Hair Loss Solutions For Thyroid Patients

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Your hair is a fairly accurate barometer of your health. Hair cells are some of the fastest growing in the body, and when your body is under stress or in crisis, hair cells can shut down in order to redirect energy elsewhere, to places where it is needed. The types of physical situations that can cause hair loss include hormonal changes, nutritional deficiencies, a variety of medications, surgery, and many medical conditions, in particular, thyroid disease.

Hair loss is actually fairly common. According to the American Academy of Dermatology, nearly half of all adults in the U.S. will experience thinning hair by age 40. But thyroid patients in particular may experience hair loss earlier and more quickly than usual.

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.

Hormonally induced hair loss takes place when an enzyme starts to convert the hormone testosterone on the scalp to its less useful version, dihydrotestosterone, or DHT. DHT then attacks the hair follicle, and shrinks it, even making it disappear entirely. Hair becomes thinner and finer, and may stop growing entirely.

This conversion of testosterone to DHT seems to be sped up in some patients with hyperthyroidism or hypothyroidism, and may be the cause of hair loss that continues for thyroid patients, despite what is considered sufficient thyroid treatment.

Some people actually complain that rapid hair loss is the worst symptom of their thyroid problem - the thinning hair, large amounts of hair 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 a hairdresser, who noticed the change in their hair!

While thyroid disease frequently causes general hair loss from the hair on the head, a unique and characteristic symptom of hypothyroidism is loss of the hair on the outer edge of the eyebrows. General loss of body hair from areas other than the head can also be seen in thyroid disease.

If you have a thyroid condition, and are concerned about the amount of hair you are losing, here are some steps to take.

Get Evaluated by a Dermatologist

Even if you are in the midst of dealing with a thyroid problem, it's still a good idea to see a dermatologist. A good dermatologist experienced in hair loss can do a complete workup in order to assess the various causes of hair loss, and run tests that may identify other autoimmune conditions besides thyroid that may cause hair loss. For a hair loss specialist, visit the American Hair Loss Council website at http://www.ahlc.org/members.htm, or contact the American Academy of Dermatology, who can provide a referral to a dermatologist in your area.



American Academy of Dermatology
930 N. Meacham Road, P.O. Box 4014
Schaumburg, IL 60168-4014
Phone: 1-888-462-DERM (1-888-462-3376) for information on finding a dermatologist
Phone: (847) 330-0230
Web Address: http://www.aad.org

Make Sure It's Not Your Thyroid Drug

If you are taking levothyroxine (i.e., Synthroid, Levoxyl, Unithroid, Levothroid, Tirosint) 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 these drugs for some people. Note: Many doctors do NOT know this, even though it is a stated side effect in the Synthroid patient literature, for example, so don't be surprised if your doctor is not aware of this.

Make Sure You're Not Undertreated

Hair loss can also result from being UNDERtreated...not being at the right TSH, or not taking the right drugs for you. An increasing number of doctors believe 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.) To understand UNDERtreated hypothyroidism better, you may want to read my book Living Well With Hypothyroidism, 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.

Find Out if You Need a Second Drug

I am one of the people who does better and has less hair loss on a T4/T3 drug versus pure synthetic T4 only (like Synthroid.) Having both T4 and T3 has worked far better for me than levothyroxine. Some studies have shown that a subset of patients feel and do better on a combination of T4 and T3, not T4 (i.e., levothyroxine drugs like Synthroid) alone. For me, 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, however, 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.

Consider an Alternative Treatment

When I have had major bouts of hair loss (despite low normal TSH and being on a T4/T3 drug), I took the advice of a doctor I interviewed for my book, Living Well With Hypothyroidism. 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 I became 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.

Have Ferritin Evaluated and Treated if Needed

Some physicians feel that ferritin levels -- ferritin is the stored form of iron -- are integral to healthy hair growth, and that levels that are not optimal may contribute to hair loss, or impede hair regrowth. Have your ferritin levels checked, and if not optimal -- Sara Gottfried, MD says that levels below 80 are not optimal for thyroid patients suffering hair loss -- talk to your doctor about supplementing with iron.

(But remember not to take iron within three hours of thyroid medications.)

Be Patient

If you've been checked out by the dermatologist and determined to have thyroid-related hair loss, you may have to settle in and be a bit patient. It's likely that for most, the hair 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 most of 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 at one point, I lost almost half my hair. I had long, thick hair, and it got much thinner at various times. But now, with my thyroid fairly regulated, a T4/T3 drug, and use of EPO, it is at about 85-90% of where it used to be.

I still have short periods when it seems to be shedding a bit more than usual, but they are quite infrequent. (I used to think I was going to able to stuff pillows with all the hair I was losing!)

Look at Other Alternatives

In one 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.

Some other natural ways to deal with hair loss include:

  • Arginine
  • Cysteine
  • Green Tea
  • Polysorbate 80
  • Progesterone
  • Saw Palmetto
  • Trichosaccaride
  • Vitamin B6 Zinc

A comprehensive listing of supplements useful for hair loss is featured in my book, The Hair Loss Master Plan

Consult a Doctor for a Prescription Treatment

In some cases, your dermatologist may recommend that you try drug treatments. The two popular drugs for hair loss -- Rogaine and Propecia -- both interfere with DHT's ability to destroy hair follicles. Neither drug is safe to use during pregnancy, however, and so they are not as commonly used in women of child-bearing age.

Rogaine, the brand name for minoxidil, is available without a prescription. Women typically use a 2% minoxidil solution applied to the scalp twice a day, and men use a 5% solution. Improvements with minoxidil are slow - it may take months to see any improvement, and a year or more for any dramatic change in hair loss and regrowth. To maintain improvements, minoxidil needs to be continued daily. Propecia, the brand name for finasteride, is a prescription drug taken in pill form. It is not to be used by women in child-bearing years because of its ability to cause serious birth defects, but it has been shown to help some women. Propecia does not, however, appear to be any more effective than minoxidil, and like minoxidil, it can take a year to see results, and must be taken for life to maintain regrowth.

Consider Other Options

Ultimately, if thyroid treatment, drugs, and supplements do not resolve your hair loss, and it is a debilitating problem, you may want to consider other options, including:

  • Hair Extensions - read Hair Loss Master Plan for more details and information.

  • Hair products that thicken hair and prevent breakage

Could You Have Alopecia?

Some thyroid patients lose hair due to an underlying autoimmune disease known as alopecia. In the case of alopecia, the body is having an autoimmune reaction against its own hair follicles.

The primary symptom of alopecia is hair loss in round or oval hairless patches. This type of alopecia is known as alopecia areata. Typically, in 80% of cases, alopecia will affect only 1 patch, usually around the size of a quarter. Approximately 12% will have 2 patches, and 8% will have a number of patches of hair loss. The most frequent location is the scalp, which affects from two-thirds to almost all alopecia patients. In men, around 33% lose hair in the beard. Rarely, hair is lost from eyebrows and extremities. In only 7% of cases, alopecia is extensive, and involves loss of more than half of the body's hair. The loss of all facial and scalp hair is known as alopecia totalis. Only a very small percentage of those cases will have total hair loss throughout the body, known as alopecia universalis. Less common alopecia symptoms include pitting in nails, a burning sensation and itching of the skin.

Treatment

Some practitioners do not believe in even treating alopecia, because the condition is not considered medically "dangerous," and because remission and hair regrowth can be expected in the majority of cases.

In alopecia patients with extensive disease, as many as 8 to 45% have some positive regrowth with use of the 5% solution of minoxidil (Rogaine), but the treatment needs to be continuous in order to promote and maintain regrowth.

Drug treatments that are sometimes used include injected corticosteroids into the affected area. While this treatment hasn't been extensively studied, one study found that 92% of patients with small amounts of hair loss had some regrowth, and 61% of patients with total alopecia had some regrowth.

Topical steroids are also used in some patients, and fluocinolone acetonide cream 0.2% (Synalar) and betamethasone dipropionate cream 0.05% (Diprosone) had some regrowth results in studies.

Occasionally, in cases where alopecia comes on suddenly and extensively, oral corticosteroids may be used, in order to attempt to slow or stop the alopecia. Some practitioners, however, have found no results with this treatment, and even when success has been reported, patients relapse after stopping the therapy. The doses needed to obtain results are high enough that adverse side effects can also be experienced.

Oral cyclosporine is used in some patients, and all patients experienced some regrowth taking this drug, with half having cosmetically acceptable regrowth. Stopping the drug almost always triggers a relapse, however, and there's no evidence that oral cyclosporine can slow or prevent hair loss.

In cases of severe alopecia, topical immunotherapy may be beneficial. In this therapy, allergic irritation in the skin is triggered by topically applying strong allergens to the skin. The allergens include squaric acid dibutylester (SADBE) and diphencyprone (DPCP). These products are, however, not approved by the Food and Drug Administration, and their long-term safety is not known, although the treatment has been used for almost 20 years with no major adverse effects reported. Anthralin is another immunotherapy agent that is used. Some studies have shown no response to this treatment, while others have shown varying response rates for patchy alopecia, with lesser response for severe alopecia. How immunotherapy works is not clearly understood.

Another common treatment for alopecia is Psoralen plus UV-A light therapy, a treatment known as "PUVA." The initial response rate varies from 20-73%, but patients usually relapse after treatment is stopped, and is generally not considered an effective long-term treatment for alopecia.

Things to Know

There's a significant linkage between alopecia, and stress and mental health. People with alopecia are at higher risk for developing anxiety, personality disorders, depression, and paranoia, and as many as three-fourths of all alopecia patients may suffer from some sort of mental health condition.

Patients who have extensive hair loss tend to have less spontaneous remission than patients who have small patches of hair loss. In one study of 50 patients, 24% experienced spontaneous complete or nearly complete regrowth at some stage over a 3 year period.

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