Hypothyroidism patients often spot ‘carotenemia’ on their ‘palms’

Dr Renee talks about symptoms of hypothyroidism

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There are several dermatological manifestations associated with hypothyroidism, but many of these are easily confused with other ailments. Sometimes, an underactive thyroid interferes with the conversion of nutrients during digestion. The result may be a yellowing of the palms, soles and nasolabial folds on the face.

The journal Dermato-Endocrinology states that in hypothyroidism, the skin “tends to be pale” because of the water content in the skin.

It adds: “In addition, increased dermal carotene may appear as a prominent yellow hue on the palms, soles and nasolabial folds.”

Carotene is a molecule that adds a yellow colour to the skin, so when levels are elevated, the prominence of yellow in the skin may be raised.

This condition is medically known as carotenaemia, which in most cases is induced by prolonged and excessive intake of carotene-rich foods such as carrots, squash and sweet potatoes.

The MSD Manual warns that the dermatological manifestations of hypothyroidism are often “subtle and insidious”.

The health body adds: “The most common presenting symptoms are found retention and puffiness, especially periorbital, tiredness, cold intolerance and mental fogginess.”

Primary hypothyroidism is due to the decreased secretion of the hormones T4 and T3 from the thyroid.

When both these hormones are depleted, levels of thyroid-stimulating hormone (TSH) are increased.

Many of the body’s functions start to falter as a result, particularly metabolism and body temperature.

“It is also known that persons with hypothyroidism and diabetes mellitus tend to develop hypercarotenemia with normal intake of carotenoid-rich foods,” states Science Direct.

The medical journal cites the example of one 46-year-old woman with hypothyroidism, who visited her doctors with the chief complaint of yellowing of the skin on her palms for two years.

During the physical examination, doctors confirmed yellow pigmentation on the patient’s palms.

The patient thought she had severe jaundice, which her relatives suggested she may be able to correct with fruits and vegetables like carrots, pumpkin and tomatoes.

“Once perceiving that she had increased severity of jaundice she started eating more and more carrots and pumpkins,” explains the journal.

This overload of carotene in the system is likely to have exasperated the yellowing of the skin.

Because vitamins and nutrients get metabolised more slowly in hypothyroidism, they are more likely to build up inside the body.

“The commonly accepted cause of carotenemia in hypothyroidism is a decrease in the conversion of carotene into vitamin A, as well as associated hyperlipidemia and hyper-cholesterolaemia,” explains Medscape.

“Thyroid hormone is antagonistic to vitamin A and controls its rate of consumption.”

Other common indications of an underactive thyroid include weight gain, difficulty concentrating, and increased sensitivity to cold temperatures.

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