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Vitiligo and Thyroid Autoimmunity: What’s the Connection?

Posted on November 22, 2021
Medically reviewed by
Kevin Berman, M.D., Ph.D.
Article written by
Elizabeth Wartella, M.P.H.

Vitiligo is a skin condition associated with autoimmune thyroid diseases such as Hashimoto’s disease and Graves’ disease. People with vitiligo may have up to a 2.5-times higher risk of developing an autoimmune thyroid disease as compared to people without vitiligo.

Vitiligo is considered an autoimmune disease, and it affects about 2 percent of the world’s population. Among people with vitiligo, up to about 14 percent may also have an autoimmune thyroid disease.

People on MyVitiligoTeam, the online support network for people with vitiligo, have talked about having other autoimmune conditions, including autoimmune thyroid disorders. One member wrote, “I am curious … do many of you women also have thyroid problems? I read that vitiligo can make you have thyroid problems.”

Although there is an association between vitiligo and autoimmune thyroid diseases, there is no evidence that one condition causes the other. The conditions are related in that they are both autoimmune conditions and they both have hereditary components — they are passed down from parent to child through specific genes.

If you have vitiligo, it does not mean that you will develop thyroid disease. This article will discuss ways to manage your risk of autoimmune thyroid disease, as well as explain the connection between vitiligo, Hashimoto’s, and Graves’ disease.

What’s the Connection Between Vitiligo and Autoimmune Thyroid Disorders?

Vitiligo (including both segmental and nonsegmental vitiligo) and autoimmune thyroid disorders are related because they are both autoimmune disorders. Autoimmune disorders are conditions in which the immune system mistakenly attacks the person’s body as it would attack foreign invaders such as bacteria or viruses. Your immune system makes antibodies against your cells by an unknown mechanism.

Additionally, it is thought that vitiligo and autoimmune thyroid disorders both have large hereditary components, meaning that each disorder can be passed down from parent to child. However, the genetics of these conditions are not completely clear and likely involve multiple genes.

Autoimmunity

One of the most common theories about the development of vitiligo is that it’s an autoimmune disorder. Researchers believe that in vitiligo, the melanocytes (pigment-producing cells) are abnormal or defective. In certain people, the abnormalities in melanocytes trigger an autoimmune response, in which the immune system mistakenly creates antibodies (autoantibodies) that attack and destroy melanocytes. Destruction of melanocytes leads to the loss of skin pigment.

This theory is supported by the association of vitiligo with many other autoimmune conditions, including:

  • Type 1 diabetes
  • Alopecia areata
  • Rheumatoid arthritis
  • Systemic lupus erythematosus
  • Pernicious anemia (sometimes called Addison anemia)

People with vitiligo will sometimes have up to three or more other autoimmune disorders. One member of MyVitiligoTeam said, “I have vitiligo, thyroid dysfunction, and diabetes mellitus — all a result of autoimmune disease. I also have osteoarthritis in both knees and rheumatoid arthritis in my feet and hands.”

With autoimmune thyroid disorders like Hashimoto’s or Graves’ disease, the immune system creates antibodies that attack the thyroid gland in the neck. The thyroid gland is a key part of the endocrine system, which produces and regulates hormones in the body. Inflammation of the thyroid gland leads to thyroid dysfunction and hormonal dysfunction.

One meta-analysis, or summary of multiple research studies, found that 14 percent of people with vitiligo had an autoimmune thyroid disorder. Twenty percent of people with vitiligo tested positive for thyroid-specific antibodies, indicating some level of thyroid autoimmunity. Furthermore, 77 out of 79 people with vitiligo had anti-thyroid hormone antibodies, a finding that also indicates some level of thyroid autoimmunity. This sample size is small, however, which means the results may have limited larger applications.

A different study of people with vitiligo found that there are specific vitiligo factors associated with an increased chance of developing autoimmune thyroid disorders. These factors include:

  • Vitiligo that covers more body surface area
  • Having had vitiligo for a longer time
  • A family history of autoimmune thyroid conditions
  • Stress as a factor your vitiligo’s development

Heredity

Genetics and heredity likely play a role in the development of all autoimmune diseases, including vitiligo and thyroid diseases. These diseases tend to run in families, so if you have one of these conditions, you likely inherited the risk genes from your parents. At times, these genes are only triggered and expressed under certain circumstances that affect the immune system.

Research suggests that because there is a higher prevalence of both thyroid disease and vitiligo together, the conditions may have some shared genes. In studying the association, researchers have identified nine genes that may underlie the development of both vitiligo and autoimmune thyroid disorders. Having one or several of these shared genes may explain why someone would be more susceptible to both disorders.

Autoimmune Thyroid Disorders Related to Vitiligo

Specific autoimmune thyroid disorders related to vitiligo include Hashimoto’s and Graves’ disease. Each disease is characterized by dysfunction of the thyroid gland and results in somewhat nonspecific symptoms. Familiarizing yourself with the symptoms will help you to understand when you should consult a doctor.

Hashimoto’s Disease

Research has found that people with vitiligo have an increased risk of Hashimoto’s disease, especially young people and males. Another pediatric study found that children and adolescents with vitiligo had a 2.5-times higher risk of Hashimoto’s as compared to those without vitiligo.

Hashimoto’s disease is an autoimmune thyroid disease in which the immune system attacks the thyroid gland and creates inflammation, called Hashimoto’s thyroiditis. The inflammation affects thyroid function and results in the underproduction of thyroid hormones, which is called hypothyroidism.

Symptoms of Hashimoto’s may take years to develop. These symptoms may include:

  • Unexplained fatigue
  • Constipation
  • Unexplained weight gain
  • Hair loss (on the scalp and eyebrows)
  • Joint stiffness and pain
  • Depression
  • Face puffiness
  • Increased sensitivity to cold

One member of MyVitiligoTeam wrote about their symptoms and getting diagnosed with hypothyroidism, saying, “The only reason I had my thyroid checked was because of a suggestion from my dermatologist years ago … sure enough, I have hypothyroidism. I do notice when my thyroid is dysfunctioning — my hair gets brittle, my skin gets very dry, and I’m cold all the time.”

Doctors can test for Hashimoto’s disease by examining the levels of hormones like thyroid-stimulating hormone or anti-thyroid peroxidase antibodies (TPO antibodies) in your blood. Tell your doctor if you experience any new symptoms like constipation, a puffy face, fatigue, or depression.

Graves’ Disease

Another autoimmune thyroid disorder associated with vitiligo is Graves’ disease. Studies have found that rates of Graves’ disease are significantly higher in people with vitiligo as compared to the general population.

“I have Graves’ disease along with vitiligo. I had my physical with my doctor a few days ago and found out that my thyroid levels are very low, which would explain why I’m so tired lately,” wrote one member of MyVitiligoTeam.

Graves’ disease is similar to Hashimoto’s in that the immune system mistakenly attacks the thyroid gland in the neck. However, Graves’ disease results in an overproduction as opposed to an underproduction of thyroid hormones, also known as hyperthyroidism.

Hyperthyroidism and Graves’ disease produce a range of symptoms, including:

  • Increased perspiration and sensitivity to heat
  • Irritability or anxiety
  • Unexplained weight loss
  • Reduced libido or erectile dysfunction
  • Fatigue
  • Slight tremor in the fingers or hands
  • Irregular or rapid heartbeat (heart palpitations)
  • Eye bulging (in the case of Graves’ ophthalmopathy)
  • Development of red, thick skin on shins or feet (in case of Graves’ dermopathy)

As with Hashimoto’s, Graves’ disease symptoms are similar to other conditions or diseases. Take note of any new or increased symptoms and tell your doctor about them. If you experience heart symptoms or changes in vision, contact your doctor immediately.

How To Manage the Risk of Autoimmune Thyroid Conditions With Vitiligo

If you have vitiligo, be aware that you are at an increased risk for conditions like autoimmune thyroid diseases. You can take several steps to manage your risk of these diseases:

  • Get yearly blood tests to examine your thyroid hormone levels.
  • Know the signs and symptoms of autoimmune thyroid diseases. Although many of the symptoms are general, keep track of your symptoms and let your doctor know about any changes.
  • Know whether you have a family history of autoimmune thyroid disease, and tell your doctor. Because there is a genetic factor, a family history of these diseases further increases your risk.

A MyVitiligoTeam member wrote, “The first thing my general practitioner did was check my thyroid because it can be related to vitiligo and because my mom had hypothyroidism.”

Talk to Others Who Understand

MyVitiligoTeam is the social network for people with vitiligo. More than 9,000 members come together to ask questions, give advice, and share their stories with others who understand life with vitiligo.

Do you have vitiligo and an autoimmune thyroid disorder? Share your experience in the comments below, or start a conversation by posting on your Activities page.

Kevin Berman, M.D., Ph.D. is a dermatologist at the Atlanta Center for Dermatologic Disease, Atlanta, GA. Review provided by VeriMed Healthcare Network. Learn more about him here.
Elizabeth Wartella, M.P.H. holds a masters in public health from Columbia University and is passionate about spreading accurate, evidence-based health information. Learn more about her here.

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