Short answer: US medical bodies connect thyroid disease and chronic hives. They name thyroid disease rather than Hashimoto's. The American College of Allergy, Asthma and Immunology (ACAAI) says "Chronic hives may also be signs of thyroid disease or other hormonal problems." Mayo Clinic says that in some people, the risk of chronic hives increases if they have certain medical conditions, and thyroid disease is one it names. Cleveland Clinic says about 1 in 5 people who develop chronic hives also have an autoimmune disease, and lists thyroid disease among them. ACAAI and Cleveland Clinic both say that for most people with chronic hives, no cause is found. Mayo Clinic says to see a healthcare professional if you have severe hives or hives that last for more than a few days, and to seek emergency care if you get hives as part of a severe allergic reaction, whose symptoms it says include dizziness, trouble breathing, and swelling of the tongue, lips, mouth or throat.
If you have Hashimoto's and your skin has started breaking out in itchy welts that come and go, this is for you. You're allowed to want an answer for that. The useful thing to bring is a record, because the welts may be gone by the time you're in the room.
Osmi's daily check-in is one place to keep the dates. It takes about a minute: answer seven questions or speak with Rose, your thyroid mascot, and every answer lands on the same record as your labs, cycle, and sleep. The photos live on your phone.
If your lips, face or throat swell, or you have trouble breathing, that's not a note for later. Mayo Clinic, the American Academy of Dermatology and Cleveland Clinic each say to get emergency care for signs like these.
What the US sources say about thyroid disease and hives
Four US bodies put thyroid disease and chronic hives on the same page. Each one says it a little differently, and the hedge matters as much as the link.
| Source | What it says | How it scopes it |
|---|---|---|
| ACAAI, chronic hives page | Chronic hives may also be signs of thyroid disease or other hormonal problems | "may also be"; it says no true cause is found in most cases |
| Mayo Clinic, chronic hives page | The risk of chronic hives increases in some people with certain medical conditions, including thyroid disease | "In some people"; it says it's often not known why chronic hives happen |
| Cleveland Clinic, chronic hives page | About 1 in 5 people who develop chronic hives also have an autoimmune disease; its list includes thyroid disease | The 1 in 5 counts any autoimmune disease, not thyroid disease alone |
| American Academy of Dermatology (AAD), chronic hives page | A thyroid condition is one of the possible causes a dermatologist can find or rule out | "find or rule out"; it says most people who have hives are otherwise healthy |
Every one of those four says thyroid disease or a thyroid condition. None of them names Hashimoto's in that line. NIDDK calls Hashimoto's disease an autoimmune disorder that can cause hypothyroidism, and Cleveland Clinic puts thyroid disease on its list of autoimmune diseases seen with chronic hives.
What they don't say matters too. ACAAI says, "In most cases, no true etiology is found." Cleveland Clinic says, "For most people with chronic hives, there’s no known cause." So if you have both, it's something to tell your doctor about, knowing that both bodies say most people don't get a known cause.
Dry skin and hives sit on different lists
The Hashimoto's pages from NIDDK, the American Thyroid Association and Cleveland Clinic each list dry skin among the symptoms of hypothyroidism. None of those three pages mentions hives, urticaria or a rash. If dry skin is what you've noticed, see hypothyroidism symptoms people don't think to write down.
Hives look different. Mayo Clinic describes welts that might be red, purple or skin-colored, depending on your skin color, that vary in size, change shape, and appear and fade repeatedly. Mayo adds, "Each individual welt typically lasts less than 24 hours." Cleveland Clinic says it can be easy to confuse hives with other types of rashes, and that common features of hives include not leaving a mark or bruise.
The six-week line is the one the sources share. AAD says that if you continue to get hives daily or almost every day for 6 weeks or longer, you have chronic hives. ACAAI says chronic hives appear at least twice a week and last more than six weeks. Cleveland Clinic says chronic hives are more common in women ages 30 to 50, and that for half of people with chronic hives, the hives go away within a year.
What to write down, and the photo
Here's the problem with hives at an appointment. AAD says it plainly: "When you see your dermatologist, you may not have hives." Its answer is to take photos of your hives, because pictures can help your dermatologist make sure you have hives.
Mayo Clinic says your healthcare professional might ask you to keep a diary. Built from the items on Mayo's list and the questions AAD and Mayo say you'll be asked, here's what to keep:
- The date they started, and each day they came back. Mayo lists "When did you first have symptoms?" among the questions you're likely to be asked.
- A photo of each outbreak. Most phones save the date with every picture, so the camera roll becomes the timeline.
- Where they appeared on your body.
- How long a welt took to fade, and whether it left a bruise or other mark.
- Whether they came with painful swelling, which Mayo calls angioedema, around the eyes, cheeks or lips.
- Itch, burn or sting. Mayo asks: "Do your hives mainly itch, or do they burn or sting?"
- Anything else at the same time, like feeling lightheaded or nauseous, which AAD asks about.
- What you were doing beforehand. Mayo's diary list starts with your activities, and Mayo names heat, exercise or stress among what can trigger flares.
- Everything you take. Mayo says to list any medicines you're taking, including vitamins, herbs and supplements, for the appointment.
Six weeks of that is worth more than any description you can give from memory. If your Hashimoto's has its own rough stretches, what to log in a Hashimoto's flare-up covers the thyroid side, so the two records sit on the same dates.
Who to see, and what to ask
Mayo Clinic says you'll likely start with your primary healthcare professional, or you may be referred to an allergy specialist or a dermatologist. Cleveland Clinic lists allergists, dermatologists and primary care physicians as the providers who diagnose and treat chronic hives. ACAAI says chronic hives should be evaluated by an allergist.
AAD says a dermatologist can often diagnose hives by looking at your skin, and that finding the exact cause of hives can take time. The tests it says a dermatologist may require include allergy tests, blood work to rule out an illness or infection, and a skin biopsy. Mayo Clinic says you also may need blood tests to determine the cause of your symptoms.
Whoever you see, tell them you have Hashimoto's. AAD names a thyroid condition among the possible causes a dermatologist can find or rule out, so it belongs in the room.
Mayo Clinic's own questions to ask include:
- "What is likely causing my symptoms?"
- "How long will hives last?"
- "What kinds of tests do I need?"
And two more for your situation:
- You know I have Hashimoto's. Does that change what you'd look for?
- If these keep coming back, who should I see next?
Osmi's appointment sheet is one page, built from the record you already keep, that you share with your practitioner in one tap. It doesn't diagnose anything and it doesn't read your results for you. For the rest of the visit, see walk into your thyroid appointment with a real record.
When hives can't wait
Mayo Clinic says chronic hives don't put you at sudden risk of a serious allergic reaction, called anaphylaxis. It also says that if you get hives as part of a severe allergic reaction, seek emergency care, and that symptoms of anaphylaxis include dizziness, trouble breathing, and swelling of the tongue, lips, mouth or throat.
AAD says to go to urgent care or the nearest emergency room if hives cause swelling on your face, inside your mouth or in your throat, problems swallowing or breathing, feeling light-headed or faint, or a racing heart. In its words: "Swelling on your face, inside your mouth, or in your throat can cause problems breathing or swallowing, which can happen fast and require immediate medical care."
Cleveland Clinic says, "Call 911 or have someone take you to the emergency room if you’re having difficulty breathing, dizziness or swelling in your face, lips, tongue or throat."
For everything short of that, Mayo Clinic says to see a healthcare professional if you have severe hives or hives that last for more than a few days. One small thing for today: if the welts are there right now, take the photo.
Questions women ask about Hashimoto's skin rash and hives
Is there a link between Hashimoto's and hives? ACAAI, Mayo Clinic and Cleveland Clinic link thyroid disease and chronic hives on their chronic hives pages, without naming Hashimoto's. ACAAI says chronic hives may also be signs of thyroid disease or other hormonal problems. Mayo Clinic says the risk of chronic hives increases in some people with certain medical conditions, including thyroid disease. Cleveland Clinic lists thyroid disease among autoimmune diseases seen with chronic hives. ACAAI and Cleveland Clinic both say that for most people with chronic hives, no cause is found.
What does a Hashimoto's skin rash look like? The Hashimoto's pages from NIDDK, the ATA and Cleveland Clinic list dry skin among hypothyroidism symptoms and don't describe a rash. For hives, Mayo Clinic describes itchy welts that might be red, purple or skin-colored, depending on your skin color, that change shape and appear and fade repeatedly, each typically lasting less than 24 hours.
When do hives count as chronic? AAD says that if you continue to get hives daily or almost every day for 6 weeks or longer, you have chronic hives. ACAAI says chronic hives appear at least twice a week and last more than six weeks. Cleveland Clinic says that for half of people with chronic hives, the hives go away within a year.
Which autoimmune diseases are linked to chronic hives? Cleveland Clinic says about 1 in 5 people who develop chronic hives also have an autoimmune disease. Its examples are celiac disease, dermatomyositis, diabetes, lupus, polymyositis, rheumatoid arthritis, thyroid disease and vitiligo. ACAAI says some cases of chronic hives are associated with an autoimmune disorder.
Should I see a dermatologist or an allergist for hives? Mayo Clinic says you'll likely start with your primary healthcare professional, or be referred to an allergy specialist or a dermatologist. Cleveland Clinic lists allergists, dermatologists and primary care physicians. ACAAI says chronic hives should be evaluated by an allergist. Whoever you see, bring your dated photos and tell them you have Hashimoto's.
When is a hives outbreak an emergency? Cleveland Clinic says to call 911 or have someone take you to the emergency room if you're having difficulty breathing, dizziness or swelling in your face, lips, tongue or throat. AAD adds problems swallowing, feeling light-headed or faint, and a racing heart. Mayo Clinic says to seek emergency care if hives come as part of a severe allergic reaction.
Educational, not medical advice.
