Thyroid disease in its various forms is common, affecting some 5% of the population, predominantly females1. Thyroid disorders, both hypothyroidism and hyperthyroidism, involve skin and because dermatology is a visual speciality, it is crucial that we detect symptoms and signs of their cutaneous manifestations for early diagnosis and interventions of thyroid disease.
Thyroid hormones are essential for optimal epidermal proliferation both invitro and invivo. They regulate genes involved in keratinocyte proliferation and also stimulate the expression of certain keratins2.
Thyrotoxicosis may lead to multiple cutaneous manifestations, including hair loss, pretibial thyroid dermopathy, onycholysis and acropachy3.
In patients with hypothyroidism, there is hair loss, cold and pale skin with myxedematous changes, mainly in hands and peri-orbital region3.
Not many studies have been done in India to assess cutaneous manifestations of thyroid diseases. The data collected from this descriptive study could be used for further studies. Hence, there is a need for this study that I am conducting at Department of Dermatology, Venereology and Leprosy in Dr.B.R.Ambedkar Medical College and Hospital, Bangalore.
6.2 REVIEW OF LITERATURE
Thyroid dermopathy is said to be the most characteristic cutaneous sign of hypothyroidism which is characterised by generalised myxeodema caused by deposition of dermal acid mucopolysachharides especially hyaluronic acid and chondroitin sulphate4.
According to a study on thirty two patients of hypothyroidism, thirteen patients had telogen effluvium5.
Milgraum et al found that in a study of 45 children with alopecia areata, 24% had an abnormality of one or more thyroid function tests (i.e., T4, T3, TSH and/AMA levels) although clinically most patients appeared normal6.
The incidence of antithyroid antibodies in patients with chronic urticaria is 24% approximately7.
According to a study by RJ Lutfi, et al, in patients with melasma, the frequency of thyroid disorders (58.3%) was 4 times greater than in thecontrol group who did not have melasma8.
In vitiligo, the most prevalent associated endocrinopathy is thyroid dysfunction, either hyperthyroidism (Graves disease) or hypothyroidism (Hashimoto thyroiditis)9.
6.3 OBJECTIVES OF THE STUDY To study the clinical spectrum and epidemiological characteristics of the cutaneous manifestations of thyroid diseases.
MATERIALS AND METHODS
7.1 SOURCE OF DATA Patients with proven or suspected thyroid diseases from the departments of Dermatology, Venereology and Leprosy and Medicine.
7.2 METHODOLOGY OF COLLECTION OF DATA
All patients with cutaneous manifestations of thyroid disease attending the in and out patient departments of Dermatology, Venereology and Leprosy and Medicine would be consented and included into the study.
Detailed history taking and thorough physical examination, with special emphasis on cutaneous involvement, will be carried out in all these patients. Routine as well as relevant investigations like thyroid function test will be done along with thyroid antibodies and skin biopsy where required.
All the findings of my descriptive study will be recorded and statistically analyzed.
Sample size, study design and duration
This is a descriptive study to be done on hundred patients with cutaneous manifestations of thyroid disease over a period of one year that is from 1st February 2009 to 31st January 2010.
1. All newly diagnosed patients of thyroid disease.
2. All patients with clinical suspicion of thyroid disease.
3. Patients would be above age of 18 years.
All patients with proven thyroid disorders who are already under treatment.
7.3 Does the study require any interventions or investigations to be conducted on patients or other humans or animals?
Jabbour, Serge A. Cutaneous Manifestations of Endocrine Disorders- A Guide for Dermatologists. American Journal of Clinical Dermatology 2003;4(5):315-31.
Heymann WR. Cutaneous manifestation of thyroid disease. Journal of American Academy of Dermatology 1992;26:885-902.
Dogra A, Dua A, Singh P. Thyroid and skin. Indian Journal of Dermatology 2006;51:96-9.
Milgraum SS, Mitchel AJ, Bacon GE, Rasmussen JE. Alopecia areata, endocrine function and autoantibodies in patients 16 years of age or younger. Journal of American Academy of Dermatology 1987;17:57-61.
Kikuchi Y, Fann T, Kaplan AP. Antithyroid antibodies in chronic urticaria and angioedema. Journal of Allergy and Clinical Immunology 2003 July;112(1):218.
Lutfi RJ, Fridmanis M, Misiunas AL, Pafume O, Gonzalez EA, Villemur JA et al. Association of melasma with thyroid autommunity and other thyroid abnormalities and their relationship to the origin of Melasma. Journal of Clinical Endocrinology and Metabolism 1985;61:28-31.
Klaus W, Lowell AG, Stephen IK, Barbara AG, Amy SP, David JL. Fitzpatrick’s Dermatology in General Medicine. 7th ed. New York: McGraw-Hill; 2008. p. 619.