroid dysfunction was recorded. All patients were tested for thyroid stimulating hormone (TSH) and auto antibodies to thyroid peroxidase (TPOAb) by electro-chemiluminescence immunoassay, a third generation assay with a sensitivity of 0.001 mIU/L. The reference range of test values for TSH are as follows: Euthyroid: 0.4-4, hyperthyroidism: <0.1, subclinical hypothyroidism: 4-20, hypothyroidism: >20. TPOAb values below 60 U/ML were considered normal. Definitions used were: Euthyroid: Normal values of TSH and TPOAb, hypothyroid: Patients with an increased TSH and TPOAb and those with raised TSH but normal TPOAb, hyperthyroid: Patients with subnormal TSH values and normal TPOAb and those with subnormal TSH and raised TPOAb, subclinical: Patients with normal TSH but raised TPOAb. Data were analyzed using the Statistical Package for the Social Sciences (SPSS) Version 16.0 (IBM Inc, USA).
A total of 1232 patients were seen during a period of 25 months. The main types of alopecia seen were diffuse alopecia (71.35%), alopecia areata (11.8%), and androgenetic alopecia (14.29%). The others comprised of alopecia totalis (0.16%), alopecia universalis (0.41%), cicatricial alopecia (0.32%), madarosis (0.89%), diminished/absent facial hair (0.57%), and diminished body hair (0.16%). Since, the sample size of these was small they were clubbed together as “others” in the analysis. A significant difference between females and males was seen in diffuse alopecia and androgenetic alopecia. In the case of alopecia areata, no significant difference was noticed between females and males . It was found that there was a significant difference in thyroid dysfunction with respect to sex (P < 0.001). Initially patients were analyzed on a decade basis that is, 0-10 years, 11-20 years, 21-30 years, 31-40 years, 41-50 years, and >50 years. However, as the number of patients in some of the groups were nil or very small, they were regrouped into three groups for ease of analysis into 0-20 years, 21-40 years, and more than 40 years. More number of patients with complaints of alopecia was seen in the 21-40 age groups. Of this diffuse alopecia was the commonest (44.64%) followed by androgenetic alopecia. In the age groups of 0-20 years and 21-40 years thyroid dysfunction was seen more in alopecia areata and diffuse alopecia, showing almost equal prevalence, whereas in the group above 40 years thyroid dysfunction was noted more in alopecia areata and androgenetic alopecia (50%). Here, again there was a significant difference in thyroid dysfunction with respect to age (P < 0.001) . It was seen that as age advanced the thyroid dysfunction associated with alopecia also increased and this was reflected in all types of alopecia.
Alopecia – Sex-wise distribution
Thyroid, alopecia, age cross-tabulation
The main associations seen were urticaria, ichthyosis, hirsuitism, psoriasis, seborrheic dermatitis, acanthosis nigricans, premature greying, and acne. Other conditions such as lichen planus, systemic lupus erythematosis steatocystomas, para-psoriasis, facial pigmentation, lichen amyloidosis, herpes genitalis were seen in very small numbers and as the sample size was very small, they were all considered together as “others.” The relationship of these associated conditions with thyroid abnormality is given in Table 3. Although, madarosis is commonly stated to be associated with thyroid dysfunction in our study we found only 11 patients to be havingmadarosis and out of that only 2 patients showed thyroid dysfunction out of which 1 was hypothyroid (1%) and the other was in the subclinical group (1%). Premature greying was the most common association seen. Significant association with alopecia and thyroid dysfunction was found in urticaria (62.5%), vitiligo (50%), acanthosis nigricans (43%), premature greying (25%), hirsuitism (27%), psoriasis (27%), seborrheic dermatitis (25%), and ichthyosis (18%). Other conditions seen associated could be considered incidental as sample size was very small.
Relationship between thyroid dysfunction and clinical associations
The present study has described the different patterns of alopecia seen among a cross-section of alopecia patients and their relation to thyroid dysfunction, age, sex, and associated conditions. Such a comprehensive study is not available in the literature. As this is a descriptive study only there is no scope for comparison with a normal population. It is worth mentioning that a cross-sectional population survey conducted among the residents of urban coastal area of central Kerala, similar to our locality, showed a high prevalence of thyroid dysfunction (19.6%) among the adult population, where females predominated over males (23.6% vs. 13.3%), similar to the results in our study, where females were more among alopecia patients and also with thyroid dysfunction. This is in keeping with other studies of the general population where women were found to have a higher prevalence of thyroid dysfunction. In the higher age group also women prevailed as thyroid dysfunction is more in perimenopausal and postmenopausal women. Thyroid dysfunction is reported in children with alopecia areata and our study also showed a high prevalence of thyroid dysfunction in the group 0-20. Hence, routine screening of all children coming with any type of alopecia is recommended.
Thyroid autoimmunity is well documented in alopecia areata. In androgenetic alopecia multilayered interactions between thyroid hormones and androgens may contribute to the development of alopecia. In females, significant hypophyseal hypothyroidism may play a role in androgenetic alopecia.
In the screening tests for thyroid, TSH assay methodology has undergone dramatic improvements that have revolutionized strategies for thyroid testing and firmly established TSH as the first-line thyroid function test to assess thyroid hormone status for most of the clinical conditions. Both thyroglobulin and thyroid peroxidase antibodies are markers of thyroid autoimmunity. They are found in a small percentage of the normal population. TPOAb, in addition to anti-thyroglobulin antibody, was a clinically useful marker for defining autoimmune thyroid diseases and for detecting an underlying autoimmune process in the thyroid. From the clinical point of view thyroglobulin antibody are less prevalent than TPOAb and less useful than TPOAb for prediction of thyroid dysfunction. Raised TPOAb is a good predictor of hypothyroidism and other autoimmune disorders. High levels of thyroid antibodies with raised TSH strongly suggest progression to overt hypothyroidism.
Skin findings observed in thyroid dysfunction at a study at Numune Education and Research Hospital in Ankara, Turkey were chronic urticaria (6.8%), vitiligo (6.8%), diffuse alopecia (6%), acne vulgaris (5%), and acne rosacea (306%). In our study, patients were seen to have significantly higher association of urticaria and vitiligo as co-association of alopecia with thyroid dysfunction.
The present study has its limitations. Screening for thyroid was based on TSH and TPOAb which are good markers for the purpose. It was not followed-up with additional tests as many of the patients could not afford the cost. However, based on our observations, we recommend that all patients coming with alopecia, irrespective of the pattern of alopecia should be screened for thyroid and TSH and TPOAb are good screening tools and cost effective.
Is Thyroid Disease Causing Your Hair Loss?
When your hormones get out of whack as a result of thyroid disease, your whole body can feel off-kilter. Your weight, your mood, and even your thinking, can be affected, and you may have a host of other physical symptoms too. Hair loss is a common side effect of thyroid disease, but it’s not a permanent problem as long as you get the treatment you need.
How Thyroid Hormones Cause Hair Loss
Your hair follicles follow a natural cycle of hair growth and resting phases. At any given time, most of your hair is growing while only a small portion of it is resting. But when changes in the body throw off that cycle, too much hair rests at one time and not enough grows, resulting in excessive hair loss, thinning hair, or balding.
Many medical conditions can cause hair loss, with thyroid disease a common culprit. Thyroid problems include both an underactive thyroid gland (hypothyroidism) and an overactive thyroid gland (hyperthyroidism). Because hair growth depends on the proper functioning of the thyroid gland, abnormal levels of thyroid hormone produced by this gland can result in hair changes, along with many other side effects, if left untreated. When there is too much thyroid hormone, the hair on your head can become fine, with thinning hair all over the scalp. When there is too little of this hormone, there can be hair loss, not just on the scalp, but also anywhere on the body.
Ironically, taking the hormone levothyroxine to treat an underactive thyroid can contribute to some hair loss, among other side effects, but this seems to be more common within the first month of treatment and more often in children than adults. This hair loss is only temporary and will go away as treatment is continued and thyroid hormone levels stabilize.
Symptoms of Thyroid Disease
Any type of thyroid disease can cause a number of different symptoms, but they can sometimes be subtle. In addition to hair loss or thinning hair, be aware of these other symptoms:
- Changes in mood, such as anxiety, irritability, and increased nervousness
- Being unable to tolerate hot temperatures or cold temperatures
- Insomnia or lethargy and sleeping too much
- Weight changes — either weight loss or weight gain
- Abnormal menstruation
- Pain or weakness in the muscles
- Dryness in the hair or skin
- Cognitive impairment, such as having trouble paying attention, remembering, and concentrating
Thyroid function can be measured using a simple blood test, so if you notice any symptoms that could signal thyroid disease, see your doctor promptly.
Treating Thyroid Disease and Hair Loss
The good news is that once you get your thyroid disease diagnosed and the right treatment is prescribed to regulate thyroid hormone levels, the hair loss problem should resolve itself. Healthy hormone levels mean healthy hair growth.
It may take some time to find the right dosage of thyroid hormone to get your thyroid under control. If you’re uncomfortable with the look of your hair while treatment is underway, there are options to consider. Wearing a hair piece or wig or getting a new hairstyle can help camouflage hair loss as you wait for the results of thyroid treatment to begin. Ask your doctor if it makes sense to try a topical medication that helps spur hair growth like mixoxidil (Rogaine).
Thyroid disease affects many body functions besides hair growth, so be sure to talk to your doctor if you suspect that a thyroid problem could be the cause of your hair loss. Treatment will improve how you feel as well as how you look.
Hypothyroidism & Hair Loss
An estimated 20 million Americans have some form of thyroid disease, and as many as 60% are unaware of their condition. Hashimoto’s thyroiditis, a type of autoimmune disorder, accounts for 14 million cases of thyroid disease. In Hashimoto’s, immune cells mistakenly attack healthy thyroid tissue, causing inflammation of the thyroid and a decrease in hormone production. Unlike regular hypothyroidism, Hashimoto’s can cause severe inflammation and enlargement of the thyroid gland, leading to goiter in some cases.
Located in the neck just below the Adam’s apple (larynx), the thyroid gland is small, but it produces two hormones that influence every cell, tissue, and organ in the body. These hormones regulate metabolism and affect critical body functions, such as energy level and heart rate. The thyroid gland produces thyroxine (T4) and lower amounts of the more active hormone, triiodothyronine (T3), which together are known as the thyroid hormones. Thyrotrophin-releasing hormone (TRH) from the hypothalamus in the brain and thyroid stimulating hormone (TSH) produced by the pituitary gland control release of the thyroid hormones.
Hypothyroidism Hair Loss
In hypothyroidism, the thyroid gland does not produce enough thyroid hormone. Symptoms can include extreme fatigue, depression, forgetfulness, weight gain, and hair loss. Hair follicles follow a natural cycle of hair growth and resting phases. Normally, hair grows about a half inch per month for about 3-6 years, followed by a resting period. At any given time, most hair is in the growing phase, while only a small portion is resting. Typically, one in 10 hairs rest at any one time, and after the 3 month-resting period, a new hair grows in place of an old one. Changes in the body alter the natural cycle, resulting in too much hair resting at the same time and not enough growing, which leads to noticeable hair loss – either thinning or balding. Hair loss is more common if hypothyroidism is severe and prolonged, which generally results from inadequate or no treatment. This hair loss is usually diffuse, involving the entire scalp rather than specific areas.
In addition, hormone-induced hair loss occurs when an enzyme starts to convert the hormone testosterone on the scalp to its less useful version, dihydrotestosterone (DHT). DHT attacks the hair follicle and shrinks it, sometimes making it disappear entirely. Hair becomes thinner, finer, and may stop growing entirely. In some people with hypothyroidism or hyperthyroidism, the DHT conversion process appears to be sped up. This process may be responsible for continued hair loss after a person is on thyroid medication and hormone levels have stabilized.
The medication levothyroxine is the gold standard treatment for an underactive thyroid. It may take a period of time to find the right dosage of thyroid hormone to normalize hormone production. Your doctor may retest your levels to assess the effectiveness of the medication. Make sure your TSH level is also tested, since it plays an important role in controlling the thyroid hormones. Ironically, levothyroxine itself can contribute to some hair loss, however, this appears to be more common within the first month of treatment and impacts children more frequently than adults. In the majority of cases, this hair loss is temporary, diminishing after you’ve been taking medication for a long enough period for thyroid hormone levels to stabilize. Hair loss can also result from being undertreated. This could mean not having adequate TSH levels or taking drugs that aren’t working optimally for you. Some people do better on medications containing both T3 and T4, not solely synthetic T4 (e.g. levothyroxine drugs like Synthroid).
Thyroid Hair Loss Tips
Wear a hair piece or wig
Get a new hairstyle to camouflage hair loss
Have ferritin levels tested (the stored form of iron), because low levels are a common cause of hair loss in women
Have iodine, zinc, vitamin D, B12, and magnesium levels tested, because deficiencies in these can also contribute to hair loss
Take a high quality multivitamin supplement with the above-mentioned vitamins
Control blood sugar – swings in levels can induce the conversion of T4 to Reverse T3, an inactive hormone that blocks T3 activity, which can lead to hair shedding
Ask your doctor about using Rogaine (minoxidil), available over the counter in 2% and 5% strengths
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THANK YOU Review by Christine Hypothyroidism & Hair Loss Rating 100 100
I’ve been pulling out eyebrows since I was 12. Now as a 42 yr old mother I just accepted I’d have to draw on my eyebrows every day. Until now, I received my eyebrows today, as funny as that sounds to the “average” person and cannot stop smiling. I feel whole again, I feel confident and I feel gratitude. With all of my heart, I want to say thank you to the person(s) who made these, who know about trichotillomania. (Posted on 09/19/2017)
10 Tips to Reverse Thyroid Hair Loss
August 19th, 2019
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There I was, standing in front of my bathroom mirror brushing my hair, when I noticed chunks of it coming out on my hair brush. It was horrifying and depressing, after all I was 32 years old and this was not normal! I would later discover that this was a symptom of my Graves’ Disease, and I would even have the misfortune of experiencing it again during my thyroid treatment. While thyroid hair loss might not be one of the more dangerous symptoms of thyroid dysfunction, it can be one of the more disheartening, and it was a constant reminder that something was not right with my body.
Thankfully, after a long journey to restore my thyroid function, my hair returned to being as full and healthy as ever. However, when I first meet with thyroid patients, they are often times struggling with thyroid hair loss even while being treated for their thyroid dysfunction.
As with many health issues, this is often because conventional medicine doctors fail to identify and address the root cause of thyroid symptoms. I discuss all of these environmental root causes in my book, The Thyroid Connection, and I interviewed 35 of the world’s top thyroid experts about this topic for my FREE online event, The Thyroid Connection Summit, which started yesterday and airs through October 31st. Sign up for free here!
In this article, I’ll share ten tips for addressing the root causes of thyroid hair loss and getting your hair back to being full, shiny, and healthy!
1. Make Sure Your Labs Are Optimal
My first recommendation if you are dealing with thyroid hair loss is to have your doctor run a full thyroid panel to make sure your TSH, Free T4 (FT4), Free T3 (FT3), and Reverse T3 (RT3) levels are all optimal. In last week’s article, What Your Thyroid Lab Results Really Mean, I explained what each of these blood tests measures, why your doctor needs to order all of them (not just the TSH and T4 that most doctors use), and why they should use optimal rather than “normal” reference ranges. It’s important to understand that you can still have thyroid dysfunction and symptoms, including thyroid hair loss, even if your TSH and T4 are “normal,” and the first step in optimizing all of your levels is to have them tested.
2. Make Sure You’re On the Right Type and Dose of Supplemental Thyroid Hormone
Once you know all of your thyroid levels, you can work with your doctor to make sure that you’re on the right type and dose of supplemental thyroid hormone. Free T3, the active form of thyroid hormone, plays a big role in the health of your hair, yet the most commonly prescribed supplemental thyroid hormone is a T4-only hormone, such as Synthroid® or Levoxyl®. Many thyroid patients have difficulty converting T4, the storage form of the hormone, to Free T3, and do better on natural desiccated thyroid hormone, such as Armour® or Naturethroid®, which includes both T4 and T3, or by adding in a T3-only form of supplemental thyroid hormone, such as Cytomel® or a compounded time-release T3 formula. I discuss in detail all of the different forms of supplemental thyroid hormone and how to determine which one is right for you, in my book, The Thyroid Connection.
3. Optimize Your Diet
From there you’ll want to make sure your diet has been optimized for thyroid health, which includes ditching toxic and inflammatory foods and adding in plenty of the nutrients needed for essential thyroid function. I’ve written many articles about the huge impact I’ve seen from my thyroid patients going gluten-free, and I cover the scientific research behind it in my book. Dairy is another big culprit for thyroid patients because of its chemical similarities to gluten and because it is so inflammatory for many people. Other inflammatory foods I recommend eliminating while you work to resolve thyroid symptoms include corn, soy, nightshades, eggs, nuts, and seeds.
Instead, you’ll want to focus on eating real, whole foods rich in the nutrients needed for thyroid health, including iodine, selenium, zinc, iron, vitamin D, B vitamins, and vitamin A. If you are low in these nutrients, your thyroid can’t adequately produce its hormones, convert T4 to T3, or get T3 into your cells to attach to thyroid receptors, which can cause hypothyroidism symptoms, such as thyroid hair loss. I recommend a diet with plenty of grass-fed, pasture-raised meat, leafy greens, starchy vegetables, organic fruits, and healthy fats. I’ve included a full 28-day meal plan with recipes packed with these nutrients in The Thyroid Connection book.
4. Take a High-Quality Multivitamin
While eating a diet rich in these nutrients is an important step in maintaining your levels of each, the unfortunate fact is that our soil has been depleted of nutrients and our food is less nutrient-dense than our parents’ and grandparents’. That’s why I recommend for everyone to take a high-quality multivitamin each day. I recently developed and released a custom-formulated multivitamin specially designed to provide all of the essential nutrients for thyroid function and general health. It includes all of the vitamins and minerals listed above in their most bio-available and easily absorbable forms.
5. Increase Your Iron
Although all of the nutrients I’ve listed above are key for thyroid health, iron deficiency in particular is a common cause of thyroid hair loss in premenopausal women. I find that most of the women I treat in my clinic are deficient in iron, specifically ferritin, the protein that stores your iron, since they are menstruating monthly. It is particularly common among women following a vegetarian or vegan diet, but I see it frequently in those following a paleo diet as well. If you are a menstruating female or your iron levels are low, I recommend taking a daily iron supplement.
6. Add in Collagen Protein
Collagen is a protein that is packed with amino acids, including glutamine. It gives your hair its strength, your skin its elasticity, supports healthy bones and joints, and helps maintain gut health. Your body produces collagen on its own, however your production of it decreases as you age, and if you are chronically ill or stressed your ability produce it is reduced.
I add The Myers Way® Collagen Protein into my smoothie each morning! It’s great for your overall health, especially if you are healing a leaky gut, and it can be particularly helpful for those dealing with thyroid hair loss.
7. Check for Low Stomach Acid
I’m sure you’re familiar with the saying “you are what you eat.” However, I prefer to say, “you are what you digest and absorb!” If you have a chronic illness such as thyroid dysfunction or an autoimmune condition, you may not be fully digesting and absorbing all of the nutrients that are vital for thyroid function and healthy hair. A primary reason for this is low stomach acid, which breaks down your food once it reaches your gut.
Some tell tale signs of low stomach acid include acid reflux, gas, and bloating, particularly after heavy meals high in protein. There is a simple test you can do to find out if you are low in stomach acid. You can take one capsule of HCL (the primary stomach acid) with water before a meal, and then see how you feel after about 30 minutes. If you feel a burning sensation, your HCL levels are fine. But, if you feel nothing, you probably need to add an HCL supplement. For more information on how to test your stomach acid levels and how to figure out how much HCL to take, see this video.
8. Balance Your Hormones
Many women develop or see a flare in thyroid dysfunction during pregnancy or menopause, when our bodies are going through major hormonal shifts. If your estrogen levels are too high, due to either hormonal changes or chronic stress, the excess estrogen increases your levels of TBG, thyroid binding globulin. This is the protein that allows your thyroid hormones to travel through your bloodstream. When thyroid hormones are attached to TBG they remain inactive, so T4 can’t be stored in your tissues or converted to Free T3, causing hypothyroid symptoms such as hair loss.
9. Balance Your Blood Sugar
Eating lots of carbohydrates and not enough quality proteins and healthy fats can send your blood sugar on a rollercoaster. These dramatic swings in blood sugar encourage your body to convert more T4 to Reverse T3, an inactive form of thyroid hormone. This slows down all of your metabolic processes and can cause you to shed hair more quickly.
To avoid this, I recommend starting off your day with a high-protein breakfast, whether that’s a protein-packed smoothie or a dish such as my Beef and Veggie Breakfast Scramble, and pairing your starchy vegetables throughout the day with grass-fed, pasture raised meat and high-quality fats, such as avocados and coconut oil.
10. Address Adrenal Fatigue
You probably know your adrenal glands for producing adrenaline and managing your fight or flight response, but did you know that, as part of your endocrine system, they also produce hormones that impact your major metabolic processes, just like your thyroid? These hormones help to regulate blood pressure, electrolyte balance, blood sugar, immune response, digestion, and more.
Chronic stress, which many of us face on a daily basis, puts your adrenals on overdrive for extended periods of time, leaving you in a state of adrenal fatigue. The flooding and eventual plummeting of stress hormones has many negative impacts on the thyroid. It slows thyroid production, reduces your ability to convert thyroid hormones to their active form, and increases thyroid hormone resistance, causing hypothyroid symptoms, including thyroid hair loss.
While stress may be an unavoidable part of our modern lifestyles, there is much we can do to manage our stress levels and their impact on thyroid health, whether that’s taking a walk outside, practicing meditation, or taking a nice relaxing bath.
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Hyperthyroidism, Hypothyroidism and thyroid hair loss
Did you know that your hair doesn’t continually grow? Rather each hair has periods of growth and periods of rest (the telogen phase) so your hair follicles will each be at a different phase of the growth cycle which in itself is several months long.
The most common cause of general hair loss is called “telogen effluvium” and this normally comes about because of an event like
- Physical or emotional trauma
- Severe infections
- Long term illness
- Major surgery
- Crash dieting
If you hair is thinning and you have not experienced some form of “trauma” as above it may well be due to a thyroid problem so do go and see your GP.
Hyperthyroidism and hair loss
The most common form of hyperthyroidism is an autoimmune disease called Graves’ disease and it’s not unusual for people with one autoimmune disease to develop another. This is the likely explanation for hyperthyroid patients developing the autoimmune disease “Alopecia areata” during which there are small, often circular areas of hair loss. In most cases this does not progress but in severe cases it can cause significant baldness (“Alopecia totalis”).
Hypothyroidism and hair loss
Hair loss is caused by hypothyroidism as a consequence of your cells regeneration being slowed down. The most common form of hypothyroidism is an autoimmune disease (called Hashimoto’s thyroiditis). This results in a general thinning of the hair across the entire scalp.
Loss of hair on the outer edge of your eyebrows is a classic sign of the hair loss problem being caused by hypothyroidism – this is known as the “Queen Anne’s sign” due to a portrait of her showing this characteristic (although it was never established if she actually was hypothyroid!)
What if you have thyroid hair loss?
Because the hair growth cycle IS months long it is easy to misinterpret the cause of hair loss which may actually appear several months after the initial cause. This can lead to people wrongly blaming their thyroid medication rather than the medical condition. Unfortunately if they then stop the medication the hair loss will become more significant.
It is very rare indeed for anti-thyroid drugs or treatment to cause hair loss.
In most cases, loss of scalp or eyebrow hair is temporary but regrowth can take several months whilst the medication normalises the cycle of regrowth. When it does grow back it is possible that it may be different in both texture and colour.
The loss of hair can obviously be extremely traumatic, but the key is to be patient and not to be taken in by “miracle cures”. You can also do several things to help you get through this most challenging time
- Talk to friends and family
- Join a local alopecia support group
- Or find help via an alopecia forum of the Facebook Group @AlopeciaUK
- You might want to consider a wig or a medical tattoo to restore your eyebrows
- Do listen to tips from qualified hairdressers
- Don’t stress your hair – avoid straighteners and use wide tooth combs
- Check out product guidelines from the British Association of Dermatologists
- Eat a healthy diet and make sure it is rich with calcium and iron.
Please talk to your pharmacist if you are considering taking hair supplements. Some of these may interfere with the absorption of your Levothyroxine medication or contain iodine which can cause thyroid underactivity or over activity.
I hope this has been helpful.
You may also be interested in this blog post about the effects of PCOS on hair
Although every effort is made to ensure that all health advice on this website is accurate and up to date it is for information purposes and should not replace a visit to your doctor or health care professional.
As the advice is general in nature rather than specific to individuals Dr Vanderpump cannot accept any liability for actions arising from its use nor can he be held responsible for the content of any pages referenced by an external link