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Hair loss and thyroid disease
We all see patients with a chief complaint of hair loss — “My hair falls out in clumps when I brush it” is a common refrain. Many patients with this complaint can, indeed, point to areas of thinning hair on the scalp and most have reached the conclusion that it must be due to something wrong with their hormones. Certainly an increase in testosterone levels in women, for whatever cause, can lead to hair thinning, but that is uncommon. More often the patient has read or heard about a link between their thyroid and their hair, and many of them are already on thyroid replacement or produce a family history of thyroid disease.
Overt clinical evidence of hypothyroidism or hyperthyroidism is not common in that population, at least in my practice, but I do proceed to order thyroid function labs as well as thyroid antibodies. I have not kept track of the data, but it is my impression that positive antibodies are more common than abnormal T4 (total and/or free) or thyroid-stimulating hormone. I take time to explain the link between thyroid antibodies and hair loss as best I can and recommend that a dermatology consult would be the best way to follow-up on their concern.
I have had to change my thinking somewhat after I saw two new patients, both women in their 40s, who did not complain of hair loss per se, but each one could quickly point out a bald spot about the size of a quardter — alopecia areata. (I forgot to take a clinical photograph, but you can find many examples on a web images search.) A literature search on PubMed resulted in only a few articles published this century that were directly related to thyroid disease, alopecia and autoimmunity, and the most relevant ones were studies done in India, Romania and Iran. On the broader topic of treatment of alopecia areata, there were 530 articles published this century and, while I only looked at a handful of the most recent abstracts, I was struck by the number of treatment approaches that have been studied with variable success. I have attached links to two recent educational articles published in the Journal of the Academy of Dermatology just last year.
From an endocrine perspective, if the patient has clinical and laboratory evidence of thyroid disease, treat the thyroid disease. If they have complications that may be related to thyroiditis (eyes, hair, nails, etc.) referral to the appropriate specialist is indicated.
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