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At Endocrine

Hair Loss and Thyroid Disease

Hair can be considered a barometer of health because hair cells are some of the fastest growing in the body. When the body is in crisis, the hair cells can shut down to redirect energy elsewhere. The types of situations that can cause hair loss include hormonal changes, poor diet and nutritional deficiencies, a variety of medications, surgery, and many medical conditions, but noticeably, thyroid disease.

Many people notice rapid hair loss as a symptom of their hyperthyroidism or hypothyroidism. Some people actually say this is the worst symptom of their thyroid problem -- this thinning hair, large amounts falling out in the shower or sink, often accompanied by changes in the hair's texture, making it dry, coarse, or easily tangled. Interestingly, some people have actually written to tell me that their thyroid problem was initially "diagnosed" by their hairdresser, who noticed the change!

To deal with hair loss, before assuming it's your thyroid, always have any hair loss evaluated by a dermatologist to rule out any other causes -- such as infection.

If you're experiencing hair loss and are just starting treatment for a hyperthyroid or hypothyroid condition, it's likely that for most of you, the loss will slow down, and eventually stop, once hormone levels are stabilized and in the normal range. This may take a few months, however. But rest assured, I've had many thousands of emails from people, and have yet to hear from anyone who lost all his or her hair, or became bald, due to thyroid disease. But people -- including myself -- have experienced significant loss of hair volume. In my case, I'd guess I lost almost half my hair. I had long, thick hair, and it got much thinner at various times.

Types of Hair Loss

There are three common types of hair loss. General shedding of hair is typically hair lost throughout the head. You'll often notice more hair in drains and in the shower, in hair brushes, and when you brush your hair, but there are no specific patches of loss or even baldness. Typically, with hyperthyroidism or hypothyroidism prior to treatment, this is the most common form of hair loss. This can occasionally continue for some people after hypothyroidism treatment, and particularly when taking Synthroid, which is discussed later in this article.

A second type of hair loss is more commonly associated with fungal infection or autoimmune alopecia, and involves circular patches of hair loss, in some cases, complete loss of hair in these small patches. These sorts of hair loss problems need to be evaluated by a dermatologist, and are not particularly associated with thyroid problems.

A third type of hair loss is male pattern hair loss -- - men are most susceptible, but women can get it too. Male pattern hair loss is concentrated on the temples and top of the head. It's caused when an enzyme starts to convert the hormone testosterone on the scalp to its less useful version, dihydrotestosterone. This makes hair follicles shrink and then they disappear. This conversion of testosterone to dihydrotestosterone seems to be speeded up in some patients with treated hyperthyroidism or hypothyroidism, and may be the cause of hair loss that continues despite treatment.

How Hair Grows Normally, hair grows about a half inch a month for about three years, and then it goes into a resting period. One in ten hairs is in a resting period at any one time, and after about three months a new hair pushes the old one out. When more hairs go into resting period, or the conversion process speeds up, the balance becomes disrupted, and hair loss occurs. For a comprehensive review of how hair grows, see: Dr. Richard De Villez' Growth and Loss of Hair.

How to Deal With Thyroid-Related Hair Loss

First, if you are hypothyroid and taking levothyroxine (i.e., Synthroid) as your thyroid hormone replacement, and still losing hair, you may need to take action. Prolonged or excessive hair loss IS a side effect of Synthroid for some people. Note: Many doctors do NOT know this, even though it is a stated side effect in the Synthroid patient literature, so don't be surprised if your doctor is not aware of this. You can read more information about my own experiences with hair loss on Synthroid.

Also, hair loss can also result from being UNDERtreated...not being at the right TSH, or not taking the right drugs for you. My doctor believes that a TSH of around 1 - 2 is optimal for most people to feel well and avoid having hypothyroid or hyperthyroid symptoms such as hair loss. (Note that these levels are kept lower for thyroid cancer patients to prevent cancer recurrence.) This was anecdotal information, until recently, when researchers reported that values above TSH of 2 may represent abnormal levels. See the British Medical Journal for this medical article. To understand UNDERtreated hypothyroidism better, you might want to read: HELP! My TSH Is "Normal" But I Think I'm Hypothyroid, which looks at your next steps -- including defining the "normal" range with your doc, antibody testing, TRH testing, and drugs beyond T4 therapy -- and where to find a doctor to help.

I am also one of the people who does better and has less hair loss on a T4/T3 drug versus pure synthetic T4 only (like Synthroid.) I take Thyrolar, and it has worked far better for me than Synthroid. Others have had success with Armour, the natural thyroid hormone replacement. There was just published February 11, 1999 in the New England Journal of Medicine a research report that says that many patients feel better on a combination of T4 and T3, not T4 (i.e., Synthroid) alone. The addition of T3 helped relieve depression, brain fog, fatigue and other symptoms. This information about T3 is groundbreaking and has major implications for people who don't feel well on their current thyroid therapies!!! Hair loss and restoration takes place over a longer time frame than this study looked at, so I wouldn't be surprised if it too was affected positively by the addition of T3. It certainly proved to be the case for me personally. For more info, see this in-depth article.

When I had a major bout of hair loss recently (despite low normal TSH and being on a T4/T3 drug, I took the advice of a doctor I interviewed for my upcoming book, "Living Well With Hypothyroidism: What Your Doctors Don't Tell You...But You Need to Know" coming late 1999 from Avon/Hearst's WholeHealth Line. (Please click here to receive notification when the book is available.)

Here's an excerpt from the book:

". . . evening primrose oil (also known as EPO) is a nutritional supplement that is frequently mentioned. In his book, Solved: The Riddle of Illness, Stephen Langer, M.D. points to the fact that symptoms of essential fatty acid insufficiency are very similar to hypothyroidism, and recommends evening primrose oil -- an excellent source of essential fatty acids -- as helpful for people with hypothyroidism. The usefulness of evening primrose oil, particularly in dealing with the issues of excess hair loss with hypothyroidism, was also reinforced by endocrinologist Kenneth Blanchard. According to Dr. Blanchard:

For hair loss, I routinely recommend multiple vitamins, and especially evening primrose oil. If there's any sex pattern to it -- if a woman is losing hair in partly a male pattern - -then, the problem is there is excessive conversion of testosterone to dihydrotestosterone at the level of the hair follicle. Evening primrose oil is an inhibitor of that conversion. So almost anybody with hair loss probably will benefit from evening primrose oil.

As someone who has had a few periods of extensive hair loss since become hypothyroid, I can vouch for the fact that taking EPO was the only thing that calmed it down. It not only slowed, then stopped my hair loss over about two months, but new hair grew back, and my hair was no longer straw-like, dry and easily knotted.

In a recent study, Dr Hugh Rushton, a professor at Portsmouth University, also found that 90 percent of women with thinning hair were deficient in iron and the amino acid lysine. Lysine is the most difficult amino acid to get enough of via diet. Lysine helps transport iron, which is the most important element in the body and essential for many metabolic processes. When lysine and iron levels are low, the body probably switches some hair follicles off to increase levels elsewhere. Meat, fish and eggs are the only food sources of lysine. There are also supplements that contain lysine.

You can also consult with a dermatologist to work with you on drug treatments, including scalp injections, drugs like Rogaine(minoxidil) and Propecia, and other treatments that can help non-thyroid related hair loss. Visit the American Hair Loss Council to find a doctor who specializes in hair loss treatment.

(The excerpt from Living Well With Hypothyroidism: What Your Doctors Don't Tell You...But You Need to Know, published by Avon/Hearst Whole Health, 1999, is copyright Mary J. Shomon, 1999)

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