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Index of Q&As with Dr. David Derry
Topic: Hair Loss
These answers are personal opinions. Please discuss any ideas you get with your physician.
A Reader Writes:
I have severe patchy hair loss that has lowered my self esteem. I resemble a cancer victim. I have hypothyroidism, this causes my scalp to itch & burn, it also feels like a severe case of head lice. The Doctor placed me on 50 mcg of Synthroid along with 2% Nizoral shampoo & 2.5% hydrocortisone lotion for my scalp, which has somewhat given me some comfort, but I still suffer the symptoms help me. Is there anything out there that I can try, that won't break the bank? I was diagnosed 4 months ago.
David Derry Responds:
Dear Patient,
The most common cause of hair loss in women is low circulating thyroid hormone or hypothyroidism.(1) Occasionally iron will contribute to the cause but most times the hair loss will respond to treatment with thyroid hormone and so will the iron problem. Itchiness also is relieved with adequate thyroid hormone. These are not common presenting symptoms of low thyroid but they are well known in the literature. In one of my patients only the eyebrows were falling out and in another patient just the eyelashes, both responded to thyroid therapy. In addition by careful questioning you can pick up patient's other symptoms of low thyroid. However hair loss for a women is devastating and preoccupies most normal women constantly.
The real problem of why you are not responding is related to the dosage of thyroid you are taking. This dosage will not help your hair or you at all. In the 1960s it was textbook material after 70 years of experience using thyroid that a dose below 180 mg of desiccated thyroid could not be measured clinically or in the laboratory. In other words it was without effect.(2) The approximate equivalent dose of synthroid or thyroxine (T4) would be about 180 micrograms.(3)
So unless your dose is above 180 there is little chance of regaining your hair back and the problem likely continue and get worse. You can tell when you are approaching the right dose personally when the itching starts to go away permanently. Depending on how old you are and other medical history it is likely though you would get complete relief with a dosage up around 200 micrograms of Synthroid or higher. We know that there are no side effects at those dosages. Dosages of thyroxine (Synthroid, T4) of up to 300 micrograms are without morbidity or mortality. (no sickness or deaths) (4)
Often the new hair growth takes months before it really gets going. But the important first part is for the hair to stop falling out and the itching to stop. Once that is accomplished then usually the hair starts to grow in again normally. I have seen it take up to six months for the hair to be growing at a normal pace again.
One patient started losing her hair at age 26, had lost it all at 35 and still didn't have any at 46 when I first met her. All of that time her TSH values were normal so she went untreated. At 46 her TSH which had been normal suddenly went to values in the hundreds. Because of her thyroid failure she was having cardiac problems which are a common side effect of low thyroid.(7) All cardiac problems disappeared with thyroid therapy. Even though she was returned to normal health with thyroid hormone and replacement estrogens her hair did not grow back. It was recognized in the 1930s that some low thyroid problems are difficult to reverse if they have been present for a long period.(5-6) However I feel from your story you can get your hair growth back with adequate treatment. As iodine is also intimately involved in skin as well it would be wise while you take the thyroid to take one drop of Lugol's daily.
Good luck with your hair. I hope this helps.
David
1. Lewi:nski A, Broniarczyk-Dy:a G, Sewerynek E, Zerek-Me:e:n G, Szkudli:nski M. Abnormalities in structure and function of the thyroid gland in patients with alopecia areata J Am Acad Dermatol 1990; 23:768-769.
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2. Williams,R.H. Bakke,J.L. The thyroid in Textbook of Endocrinology Eds Williams,R.H. 1962W.B. Saunders Company. Philadelphia. pages 252-3
3. Sawin,C.T. A comparison of thyroxine and desiccated thyroid in patients with primary hypothyroidism. Metabolism 27:1518-1525, 1978.
4. Toft AD. Thyrotropin: Assay, Secretory Physiology, and Testing of Regulation. In: Braverman LE, Utiger RD, editors. Werner and Ingbar's The Thyroid. New York: J.B. Lippincott Company, 1991: Page 296.
5. Crile, G. & Associates, Diagnosis and treatment of diseases of the thyroid gland. W.B. Saunders, Philadelphia, 1932.
6. Werner, A.A. Endocrinology, clinical application and treatment. Lea and Febiger, 1942.
About Dr. Derry:
Dr. Derry is no longer in practice.
Born in 1937, I am at the cutting edge of the war baby boom. With one exception the baby boomers tend to do what I do in large numbers about ten years later. The exception was that after finishing my internship at the Toronto General Hospital in 1963, as I had planned, I started a PhD in biochemistry at the Montreal Neurological Institute at McGill University in Montreal. After completing my PhD, I was hired by the Department of Pharmacology at the University of Toronto to teach and do research. Within a short time I became a Medical Research Council Scholar, which meant the Medical Research Council of Canada paid my salary to do research. Domestic rearrangements suddenly placed five children between the ages of 5 and 9 under my care. I abandoned my research career and took all five children, a new wife and dog out west to Victoria British Columbia.
My aim in 30 years of General Practice (an honor and a privilege) was to learn carefully and persistently how to listen to the patient. This is the one area of medical research that has gone almost totally un-examined. Sir William Osler, who I feel was the greatest physician of all time, said: if you listen to the patient they will usually give you the diagnosis and if you listen even more carefully they will likely indicate the best treatment for them. Gradually with the help of multiple self-development courses over the years I learned to listen by just getting my ego out of the way. From my patients I learned everything. Because of the arrival of effective treatments with potential side-effects, in 1945 the out-dated Hippocratic oath of “do no harm” was replaced with a new principle of ethical patient care namely “Consider first the well-being of the patient.” Combining extensive medical-literature reading with what I learned daily from patients clarified which approaches and treatments assured the “well-being of the patient.”
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