Primary hypothyroidism with exuberant dermatological manifestations

Abstract

Thyroid hormone has effects on the skin. Patients with hypothyroidism have changes such as dry, scaly and rough skin. Increase carotene in the dermis becomes a yellowish tone to the skin of the patient with hypothyroidism. There is an increase in capillary cycle (anagen phase) and nail growth and a reduction in eccrine gland secretion. It is a case of primary hypothyroidism with nail manifestations associated with dermatologic disorders and successful treatment with levothyroxine. Receptors for thyroid hormone have already been found in keratinocytes, fibroblasts, hair follicles and sebaceous glands. Genes responsive to thyroid hormones and elements of the hypothalamic–pituitary–thyroid axis were identified on the skin. This report highlights the importance of cutaneous manifestations as markers of thyroid disease.

Skin Changes in Newly Diagnosed Cases of Hypothyroidism

“…In hypothyroidism, there is a hindrance in the barrier formation of the epidermis. 8 Dermal changes include myxoedema (due to glucoseaminoglycan deposition in the skin), oedema of hands, face, eyelid and pallor. Generalized myxoedema is a classical sign of hypothyroidism.…”

“…Generalized myxoedema is a classical sign of hypothyroidism. 8 Prominent yellowish hue of skin on palms, soles and nasolabial folds known as carotenemia which is secondary to increased dermal carotene deposition. 9 Hair changes in hypothyroidism include dry brittle, coarse hair, slow-growing, patchy or diffuse hair loss (alopecia), and loss of lateral 3 rd of eyebrows (madarosis) while nail changes are coarse dull brittle striated nails, slow nail growth, longitudinal and transverse striations and onycholysis.…”

“…Decreased skin perfusion may lead to cold, pale skin which can be examined by nail fold capillaroscopy and laser doppler. 8,10,11,12 Clinical features of hypothyroidism and subclinical hypothyroidism range from mild symptoms to lifethreatening conditions. Common symptoms in adults are fatigue, lethargy, cold intolerance, weight gain, myxedematous facies, constipation, change in voice, dry skin, poor concentration, altered mood, cognitive dysfunction, depression, menstrual irregularities, bradycardia, pericardial effusion and cardiac tamponade.…”