Table of ContentsView AllTable of ContentsSymptomsCausesRelated ConditionsWhen to See a Healthcare ProviderDiagnosisTreatment
Table of ContentsView All
View All
Table of Contents
Symptoms
Causes
Related Conditions
When to See a Healthcare Provider
Diagnosis
Treatment
Thyroid diseasecan sometimes cause repeated bouts of an itchy skin rash known ashives. In fact, up to 30% of people with chronic hives (also known as chronicurticaria) have an underlyingautoimmune diseasethat affects the thyroid gland in the neck.Chronic hives are especially common in people withHashimoto’s thyroiditis, an autoimmune disease that causeshypothyroidism(an underactive thyroid gland). The rash looks like patches of raised red or skin-colored welts.
This article looks at the connection between chronic hives and thyroid disease. It also discusses the various tests and treatments used to diagnose and manage this recurrent skin condition.
Verywell / Nusha Ashjaee
Symptoms of Rash Due to Thyroid Disease
Hives associated with thyroid disease are similar to hives from other causes. The rash tends to develop rapidly and can arise anywhere on the body.
Most cases of hives tend to go away within several days to a few weeks, depending on the cause. However, hives associated with an autoimmune thyroid disorder are likely to bechronic, meaning they last for more than six weeks and recur frequently over months or years.
Symptoms of chronic urticaria include:
An itchy thyroid rash can occur on the neck, chest, back, face, and buttocks.
Hives associated with autoimmune thyroid disease are most often chronic.
DermNet /CC BY-NC-ND
Why Does Thyroid Disease Cause a Rash?
Autoimmune diseases are those in which the body’s immune system mistakenly attacks its own cells and tissues. It does so with immune proteins called autoantibodies that cause chronic or recurrent attacks known asflares.
In the case of autoimmune thyroid disease, thethyroid glandis the target of the assault. This can lead tohypothyroidism(underactive thyroid) orhyperthyroidism(overactive thyroid).
Autoantibodies that target a specific receptor found in tissues under the skin are produced during a flare. These “turn on” these receptors, triggering the production of a protein known asimmunoglobulin E (IgE)and thechain of eventsthat lead to allergies.
IgE is theantibodyresponsible for allergic reactions, such as hives or rash.
Autoimmunityis thought to be one of the most common causes of chronic hives.Not all autoimmune diseases trigger an IgE response, however.
Hashimoto’s Thyroiditis
Hashimoto’s thyroiditisis the most common kind of autoimmune thyroid disease.
Chronic hives may occur in tandem with an autoimmune flare or when the disease issubclinical(meaning active but without overt symptoms). During subclinical episodes, even low levels of autoantibodies can trigger an IgE response.
While Hashimoto’s thyroiditis may increase the risk of chronic hives, not everyone who has Hashimoto’s will get hives. This suggests that other environmental or genetic factors may contribute to the risk.
Graves' Disease
Graves' diseaseis an autoimmune disorder in which the immune system attacks the thyroid gland, leading to the overproduction of thyroid hormone. This causes the body’s functions to speed up.
In rare cases, hives have been associated with this type of thyroid condition. One 2021 case study described a person with Graves' disease who developed a neck rash which later spread to other parts of the body.
Due to limited research, the mechanism linking hives and hyperthyroidism is still not clearly understood.
Other Autoimmune Diseases Associated With Hives
Chronic hives have also been associated with other forms of autoimmune thyroid diseases.These include:
These conditions are often transient and, in many cases, thyroid function returns to normal and symptoms resolve.
Numerous other autoimmune diseases may cause chronic hives, including:
Causes and Risk Factors of Hives
There are other skin symptoms that can present with thyroid disease.
Pretibial myxedemais a skin condition that can occur with autoimmune thyroid diseases like Hashimoto’s thyroiditis and Graves' disease. It causes deposits of a natural lubricating fluid calledhyaluronic acidunder the skin, causing pink or purplish nodules on the lower legs or feet.
Other skin symptoms that can appear withhypothyroidism(such as with Hashimoto’s thyroiditis)include:
Additionally, conditions that causehyperthyroidism(such as Graves' disease)can lead to symptoms like:
Hives are often self-limited and non-severe. However, if your rash is chronic and/or you think it may be associated with a thyroid condition, let your healthcare provider know right away.
They may refer you to anendocrinologist, a physician who specializes in the diagnosis and treatment of hormonal disorders like thyroid disease.
If diagnosed, thyroid disease requires lifelong management with appropriate therapy.
Generally speaking, any time an outbreak of hives is sudden, rapid, and severe, you should seek immediate medical attention.
Call 911 or go to your nearest emergency room if you experience the signs of anaphylaxis, including:
Diagnosing the Cause of Chronic Hives
Diagnosing the cause may involve blood tests andskin biopsiesto rule out infectious or inflammatory conditions (likevasculitis).Skin-prick testsandfood challengesmay be used to rule out specific types of allergies or food intolerances.
If autoimmune thyroid disease is suspected, your healthcare provider may order tests to help confirm the diagnosis, including:
Differential Diagnoses
Chronic hives can occur as a result of autoimmunity. But, it can also occur independently of thyroid disease for any number of reasons, including:
Hives may also be a common side effect of certain thyroid medications. Methimazole and propylthiouracil, which are used to treat an overactive thyroid, can trigger this type of rash in some people.
In some cases, there may be no apparent reason for a recurrent outbreak. This is referred to as chronic idiopathic urticaria (CIU).There may be times when hives are an indication of a severe, whole-body allergy known asanaphylaxis. Anaphylaxis is a medical emergency that can lead to shock, coma, heart or respiratory failure, and death if left untreated.
How Thyroid Disease Is Diagnosed
How to Treat a Thyroid Rash
Hives are often one-off events that will clear on their own without treatment, never to be seen again. Rashes that recur should generally be treated, particularly if they are severe or persistent.
Regardless of the cause of hives, the goals of treatment are the same: to relieve symptoms and prevent a recurrence.
The first and arguably most important goal is toavoid any triggersthat instigate hives. These vary from one person to the next. They may include:
Other treatment options include topical anti-itch creams, oral antihistamines, and thyroid hormone replacement.
Topical Anti-Itch Creams
Topical creams and sprays used to reduce itch and inflammation may be useful in managing the symptoms of hives, particularly if the hives are not widespread.
Over-the-counter options include:
Antihistamines and Other Allergy Drugs
If hives are widespread, oralantihistaminesmay be a better option. These drugs block a chemical calledhistaminethat is involved in allergic reactions.
Antihistamines are the first line of treatment for moderate to severe hives. Second-generation antihistamines are usually recommended, as they do not cause drowsiness.
Over-the-counter antihistamines used to treat hives include:
If the itchiness or burning are interfering with your sleep, first-generation antihistamines like Benadryl (diphenhydramine) are mildly sedating and may help.
Other drugs may be prescribed if oral antihistamines fail to provide relief, including:
Oral antihistamines and corticosteroids can interfere with the function of your thyroid gland. Your healthcare provider may need to adjust your thyroid hormone dose if you are taking either of these.
Home Remedies to Manage Itching
There are several self-care changes you can make to help manage itchy hives, such as:
Levothyroxine
Levothyroxine, sold under the name Synthroid, Levoxyl, and others, is a synthetic thyroid hormone used to treat hypothyroidism. It does not treat the underlying autoimmunity that causes Hashimoto’s thyroiditis, but it can normalize hormone levels so that you are less likely to experiencehypothyroid symptoms.
Levothyroxine has been shown to work better than antihistamines in relieving hives related to autoimmune thyroid disease. It also tends to work for a longer period of time.
The Best Options for Hives Treatment
Summary
Hives (urticaria) are skin reactions that cause raised, itchy welts. Most cases tend to go away within several days to a few weeks. However, when this type of rash is chronic—lasting for more than six weeks or recurring over months or years—it may be the result of an autoimmune disease like Hashimoto’s thyroiditis.
Hives can be treated with topical anti-itch creams or oral antihistamines. If an autoimmune thyroid disease is involved, particularly one that results in an underactive thyroid, a synthetic thyroid hormone called levothyroxine may help prevent or treat a hives outbreak.
24 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Najafipour M, Zareizadeh M, Najafipour F.Relationship between chronic urticaria and autoimmune thyroid disease.J Adv Pharm Technol Res. 2018;9(4):158–161. doi:10.4103/japtr.JAPTR_342_18Kanani A, Betschel SD, Warrington R.Urticaria and angioedema.Allergy Asthma Clin Immunol. 2018;14(Suppl 2):59. doi:10.1186/s13223-018-0288-zSchaefer P.Acute and chronic urticaria: evaluation and treatment.Am Fam Physician.2017;95(11):717-24.Selvendran SS, Aggarwal N.Chronic urticaria and thyroid autoimmunity: a perplexing association.Oxf Med Case Reports. 2018;2018(2):omx099. doi:10.1093/omcr/omx099Bracken SJ, Abraham S, MacLeod AS.Autoimmune theories of chronic spontaneous urticaria.Front Immunol.2019;10:627. doi:10.3389/fimmu.2019.00627Johns Hopkins Medicine.Hashimoto’s Thyroiditis.National Institute of Diabetes and Digestive and Kidney Diseases.Graves' disease.Womack N, Jude E.Urticaria as a manifestation of hyperthyroidism.Clin Case Rep. 2021;9(5). doi:10.1002/ccr3.3620Gonzalez-Diaz SN, Sanchez-Borges M, Rangel-Gonzalez DM, et al.Chronic urticaria and thyroid pathology.World Allergy Organization Journal. 2020;13(3):100101. doi:10.1016/j.waojou.2020.100101Burman KD.Painless thyroiditis. UpToDate.Penn Medicine.Subacute thyroiditis.Johns Hopkins Medicine.Postpartum thyroiditis.Lause M, Kamboj A, Faith EF, et al.Dermatologic manifestations of endocrine disorders.Transl Pediatr.2017 Oct;6(4):300-12.Lause M, Kamboj A, Faith EF.Dermatologic manifestations of endocrine disorders.Translational Pediatrics. October 2017;6(4).National Institute of Diabetes and Digestive and KidneyDiseases.Hyperthyroidism (overactive thyroid).Kim SY, Kim MH, Cho YJ.Different clinical features of anaphylaxis according to cause and risk factors for severe reactions.Allergol Int. 2018;67(1):96-102. doi:10.1016/j.alit.2017.05.005American College of Allergy, Asthma & Immunology.Hives (urticaria).Food Allergy Research and Education.Oral food challenge.Lote S, Gupta SB, Poulose D, et al.Role of the Skin Prick Test in Urticaria Patients. Cureus. 2022 Feb 1;14(2):e21818. doi: 10.7759/cureus.21818World Allergy Organization.Autologous serum skin test.Medline Plus.Thyroid antibodies.Ross DS.Patient education: Antithyroid drugs (Beyond the Basics). UpToDate.Fine LM, Bernstein JA.Guideline of chronic urticaria beyond.Allergy Asthma Immunol Res. 2016;8(5):396-403. doi:10.4168/aair.2016.8.5.396American Academy of Dermatology Association.How to relieve itchy skin.Additional ReadingKolkhir P, Metz M, Altrichter S, Maurer M.Comorbidity of chronic spontaneous urticaria and autoimmune thyroid diseases: a systematic review.Allergy. 2017;72(10):1440-1460. doi: 10.1111/all.13182
24 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Najafipour M, Zareizadeh M, Najafipour F.Relationship between chronic urticaria and autoimmune thyroid disease.J Adv Pharm Technol Res. 2018;9(4):158–161. doi:10.4103/japtr.JAPTR_342_18Kanani A, Betschel SD, Warrington R.Urticaria and angioedema.Allergy Asthma Clin Immunol. 2018;14(Suppl 2):59. doi:10.1186/s13223-018-0288-zSchaefer P.Acute and chronic urticaria: evaluation and treatment.Am Fam Physician.2017;95(11):717-24.Selvendran SS, Aggarwal N.Chronic urticaria and thyroid autoimmunity: a perplexing association.Oxf Med Case Reports. 2018;2018(2):omx099. doi:10.1093/omcr/omx099Bracken SJ, Abraham S, MacLeod AS.Autoimmune theories of chronic spontaneous urticaria.Front Immunol.2019;10:627. doi:10.3389/fimmu.2019.00627Johns Hopkins Medicine.Hashimoto’s Thyroiditis.National Institute of Diabetes and Digestive and Kidney Diseases.Graves' disease.Womack N, Jude E.Urticaria as a manifestation of hyperthyroidism.Clin Case Rep. 2021;9(5). doi:10.1002/ccr3.3620Gonzalez-Diaz SN, Sanchez-Borges M, Rangel-Gonzalez DM, et al.Chronic urticaria and thyroid pathology.World Allergy Organization Journal. 2020;13(3):100101. doi:10.1016/j.waojou.2020.100101Burman KD.Painless thyroiditis. UpToDate.Penn Medicine.Subacute thyroiditis.Johns Hopkins Medicine.Postpartum thyroiditis.Lause M, Kamboj A, Faith EF, et al.Dermatologic manifestations of endocrine disorders.Transl Pediatr.2017 Oct;6(4):300-12.Lause M, Kamboj A, Faith EF.Dermatologic manifestations of endocrine disorders.Translational Pediatrics. October 2017;6(4).National Institute of Diabetes and Digestive and KidneyDiseases.Hyperthyroidism (overactive thyroid).Kim SY, Kim MH, Cho YJ.Different clinical features of anaphylaxis according to cause and risk factors for severe reactions.Allergol Int. 2018;67(1):96-102. doi:10.1016/j.alit.2017.05.005American College of Allergy, Asthma & Immunology.Hives (urticaria).Food Allergy Research and Education.Oral food challenge.Lote S, Gupta SB, Poulose D, et al.Role of the Skin Prick Test in Urticaria Patients. Cureus. 2022 Feb 1;14(2):e21818. doi: 10.7759/cureus.21818World Allergy Organization.Autologous serum skin test.Medline Plus.Thyroid antibodies.Ross DS.Patient education: Antithyroid drugs (Beyond the Basics). UpToDate.Fine LM, Bernstein JA.Guideline of chronic urticaria beyond.Allergy Asthma Immunol Res. 2016;8(5):396-403. doi:10.4168/aair.2016.8.5.396American Academy of Dermatology Association.How to relieve itchy skin.Additional ReadingKolkhir P, Metz M, Altrichter S, Maurer M.Comorbidity of chronic spontaneous urticaria and autoimmune thyroid diseases: a systematic review.Allergy. 2017;72(10):1440-1460. doi: 10.1111/all.13182
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Najafipour M, Zareizadeh M, Najafipour F.Relationship between chronic urticaria and autoimmune thyroid disease.J Adv Pharm Technol Res. 2018;9(4):158–161. doi:10.4103/japtr.JAPTR_342_18Kanani A, Betschel SD, Warrington R.Urticaria and angioedema.Allergy Asthma Clin Immunol. 2018;14(Suppl 2):59. doi:10.1186/s13223-018-0288-zSchaefer P.Acute and chronic urticaria: evaluation and treatment.Am Fam Physician.2017;95(11):717-24.Selvendran SS, Aggarwal N.Chronic urticaria and thyroid autoimmunity: a perplexing association.Oxf Med Case Reports. 2018;2018(2):omx099. doi:10.1093/omcr/omx099Bracken SJ, Abraham S, MacLeod AS.Autoimmune theories of chronic spontaneous urticaria.Front Immunol.2019;10:627. doi:10.3389/fimmu.2019.00627Johns Hopkins Medicine.Hashimoto’s Thyroiditis.National Institute of Diabetes and Digestive and Kidney Diseases.Graves' disease.Womack N, Jude E.Urticaria as a manifestation of hyperthyroidism.Clin Case Rep. 2021;9(5). doi:10.1002/ccr3.3620Gonzalez-Diaz SN, Sanchez-Borges M, Rangel-Gonzalez DM, et al.Chronic urticaria and thyroid pathology.World Allergy Organization Journal. 2020;13(3):100101. doi:10.1016/j.waojou.2020.100101Burman KD.Painless thyroiditis. UpToDate.Penn Medicine.Subacute thyroiditis.Johns Hopkins Medicine.Postpartum thyroiditis.Lause M, Kamboj A, Faith EF, et al.Dermatologic manifestations of endocrine disorders.Transl Pediatr.2017 Oct;6(4):300-12.Lause M, Kamboj A, Faith EF.Dermatologic manifestations of endocrine disorders.Translational Pediatrics. October 2017;6(4).National Institute of Diabetes and Digestive and KidneyDiseases.Hyperthyroidism (overactive thyroid).Kim SY, Kim MH, Cho YJ.Different clinical features of anaphylaxis according to cause and risk factors for severe reactions.Allergol Int. 2018;67(1):96-102. doi:10.1016/j.alit.2017.05.005American College of Allergy, Asthma & Immunology.Hives (urticaria).Food Allergy Research and Education.Oral food challenge.Lote S, Gupta SB, Poulose D, et al.Role of the Skin Prick Test in Urticaria Patients. Cureus. 2022 Feb 1;14(2):e21818. doi: 10.7759/cureus.21818World Allergy Organization.Autologous serum skin test.Medline Plus.Thyroid antibodies.Ross DS.Patient education: Antithyroid drugs (Beyond the Basics). UpToDate.Fine LM, Bernstein JA.Guideline of chronic urticaria beyond.Allergy Asthma Immunol Res. 2016;8(5):396-403. doi:10.4168/aair.2016.8.5.396American Academy of Dermatology Association.How to relieve itchy skin.
Najafipour M, Zareizadeh M, Najafipour F.Relationship between chronic urticaria and autoimmune thyroid disease.J Adv Pharm Technol Res. 2018;9(4):158–161. doi:10.4103/japtr.JAPTR_342_18
Kanani A, Betschel SD, Warrington R.Urticaria and angioedema.Allergy Asthma Clin Immunol. 2018;14(Suppl 2):59. doi:10.1186/s13223-018-0288-z
Schaefer P.Acute and chronic urticaria: evaluation and treatment.Am Fam Physician.2017;95(11):717-24.
Selvendran SS, Aggarwal N.Chronic urticaria and thyroid autoimmunity: a perplexing association.Oxf Med Case Reports. 2018;2018(2):omx099. doi:10.1093/omcr/omx099
Bracken SJ, Abraham S, MacLeod AS.Autoimmune theories of chronic spontaneous urticaria.Front Immunol.2019;10:627. doi:10.3389/fimmu.2019.00627
Johns Hopkins Medicine.Hashimoto’s Thyroiditis.
National Institute of Diabetes and Digestive and Kidney Diseases.Graves' disease.
Womack N, Jude E.Urticaria as a manifestation of hyperthyroidism.Clin Case Rep. 2021;9(5). doi:10.1002/ccr3.3620
Gonzalez-Diaz SN, Sanchez-Borges M, Rangel-Gonzalez DM, et al.Chronic urticaria and thyroid pathology.World Allergy Organization Journal. 2020;13(3):100101. doi:10.1016/j.waojou.2020.100101
Burman KD.Painless thyroiditis. UpToDate.
Penn Medicine.Subacute thyroiditis.
Johns Hopkins Medicine.Postpartum thyroiditis.
Lause M, Kamboj A, Faith EF, et al.Dermatologic manifestations of endocrine disorders.Transl Pediatr.2017 Oct;6(4):300-12.
Lause M, Kamboj A, Faith EF.Dermatologic manifestations of endocrine disorders.Translational Pediatrics. October 2017;6(4).
National Institute of Diabetes and Digestive and KidneyDiseases.Hyperthyroidism (overactive thyroid).
Kim SY, Kim MH, Cho YJ.Different clinical features of anaphylaxis according to cause and risk factors for severe reactions.Allergol Int. 2018;67(1):96-102. doi:10.1016/j.alit.2017.05.005
American College of Allergy, Asthma & Immunology.Hives (urticaria).
Food Allergy Research and Education.Oral food challenge.
Lote S, Gupta SB, Poulose D, et al.Role of the Skin Prick Test in Urticaria Patients. Cureus. 2022 Feb 1;14(2):e21818. doi: 10.7759/cureus.21818
World Allergy Organization.Autologous serum skin test.
Medline Plus.Thyroid antibodies.
Ross DS.Patient education: Antithyroid drugs (Beyond the Basics). UpToDate.
Fine LM, Bernstein JA.Guideline of chronic urticaria beyond.Allergy Asthma Immunol Res. 2016;8(5):396-403. doi:10.4168/aair.2016.8.5.396
American Academy of Dermatology Association.How to relieve itchy skin.
Kolkhir P, Metz M, Altrichter S, Maurer M.Comorbidity of chronic spontaneous urticaria and autoimmune thyroid diseases: a systematic review.Allergy. 2017;72(10):1440-1460. doi: 10.1111/all.13182
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