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Alopecia Areata, Hair Loss, and Thyroid Autoimmunity

Published May 11 2015

Many people with Graves’ Disease and Hashimoto’s Thyroiditis experience hair loss.  In most cases the imbalance of thyroid hormone is responsible for the hair loss.  However, other causes of hair loss include sex hormone imbalances, nutrient deficiencies, and certain medications.  However, another possibility is a condition called alopecia areata, which is commonly found in people with autoimmune thyroid conditions.

So what is alopecia areata?  This is an autoimmune condition which involves damage of the hair follicles.  This condition usually begins with one or two patches of hair loss on the scalp, although hair loss can also occur in the beard, eyebrows, arms, and legs (1) [1].  Some people will experience hair loss of the entire scalp, which is known as alopecia totalis (2) [2].  If it involves the whole body then this is known as alopecia universalis (2) [2].  For many people the hair will eventually grow back, although this isn’t the case with everyone.

What Causes Alopecia Areata?        

There is no single factor which causes alopecia areata.  This shouldn’t be surprising, as most autoimmune conditions involve multiple factors.  This includes a genetic predisposition, along with lifestyle and environmental factors.  In other words, in someone who has a genetic marker for alopecia areata, some type of environmental trigger will lead to the development of this condition.  It could be stress, a pathogen, or another trigger.

How Is Alopecia Areata Diagnosed?

In most cases alopecia areata is diagnosed based on the patient’s history and clinical presentation (3) [3].   However, in cases when the diagnosis isn’t clear a scalp biopsy may be required (4) [4].   A trichoscopy may also be used, as this involves dermoscopic imaging of the scalp and hair (5) [5].  There also is something called the hair pull test, which involves gentle traction on a group of hairs on three separate areas of the scalp (6) [6].  A normal or negative pull test extracts three or fewer hairs, and a positive pull test extracts six or more hairs from a single area (6) [6].

The Relationship Between Alopecia Areata and Thyroid Autoimmunity

Many people reading this are aware that having one autoimmune condition increases the likelihood of developing one or more additional autoimmune conditions in the future.  As a result, someone who has Graves’ Disease or Hashimoto’s Thyroiditis is more likely to have alopecia areata.  And the research clearly shows a correlation between alopecia areata and thyroid autoimmunity, which I’m about to discuss.

One study involving 78 patients with alopecia areata showed a high prevalence of thyroid abnormalities (7) [7].  The authors concluded that screening for thyroid function and thyroid antibodies is advised in alopecia areata.  Another study looked to determine whether alopecia areata is statistically associated with thyroid autoimmunity (8) [8].  The findings of the study showed a significant association between alopecia areata and thyroid autoimmunity.  Another study involving 50 patients with alopecia areata showed an increase in thyroglobulin and thyroid peroxidase antibodies, and it was concluded that every patient with alopecia areata should be screened for thyroid function and the presence of thyroid autoantibodies (9) [9].  Yet another study involving forty six children and adolescents showed that there is a relationship between alopecia areata and autoimmune thyroiditis, as 22 of the 46 children with alopecia areata were diagnosed with autoimmune thyroiditis (10) [10].

You might wonder which condition comes first, alopecia areata, or the autoimmune thyroid condition?  Although some of these studies suggest that alopecia areata developed before the thyroid autoimmunity, keep in mind that someone can have thyroid antibodies for many years before they present with thyroid symptoms.  So it can be challenging to know if someone developed alopecia areata first, or if they initially had an autoimmune thyroid condition.  Either way the goal is the same, which is to address the autoimmune component of the condition.

Alopecia Areata: Conventional and Natural Treatment Methods

Just as is the case with all other autoimmune conditions, conventional treatment methods for alopecia areata focus on symptom management, and do absolutely nothing for the cause.  Systemic glucocorticosteroids have been used in the treatment of some cases of alopecia areata (11) [11].  Methylprednisolone is a corticosteriod, and one study showed that pulse methylprednisolone therapy might be a therapeutic option for severe multifocal alopecia areata, although treatment results are unsatisfactory in alopecia totalis or universalis (12) [12].  There are some other studies involving different drugs, but once again, these drugs aren’t doing anything to address the cause of the condition.

On the other hand, the goal of a natural treatment protocol for alopecia areata involves addressing the autoimmune component.  If someone has thyroid autoimmunity and alopecia areata, there is a chance that the same environmental trigger was responsible for both conditions.  For example, in past articles and blog posts I’ve discussed how stress can be a trigger for Graves’ Disease and Hashimoto’s Thyroiditis, and there is also evidence that stress can play a role in the development of alopecia areata (13) [13] (14) [14].

Similarly, pathogens can also trigger autoimmunity, and there is a relationship between certain infections and alopecia areata.  One study suggested that the Epstein-Barr virus might be a potential trigger (15) [15].  The swine flu virus might also be a trigger (16) [16].  I’ve spoken about the relationship between H. Pylori and autoimmune thyroid conditions in the past, and one case study involving a 43-year old man with an 8-month history of alopecia areata showed that the patient went into remission from alopecia areata after H. Pylori eradication (17) [17].

Alopecia areata is also commonly associated with Celiac disease (18) [18] (19) [19] (20) [20], which is another autoimmune condition where the immune system reacts to gluten.  Although I usually recommend for my patients with autoimmune thyroid conditions to avoid gluten while trying to restore their health, not everyone complies.  However, avoiding gluten can not only help to put Celiac disease into remission, but it’s not uncommon for other types of autoimmune conditions to go into remission when avoiding gluten.  Once again, this doesn’t describe everyone, as I’ve had numerous patients with Graves’ Disease and Hashimoto’s Thyroiditis who avoided gluten with little or no difference in their symptoms or thyroid antibodies.  On the other hand, many do see a noticeable improvement in their health upon avoiding gluten.

In summary, alopecia areata is an autoimmune condition which involves hair loss due to damage of the hair follicles.  It is common in people with autoimmune thyroid conditions, and like Graves’ Disease and Hashimoto’s Thyroiditis, a combination of genetic, lifestyle, and environmental factors seem to cause this condition.  Conventional treatment methods focus on symptom management, while the goal of a natural treatment protocol is to address the autoimmune component.