Hair loss and the thyroid gland

THERE IS A SAYING: "Your hair is your best accessory" When hair loss suddenly strikes, it can be both depressing and frustrating. Is the hair loss permanent? Is it just temporary? What is it due to?

A common reason for hair loss, which many people don't think about, and which is often overlooked is: YOUR THYROID GLAND .

Why do you lose hair when you have thyroid problems?

Hair health can be an important sign of hormonal imbalances in the thyroid gland. Almost half a million people were treated, e.g. for hypothyroidism (underproduction in the thyroid gland) in Sweden in 2019, and many are still undiagnosed. It is estimated that as many as half of all adults experience thinning hair or hair loss as early as age 40. So there is no doubt that some of these people struggling with hair loss and thinning hair have an undiagnosed thyroid disorder.

In Sweden and the rest of the Western world, autoimmune thyroiditis (Hashimoto's thyroiditis) is the most common cause of hypothyroidism. Autoimmune means that the body's immune system attacks the body's own tissues for unclear reasons. The diagnosis is hereditary and is confirmed by the presence of antibodies against thyroid peroxidase (TPO-ak) and/or thyroglobulin (TG-ak) . Antibodies, of the blocking type against the TSH receptor (TRAK) , can also occur. The inflammation leads to part or all of the thyroid being slowly destroyed and usually requires lifelong treatment.

Some of the common hair-related symptoms of thyroid problems include hair loss, thinning hair, increased shedding and changes in hair texture.

If you've been diagnosed with thyroid disease – whether you're male or female – you may notice more hair loss if it occurs early in life.

How many hairs do you normally lose a day?

Your scalp has about 100,000 active hair follicles that produce hair in a cyclic growth cycle. The hair cycle begins with a growth phase that lasts 2-8 years (anagen phase). The hair follicle then goes into a short transitional phase (catagen phase) which lasts for 4-6 weeks and finally into a resting phase (telogen phase) where the hair remains for 2-3 months before finally falling out. Around 85-90% of the head hair is in the growth phase and grows about 1 cm per month. It is normal to lose around 50-100 hairs every day.

About 10% of hair is always in the resting phase, and this percentage can be increased by inflammation of the hair follicles or hormonal imbalances related to thyroid disease and autoimmunity. However, this process can be accelerated so that more of your hair ends up in the transition and resting phases, resulting in increased hair loss.

Could hair loss be a sign of hypothyroidism?

When you have an underactive thyroid (hypothyroidism) and it has not yet been diagnosed, hair loss may be one of the first or most important symptoms you experience. A unique sign of hypothyroidism is also the loss of hair from the outer edge of the eyebrows.

An important step for anyone experiencing hair loss is a clinical examination along with a complete thyroid evaluation , including thyroid stimulating hormone (TSH), thyroxine (T4), triiodothyronine (T3) and thyroid antibody tests (TPO-ak, TG-ak or TRAK . One can have all or just one of them TRAK is thought to occur mostly in autoimmune hyperthyroidism, but sometimes occurs in autoimmune hypothyroidism). If you are diagnosed with hypothyroidism, thyroid treatment can stop your hair loss.

Can poorly treated hypothyroidism cause increased hair loss?

Once you have been diagnosed with hypothyroidism, you will be treated with thyroid medication.

If your treatment is not optimal, this can contribute to hair loss. TSH levels at the higher end of the normal reference range and T4 as well as T3 levels at the lower end of the reference range are all associated with increased hair loss. If you are being treated for hypothyroidism and are experiencing hair loss, ask to have your thyroid levels checked again, or you can check this yourself via a blood test.

Can autoimmune thyroid disease cause hair loss?

In Sweden and the rest of the Western world, autoimmune thyroiditis (Hashimoto's thyroiditis) is the most common cause of hypothyroidism. In an autoimmune disease, antibodies can target organs, glands, tissues and cells, causing inflammation. The state of inflammation seen in people with Hashimoto's disease can affect your scalp and hair follicles. The increased inflammation can then cause increased hair loss.

Graves' disease (autoimmune disease) and hypothyroidism - especially when not adequately or optimally treated - are also known to trigger hair loss. If you have hair loss along with other common symptoms of an overactive thyroid gland (hyperthyroidism) such as anxiety, weight loss and insomnia - you should also have a clinical examination and blood tests for an evaluation of thyroid problems.

The inflammatory process of autoimmune thyroid disease and resulting hair loss can sometimes be reduced by supplementing with selenium, vitamin D, biotin, pantothenic acid, l-lysine and zinc.

Can hormonal imbalances cause hair loss?

Since the thyroid is part of the endocrine system, imbalances can also affect your production of testosterone and how it is metabolized. In some cases, testosterone can be converted into a less useful version, dihydrotestosterone, or DHT. DHT attacks your hair follicles, shrinking them and can cause them to disappear. This testosterone-DHT conversion is one of the most common causes of male pattern baldness. It is also more common in people with thyroid problems.

There are a few ways to block the conversion to DHT. The prescription drug Propecia (active ingredient is finasteride) is used in men and women (who are not of childbearing age). A weaker DHT-blocking effect can also be seen with the dietary supplement evening primrose oil.

Can thyroid-related iron deficiency cause hair loss?

A deficiency of the stored form of iron, known as ferritin, is more common in people with thyroid disease. Low levels of ferritin are a major contributor to hair loss. If you experience hair loss, you should check your levels of ferritin in the blood via a blood test . If your ferritin levels are not in the upper 25th percentile of the reference range, then supplementing with an iron supplement may be helpful. If you start taking iron supplements, remember that you should take them at least three to four hours before or after your thyroid medication, because iron can affect the absorption (uptake) of your thyroid medication.

Can autoimmune alopecia cause hair loss?

When you have an autoimmune disease, you have an increased risk of developing other autoimmune conditions, including alopecia, which is an autoimmune disease that causes hair loss. Hair loss (alopecia) has some unique signs:

• Round or oval hairless patches, usually smaller than a quarter, and most often located on the scalp or in the beard - known as alopecia areata
• Loss of all facial hair as well as hair on the head - known as alopecia totalis
• Loss of all body hair - known as alopecia universalis

There is no universal cure for alopecia, but treatments may include over-the-counter or prescription medications.

WHEN THYROID TREATMENT DOESN'T HELP WITH HAIR LOSS

If you are on optimal thyroid therapy, and have been confirmed to have adequate levels of ferritin, and have tried some of the more common hair loss supplements and treatments, then in some cases you may still experience hair loss. Your next step should then be to consult a dermatologist, or do a blood test to find other causes of your hair loss.

AN IMPORTANT THING TO CONSIDER

Remember that hair changes happen slowly, so give yourself at least three to six months to start a new treatment or make changes to your existing treatment, to find the cause of your hair loss. Two important signs to look out for are: a reduction in hair loss and the regrowth of small hairs around the hairline. Both can be proof that your treatment is working, and that your hair has entered the regrowth phase.