Could a Hives Rash Be a Sign of Thyroid Disease?

The Connection Between Urticaria and Hypothyroidism

Thyroid disease can sometimes cause repeated bouts of an itchy skin rash known as hives. In fact, up to 30% of people with chronic hives (also known as chronic urticaria) have an underlying autoimmune disease that affects the thyroid gland in the neck.

Chronic hives are especially common in people with Hashimoto's thyroiditis, an autoimmune disease that causes hypothyroidism (an underactive thyroid gland).

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.

common symptoms of urticaria

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 be chronic, meaning that they last for more than six weeks and recur frequently over the course of months or years.

Symptoms of chronic urticaria include:

  • Patches of raised red or skin-colored welts (known as wheals)
  • Wheals that can change shape and size, sometimes fading and later reappearing
  • Itching, sometimes severe, and/or a stinging or burning sensation

This itchy rash can occur on the neck, chest, back, face, and buttocks.

Hives associated with autoimmune thyroid disease are most often chronic.

Urticaria
 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 as flares.

In the case of autoimmune thyroid disease, the thyroid gland is the target of the assault. This can lead to hypothyroidism (underactive thyroid) or hyperthyroidism (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 as immunoglobulin E (IgE) and the chain of events that lead to allergies.

IgE is the antibody responsible for allergic reactions, such as hives or rash.

Autoimmunity is 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 thyroiditis is the most common kind of autoimmune thyroid disease.

Chronic hives may occur in tandem with an autoimmune flare or when the disease is subclinical (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' disease is 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 published in Clinical Case Reports described a patient 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 Thyroid Diseases

Chronic hives have also been associated with other forms of autoimmune thyroid diseases. They include:

  • Painless thyroiditis: This is a variant form of Hashimoto's thyroiditis characterized by overactive thyroid function, sometimes followed by underactive thyroid function.
  • Subacute thyroiditis: It often results from a viral infection and presents with frontal neck pain, fever, and symptoms of an overactive thyroid.
  • Postpartum thyroiditis: The thyroid can become inflamed after pregnancy, leading to hyperthyroidism followed by hypothyroidism.

These conditions are often transient and, in many cases, thyroid function returns to normal and symptoms resolve.

Related Conditions

There are other skin symptoms that can present with thyroid disease.

Pretibial myxedema is 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 called hyaluronic acid under the skin, causing pink or purplish nodules on the lower legs or feet.

Other skin symptoms that can appear with hypothyroidism (such as with Hashimoto's thyroiditis) include:

  • Mottling or discoloration
  • Cold hands and feet
  • Dry, coarse texture
  • Cracking of the skin

Additionally, conditions that cause hyperthyroidism (such as Graves' disease) can lead to symptoms like:

  • Flushing of the face
  • Redness on the palms of your hands
  • Excessive sweating on the palms of your hands and/or the soles of your feet
  • Thin, soft, and sometimes shiny skin

When to See a Healthcare Provider

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 an endocrinologist, 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:

  • A sudden outbreak of hives or rash
  • Difficulty breathing, including shortness of breath and wheezing
  • Abnormally rapid heartbeat
  • Lightheadedness or fainting
  • Swelling of the lips, face, or throat
  • Sudden clammy skin
  • A feeling of impending doom

Are There Tests to Diagnose the Cause of Chronic Hives?

Hives can usually be diagnosed by their appearance. Identifying the underlying cause is a different issue and often involves a process of elimination to narrow the possible causes.

If you have chronic hives and an autoimmune thyroid disease, it may seem reasonable to assume that they are both related. This may or may not be true. This type of rash can also be triggered by certain foods, medications, environmental irritants, and more.

This may involve blood tests and skin biopsies to rule out infectious or inflammatory conditions (like vasculitis). Skin-prick tests and food challenges may 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:

  • Autologous skin serum test (ASST), a procedure used to measure your autoimmune reactivity to histamine injected beneath the skin
  • Thyroid hormone tests, a blood test used to measure the level of the thyroid hormones TSH, T3, and T4
  • Autoimmune thyroid tests, a blood test used to detect thyroid autoantibodies such as anti-TSH, anti-TPO, and anti-Tg

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:

  • Food allergies and intolerance
  • Exposure to cold (cold urticaria)
  • Stress (stress-induced urticaria)
  • Sunlight (solar urticaria)
  • Exercise (exercise-induced urticaria)
  • Pressure on the skin, such as from a tight waistband (pressure urticaria)
  • Scratching (dermatographism)

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 as anaphylaxis. Anaphylaxis is a medical emergency that can lead to shock, coma, heart, or respiratory failure, and death if left untreated.

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 to avoid any triggers that instigate hives. These vary from one person to the next. They may include:

  • Food allergies
  • Strenuous exercise
  • Sudden changes in temperature
  • Stress
  • Medications

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, oral antihistamines may be a better option. These drugs block a chemical called histamine that 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:

  • Histamine H2 antagonists like Tagamet (cimetidine) and Pepcid (famotidine), available over the counter or by prescription
  • Leukotriene receptor antagonists like Singulair (montelukast), available by prescription
  • Corticosteroids like prednisone, available by prescription

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.

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 experience hypothyroid 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.

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.

Frequently Asked Questions

  • How do you get rid of a thyroid rash on the neck?

    Topical anti-itch creams, oral antihistamines, and thyroid hormone replacement therapy can be used to treat a thyroid rash on the neck.

  • What types of autoimmune diseases cause chronic hives?

    Numerous autoimmune diseases have been linked to chronic hives. These include lupus, polymyositis, dermatomyositis, rheumatoid arthritis, Sjögren syndrome, celiac disease, type 1 diabetes, and autoimmune thyroid disease.

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Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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Additional Reading

By Mary Shomon
Mary Shomon is a writer and hormonal health and thyroid advocate. She is the author of "The Thyroid Diet Revolution."