Thyroid Disorders with Cutaneous Manifestations by Warren R. Heymann

Author:Warren R. Heymann
Language: eng
Format: epub
Publisher: Springer London, London

New Insights and Reports into Skin Manifestations of Hypothyroidism

A number of associations between hypothyroidism and other previously unrelated disease entities are surfacing. Although the importance of these reports and the pathogenic nature of the purported associations remain to be determined, clinicians should be cognizant of their existence.

A number of reports have linked congenital hemangiomas to hypothyroidism. Huang et al. reported on a 3-month-old infant with massive hepatic hemangiomas and severe primary hypothy-roidism.100 They identified high levels of expression of type 3 iodothyronine deiodinase activity in the hemangioma tissue that was responsible for the increased rate of degradation of thyroid hormone. Type 3 iodothyronine deiodinase inactivates T4 and T3 by conversion into inactive reverse T3 and diiodothyronine (T2), respectively. The authors suggested that an endocrine or paracrine induction of type 3 iodothyronine deiodinase in endothelial cells by basic fibroblast growth factors, or other growth factors, is responsible for the increased rate of enzyme expression in hemangiomas.100 Subsequent case reports have confirmed this association with cutaneous and hepatic hemangiomas and have thus linked hypothyroidism to syndromes involving hemangiomas.101

It is interesting to note that in all reports, patients required very high doses of thyroid hormone replacement to restore euthyroidism. These reports highlight the importance of thyroid function testing on children with hemangiomas to avoid the potentially devastating effects of hypothyroidism on their growth and development. In addition, it is also essential to search for vascular tumors in infants with consumptive hypothyroidism not explained by other processes.100

Hypothyroidism has been observed in patients with cutis verticis gyrata. A 62-year-old woman with a decade-long history of hypothyroidism presented after the development of increasingly large asymptomatic grooves in the scalp.102 The pathogenesis of this association is unknown; however, it may involve a combination of factors leading to the activation of fibroblasts in hypothyroidism.

As discussed in chapter 14 on the potential uses of thyroid hormone, it has become evident that thyroid hormone is important in wound heal-ing.103 Indeed, researchers have noted that T3 is necessary for keratinocyte proliferation in wounds. Hypothyroid patients who need to undergo surgery that cannot be delayed might benefit from receiving T3 in the perioperative period.

Chronic mucocutaneous candidiasis (CMC) is a rare disorder characterized by recurrent Candida infections of the skin, nails, and oropharynx. It has been associated with endocrinopathies in 50% of cases and has been termed the Candida endo-crinopathy syndrome. Further studies have demonstrated two subsets of hypothyroid patients with CMC: one group of CMC patients with hypothy-roidism or hypoadrenalism in an autosomal recessive inheritance pattern and another group of CMC/hypothyroid patients with autosomal-dominant inheritance.104The authors urged that genetic counseling be offered to all affected members.

A report of a 15-year-old girl linked severe hypothyroidism to psoriasiform lesions and multiple abscesses.105 The temporal relationship of the development of hypothyroidism with the appearance of these psoriasiform lesions and their near resolution with treatment of the hypothyroid state was noteworthy. The authors suggested that hypothyroidism may induce epidermal proliferation in a similar way to the ichthyosiform eruptions discussed. There are few reports that link hypothy-roidism to abscess formation.

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