European Journal of Cardiovascular Medicine

Autoimmune thyroid disorders are among the most prevalent endocrine conditions, with a marked predominance in adult women and a well-established autoimmune basis involving Hashimoto thyroiditis and Graves disease [1]. These disorders arise from immune-mediated injury to thyroid tissue, leading to variable hormonal disturbances that influence multiple organ systems, including the skin. The skin is particularly sensitive to alterations in thyroid hormone levels because these hormones regulate epidermal turnover, follicular cycling, sweat gland activity, and melanocyte function [1,2].

Cutaneous manifestations in thyroid dysfunction span a wide clinical spectrum, ranging from xerosis and hair thinning to more specific autoimmune-associated findings such as vitiligo, urticaria, and alopecia areata [2,3]. Many of these features present early and may precede overt endocrine symptoms, making them valuable diagnostic clues for underlying thyroid disease [1,4]. Their recognition is especially important in routine outpatient practice, where subtle dermatological signs may be overlooked.

Despite their diagnostic relevance, dermatological features of autoimmune thyroid disorders often remain under-recognized. Population-based studies and clinical reports emphasize the need for heightened awareness of these manifestations to support earlier detection and comprehensive evaluation [3,5]. Understanding their frequency and pattern in local settings can also help refine screening strategies.

The present cross-sectional study aims to document the prevalence and spectrum of dermatological manifestations among patients with autoimmune thyroid disorders. By identifying the cutaneous profile of this population, the study highlights the importance of integrating dermatological assessment into routine thyroid disorder evaluation.

Study Design and Setting

This research was designed as a hospital-based cross-sectional study and was conducted in the Department of Dermatology, Government Medical College (GMC), Pulivendula. The study period extended from January 2024 to May 2024.

Study Population

A total of 50 patients diagnosed with autoimmune thyroid disorder were enrolled using consecutive sampling. Individuals aged 18 years and above, attending the dermatology or medicine outpatient clinics, and having confirmed autoimmune thyroid dysfunction based on thyroid function tests and anti-TPO antibody levels were eligible for inclusion.

Inclusion Criteria

Patients with newly diagnosed or known autoimmune thyroid disorder

Age ≥ 18 years

Elevated anti-TPO antibody levels supporting autoimmune etiology

Willingness to participate and provide written informed consent

Exclusion Criteria

Non-autoimmune thyroid disease

Chronic systemic illnesses (e.g., renal failure, chronic liver disease)

Pregnancy or lactation

Current use of medications known to produce dermatological side effects

Patients unwilling to undergo dermatological examination

Data Collection

A structured proforma was used to record demographic details, clinical history, thyroid status (hypothyroidism or hyperthyroidism), and laboratory markers. Each patient underwent a detailed dermatological examination under natural daylight conditions. Skin, hair, and nail findings were documented carefully, ensuring consistency across participants.

Laboratory Parameters

Thyroid function tests (TSH, T3, T4) and anti-TPO antibody levels were obtained from the hospital laboratory as part of routine evaluation.

Statistical Analysis

Data were entered and compiled using standard spreadsheet software. Descriptive statistics, including frequencies, percentages, and mean values, were used to summarize the findings. No inferential tests were performed due to the limited sample size.

Approval for the study was obtained from the concerned authorities before starting study. Written informed consent was collected from all participants before enrollment

A total of 50 individuals with autoimmune thyroid disorder were included in the analysis. The demographic pattern showed a clear female predominance, with 84% women and 16% men, and the mean age was 38.6 ± 9.4 years (Table 1). More than half of the participants were between 30 and 45 years of age.

Table 1. Demographic Profile of Study Participants (N = 50)

Regarding thyroid status, hypothyroidism emerged as the most frequent presentation, affecting 76% of the cohort, while 24% had hyperthyroidism. Anti-TPO antibodies were elevated in 44 patients (88%), confirming autoimmune involvement in the majority (Table 2).

Table 2. Thyroid Status and Autoimmune Markers

Figure 1: Thyroid Status and Autoimmune Markers

Dermatological abnormalities were widespread in the study population. Dry skin was the leading manifestation, documented in 62%, followed by hair changes in 48%, and urticaria in 20% of participants. Other findings such as hyperpigmentation, pruritus, vitiligo, alopecia areata, and nail changes appeared with lower frequency (Table 3).

Table 3. Prevalence of Dermatological Manifestations

Overall, 84% of the patients demonstrated at least one cutaneous feature linked to autoimmune thyroid dysfunction. The burden of skin involvement was slightly higher among individuals with hypothyroidism (86.8%) compared with those who were hyperthyroid (75%), as summarized in Table 4.

Table 4. Overall Dermatological Involvement by Thyroid Status

Figure 2:Overall Dermatological Involvement by Thyroid Status

The present study demonstrates that dermatological manifestations are remarkably common among individuals with autoimmune thyroid disorders, a finding that echoes longstanding observations linking thyroid dysfunction with a broad spectrum of cutaneous changes [6,7]. In our cohort, 84% of patients exhibited at least one skin, hair, or nail abnormality, underscoring the central role of thyroid hormones in maintaining epidermal turnover, hair cycling, and sweat gland activity, as highlighted in earlier dermatologic and endocrine reviews [6,11].

Xerosis was the most frequent finding, noted in 62% of participants, consistent with descriptions of diminished eccrine gland activity and slowed epidermal renewal in hypothyroid states [7,11]. Hair abnormalities were also common, occurring in nearly half of the study population. This mirrors previous reports noting that disruptions in thyroid hormone signaling can shift follicles toward telogen and impair keratin synthesis, resulting in diffuse thinning and brittle texture [6,8].

Autoimmune-associated manifestations such as vitiligo and alopecia areata appeared in a smaller yet important subset of patients. Their presence aligns with evidence that autoimmune thyroid disease frequently coexists with other organ-specific autoimmune conditions due to shared immunological pathways [8,9]. The occurrence of urticaria in 20% of cases also supports earlier findings linking chronic urticaria with thyroid-related autoantibodies and autoimmune activation [12].

Dermatological involvement was slightly higher in hypothyroid individuals than in those with hyperthyroidism, a pattern also observed in comparative analyses evaluating autoimmune and non-autoimmune thyroid cohorts [10]. This trend is clinically relevant because hypothyroidism often develops subtly, and early cutaneous clues may prompt expedited endocrine evaluation, particularly in settings where laboratory testing may be delayed.

Although limited by a modest sample size and single-center design, the findings of this study closely parallel established literature and reaffirm the importance of incorporating dermatological assessment into routine thyroid disorder evaluation. Early recognition of cutaneous manifestations not only supports timely diagnosis but also enhances comprehensive patient management.

This study highlights the strong association between autoimmune thyroid disorders and a broad range of dermatological manifestations. A striking 84% of patients exhibited at least one cutaneous change, with xerosis, hair abnormalities, urticaria, and hyperpigmentation appearing most frequently. Autoimmune-related findings such as vitiligo and alopecia areata were also documented, reflecting the shared immunological pathways between these conditions. Skin involvement was slightly higher in hypothyroid individuals, suggesting that cutaneous clues may help in early recognition of thyroid dysfunction. Routine dermatological evaluation should therefore be an integral component of clinical assessment, enabling timely diagnosis and more comprehensive management of autoimmune thyroid disease.

1. Ai J, Leonhardt JM, Heymann WR. Autoimmune thyroid diseases: etiology, pathogenesis, and dermatologic manifestations. J Am Acad Dermatol. 2003 May;48(5):641-59; quiz 660-2. doi: 10.1067/mjd.2003.257. PMID: 12734493.
2. Burman KD, McKinley-Grant L. Dermatologic aspects of thyroid disease. Clin Dermatol. 2006 Jul-Aug;24(4):247-55. doi: 10.1016/j.clindermatol.2006.04.010. PMID: 16828405.
3. Takir M, Özlü E, Köstek O, Türkoğlu Z, Mutlu HH, Uzunçakmak TK, Akdeniz N, Karadağ AS. Skin findings in autoimmune and nonautoimmune thyroid disease with respect to thyroid functional status and healthy controls. Turk J Med Sci. 2017 Jun 12;47(3):764-770. doi: 10.3906/sag-1510-39. PMID: 28618767.
4. Cohen B, Cadesky A, Jaggi S. Dermatologic manifestations of thyroid disease: a literature review. Front Endocrinol (Lausanne). 2023 May 12;14:1167890. doi: 10.3389/fendo.2023.1167890. PMID: 37251685; PMCID: PMC10214500.
5. Nagaraj N, Balaji AL, Singla S, Prakash M. Dermatological manifestations in autoimmune thyroid disorders. BMC Proc. 2012 Jul 9;6(Suppl 4):O39. doi: 10.1186/1753-6561-6-S4-O39. PMCID: PMC3426094.
6. Leonhardt JM, Heymann WR. Thyroid disease and the skin. Dermatol Clin. 2002 Jul;20(3):473-81, vii. doi: 10.1016/s0733-8635(02)00009-8. PMID: 12170880.
7. Niepomniszcze H, Amad RH. Skin disorders and thyroid diseases. J Endocrinol Invest. 2001 Sep;24(8):628-38. doi: 10.1007/BF03343905. PMID: 11686547.
8. Baldini E, Odorisio T, Tuccilli C, Persechino S, Sorrenti S, Catania A, Pironi D, Carbotta G, Giacomelli L, Arcieri S, Vergine M, Monti M, Ulisse S. Thyroid diseases and skin autoimmunity. Rev Endocr Metab Disord. 2018 Dec;19(4):311-323. doi: 10.1007/s11154-018-9450-7. PMID: 29948572.
9. Brănişteanu DE, Dimitriu A, Vieriu M, Boda D, Stoleriu G, Molodoi DA, Brănişteanu D. Cutaneous manifestations associated with thyroid disease. Rev Med Chir Soc Med Nat Iasi. 2014 Oct-Dec;118(4):953-8. PMID: 25581953.
10. Takir M, Özlü E, Köstek O, Türkoğlu Z, Mutlu HH, Uzunçakmak TK, Akdeniz N, Karadağ AS. Skin findings in autoimmune and nonautoimmune thyroid disease with respect to thyroid functional status and healthy controls. Turk J Med Sci. 2017 Jun 12;47(3):764-770. doi: 10.3906/sag-1510-39. PMID: 28618767.
11. Burman KD, McKinley-Grant L. Dermatologic aspects of thyroid disease. Clin Dermatol. 2006 Jul-Aug;24(4):247-55. doi: 10.1016/j.clindermatol.2006.04.010. PMID: 16828405.
12. Cohen B, Cadesky A, Jaggi S. Dermatologic manifestations of thyroid disease: a literature review. Front Endocrinol (Lausanne). 2023 May 12;14:1167890. doi: 10.3389/fendo.2023.1167890. PMID: 37251685; PMCID: PMC10214500.