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The link between Urticaria and Thyroiditis

Tuesday 23rd October 2018

Urticaria is a skin condition also known as Hives. The symptoms are itchy skin consisting of raised red bumps appearing in wheals of blotches on the skin, and when pressed turning white.

For relevance, this article focuses on chronic autoimmune urticaria (CAU) due to being associated with auto immune thyroid disease.
CAU is diagnosed when skin manifestations appear for longer than 6 weeks

CAU has long been thought to be associated with autoimmune thyroid disease (AITD). Oxford Medical Case Reports published a study in 2018. This detailed a 49-year-old patient with CAU distributed on both her shins and hand. Thyroid blood markers were consequently measured and resulted in low levels of thyroid hormones T4 and T3, along with elevated anti thyroid peroxidase antibodies and elevated thyroid stimulating hormone (TSH) levels. A diagnosis of Hashimoto's was confirmed and Thyroxine was prescribed. The skin lesions disappeared within 4 weeks. No relapse of CAU was reported and the patient is now on long term Thyroxine.

Typically, the treatment for CAU is antihistamines and corticosteroid creams. Diagnosis is either through a thorough case history and/or blood tests showing inflammatory markers such as c reactive protein and erythrocyte sedimentation rate (ESR), along with a skin test checking for elevated histamine antibodies.

The typical treatment offered might have cleared the skin lesions, leaving the underlying condition of raised thyroid antibodies and lowered thyroid hormones undetected. This suggests, that it is important to monitor any other symptoms, alongside skin rashes, that are common with thyroid imbalances. Such as fatigue, weight gain or weight loss, hair thinning and mood. Otherwise, the skin condition of CAU could be masking a thyroid disorder.

Urticaria appears when the immune system releases mast cells in response to either an allergy, injury, bacteria or parasite. In turn the mast cells releases histamine. This dilates blood vessels to allow more blood to reach the site of infection or injury to create healing. Though, when the immune system is constantly inflamed, this creates a cascade of elevated levels of histamine, which can trigger CAU and Thyroiditis. Therefore the healing process stops, and chronic inflammation occurs.

The key to lowering chronic inflammation is to remove triggers that are provoking the immune system to attack. Triggers include food allergies, bacteria, parasites, yeast, mould, and environmental allergies such as house mites/pollen/grass.

If you are concerned about food allergies then you can test for this through a blood test called "Food IgE".

To conclude, if you have symptoms of CAU and a family history of autoimmune disease, then I suggest the following should be considered:

• Full Thyroid Blood Panel including antibodies to rule out Thyroiditis

• Stool Test to check for bacteria, parasites, yeast infections and inflammation
• Eliminate wine, cheese, processed and cured meats, pickles, sauerkraut, kimchi, yoghurt, kefir, citrus fruits and left over foods
• Rule out environmental allergens such as pollen, mould and dust mites

Foods to help lower inflammation are:
• Watercress
• Red Onions
• Garlic
• Fresh Basil
• Fresh Thyme
• Chamomile/Nettle Tea/Peppermint Tea
• Ginger root
• Turmeric