Hair Loss in Hypothyroidism – nutrients of importance

In the previous article titled Hair Loss – root causes was about the three most common types of hair loss, including androgenic alopecia, alopecia areata, and the most common form of diffuse hair loss, telogen effluvium which is the type often associated with hypothyroidism.  This article explains the role of specific vitamin and mineral deficiencies in hair loss and how treating them can help restore hair growth.

As explained in the previous article, telogen effluvium (TE) is the most common form of hair loss in hypothyroidism and is where the hair often comes out in clumps in the shower or a brush. Hair loss is usually from all over the scalp but may occur more on the temples, the part, and the crown of the head [1]. But TE is not the only type of hair loss in hypothyroidism. In a study of more than 1200 people with thyroid disorder, half (50%) of people aged 40 years old and older had either alopecia areata, or androgenetic alopecia [2].

What makes the hair loss associated with thyroid dysfunction particularly challenging is that it occurs 2-3 months after the overt symptoms of thyroid disorder began, which is usually once they’ve already begun thyroid hormone treatment for hypothyroidism.

The pictures below are of me. The one on the left was taken at one of my son’s wedding in June 2022, just prior to being diagnosed with hypothyroidism.  I clearly had the symptom of edema (facial swelling, leg and hand swelling) associated with undiagnosed / untreated hypothyroidism, the hair on my head was minimally affected. The photo on the right was taken three months later, after beginning hormone replacement treatment for hypothyroidism, and the hair loss and shiny scalp is very apparent. 

Hair loss in hypothyroidism

Normally,  90-95% of hair follicles are in the growth (anagen) phase, with only 5–10% being in the resting (telogen) phase. Only a few follicles are in the transitional (catagen) phase [1] at any one time.  At the end of the telogen phase, the hair falls out and under normal circumstances that would amount to ~ 100-150 hairs per day.

 

In telogen effluvium, the growth (anagen) phase slows down and up to 50% of the follicles move into the telogen phase, where shedding occurs. i.e., hair loss becomes 5-10 greater than normal, with people losing up to 50% of their hair.  As can be seen in the photo above, at 3 months I had lost 50% of my hair. 

It wasn’t only half the hair on my head that I lost, also lost 1/2 my eyelashes and part of the outer third of my eyebrows.

Since the period of the most dramatic loss occurs approximately 2-3 months after the triggering event, many people don’t relate the shedding to the event that caused it. 

Hypothyroidism can result in hair loss, but nutrient deficiencies can sometimes underlie hypothyroidism (such as in iodine or iron deficiency) and can often make the symptoms of hypothyroidism worse.  Each person is different and the degree to which underlying nutrient deficiencies may make hair loss worse, varies.  As a result, the sufficiency of the key nutrients related to hypothyroidism should be evaluated. 

If any of these nutrients are found to be deficient or suboptimal, correct supplementation can support the regrowth of hair, but it should be noted that the timing of supplements with respect to each other and in relation to the timing of thyroid medication is essential. The reason for this is that some nutrients complete for binding sites (e.g., iron, zinc and copper) and need to be taken separated from each other. In addition, thyroid medication needs to be taken at least a half hour before and food or vitamin / mineral supplementation, or two hours afterwards. When there are several nutrient deficiencies and multiple doses per day of thyroid medication, this can take quite a bit of planning to get the timing right.

Iron deficiency is very common and one of the deficiencies that contributes to telogen effluvium [3,4], and iron is often low in hypothyroidism [5]. In some cases, treating iron deficiency may in itself be sufficient to restore thyroid function [5]. The reason is that the body requires sufficient iron to convert the inactive thyroid hormone thyroxine (T4) into the active thyroid hormone triiodothyronine (T3) and insufficient iron stores could interfere with this conversion. 

It has been recommend that to reverse significant hair loss due to telogen effluvium to maintain serum ferritin at levels of >157 pmol/L (70 ng/dL) [4].

Some of the best food sources of heme iron (the most bioavailable form) are oysters, clams and liver.

Adequate vitamin C intake is required for intestinal absorption of iron, so ensuring adequate vitamin C intake is important those with hair loss associated with iron deficiency.

Selenium was identified in the 1990s as a component of the enzyme that activates thyroid hormone through the conversion of (inactive) T4 to (active)T3 [6]. Selenium is also used to by the body for the formation of glutathione, a powerful antioxidant that protects the thyroid from inflammation and oxidative stress.

Food sources of selenium include Brazil nuts, with 2 Brazil nuts meeting the daily requirement of 200 mcg of selenium. Other good sources of selenium are mushrooms, eggs, fish such as cod and halibut, chicken and eggs. 

Selenium deficiency is a significant problem in the developing world, but thought to be rare in the West. Research from 2012 indicates that the selenium content of the soil in the US was already lowest in the major agricultural areas of the Northwest, Northeast, Southeast, and areas of the Midwest near the Great Lakes[7] and at the time, only the Great Plains and the Southwest were reported to have adequate selenium content in the soil [6].

Zinc plays a key role in the metabolism of thyroid hormones, specifically by regulating the enzymes that are involved in the activation of T4 to T3, as well as regulating thyrotropin releasing hormone (TRH), and thyroid stimulating hormone (TSH) synthesis [8]. Zinc also modulates structures of essential transcription factors that are involved in the synthesis of thyroid hormones, as well as influence the levels of TSH, T4,  and T3 in the blood [8]. It is important to be tested first to know if there is a zinc deficiency before taking a supplement, because supplemental zinc can result in a reduction in copper, and if taking zinc, it is important not to take it with iron or calcium supplements as they complete for binding sites.

Eating foods rich is zinc is the safest way to ensure adequate intake and good sources of zinc include red meat, poultry, seafood such as oysters, crab and lobster, as well a nuts. 

Vitamin D – in Canada which is above the 49th parallel, it is  known that between 70% and 97% of the population demonstrates vitamin D insufficiency, with 32% in Canada being Vitamin D deficient [9].  Deficiency of Vitamin D in the US is even higher, at 42% [10]. It has been known that there was a relationship between Hashimoto’s (autoimmune) hypothyroidism and Vitamin D deficiency [11], it is now known that non-autoimmune hypothyroidism is associated with vitamin D deficiency [12]. A randomized, double-blind, placebo-controlled trial from 2018 in over 200 hypothyroid patients aged 20-60 years old found that supplementing with vitamin D improved TSH levels and calcium levels in hypothyroid patients [13]. 

In addition to dairy foods that are fortified with Vitamin D, foods that are naturally good sources of Vitamin D include fatty fish such as salmon, mackerel and tuna.

 

Vitamin B12  – It is known that people with Hashimoto’s disease (autoimmune hypothyroidism) have a higher prevalence of pernicious anemia [14], which is caused by a deficiency of vitamin B12, either due to a lack of B12 the diet or an inability to absorb it. In addition, vitamin B12 deficiency can mimic many of the symptoms of hypothyroidism such as fatigue, weakness, yellowish skin, some of the mental health symptoms. The best sources of vitamin B12 are organ meats, including liver and kidney, clams, sardines, and beef.

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[UPDATE: December 11, 2022] The photo on the top, below was taken three months after being diagnosed with hypothyroidism and beginning hormone replacement treatment. The hair loss is obvious, as is my shiny scalp. The photo on the bottom was taken today — three months later. It clearly shows the regrowth of hair which is the result of both hormone replacement treatment, and three months of nutrient supplementation to support regrowth. [Note: Each person’s results will be different of course, depending which nutrient deficiencies they may have, and whether these deficiencies were due to the hypothyroidism itself, the result of inadequate dietary intake, or both].

 

…and the hair regrowth wasn’t only on my scalp.  When I first lost so much hair, I also lost most about half of my eyelashes, too.  A month ago (Nov. 18, 2022), I took a picture of them growing back in, and below is that photo and what they look like almost a month later (December 13, 2022), without any mascara or eyeliner.

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POSTSCRIPT (November 18, 2022):  In writing this post yesterday, I came across several research papers that referred to the role of several of the nutrients of importance to hair loss in hypothyroidism, to premature hair greying. While my grey hair certainly was not “premature,”  look what I found today! 

A recent study mapped hundreds of proteins inside of hair and found that white hairs contained more proteins linked to mitochondria and energy use which suggests that metabolism and mitochondria may play a role in hair greying. Since thyroid hormones are known to be the major controllers of metabolic rate, it makes sense that hair that was previously dark might turn grey as the result of hypothyroidism, and revert back to dark with thyroid hormone correction. 

[Rosenberg AM, Rausser S, Ren J, et al. Quantitative mapping of human hair greying and reversal in relation to life stress. Elife. 2021;10:e67437. Published 2021 Jun 22. doi:10.7554/eLife.67437]

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Final Thoughts…

While treating hypothyroidism is a medical prescription of thyroid replacement medication in an optimal dosage, determining if any nutritional deficiencies may be contributing to the condition, or mimicking its symptoms, is essential.

Having dietary intake assessed and, if indicated, having blood tests to determine if nutrient deficiencies exist and correcting them can go a long way to helping people feel better and supporting regrowth from hair loss.

It is important to remember that taking supplements needs to be done wisely. “More is not better” when it comes to taking nutrient supplements.

For example, nutrients such as selenium can be toxic in excess amounts, even when eaten as Brazil nuts.

Some nutrients, such as biotin which is often taken by people for hair growth can interfere with thyroid hormone tests.

Iodine is another nutrient that should not be supplemented when people are taking thyroid hormone replacement medication.

If you aren’t sure if your nutrient intake or nutrient status of specific nutrients sufficient, then having a nutritional assessment and blood tests when needed is a great place to start. 

More Info?

If you have been diagnosed with hypothyroidism and would like to better understand the condition and make sure that you have adequate intake of nutrients known to be important in thyroid health, please send me a note through the Contact Me form.

To your good health!

Joy

 

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References

1. 1. Malkud S. Telogen Effluvium: A Review. J Clin Diagn Res. 2015;9(9):WE01-WE3. doi:10.7860/JCDR/2015/15219.6492
   2. Vincent M, Yogiraj K. A descriptive study of alopecia patterns and their relation to thyroid dysfunction. Int J Trichol 2013;5:57-60
   3. Almohanna HM, Ahmed AA, Tsatalis JP, Tosti A. The Role of Vitamins and Minerals in Hair Loss: A Review. Dermatol Ther (Heidelb). 2019;9(1):51-70. doi:10.1007/s13555-018-0278-6
   4. Trost LB, Bergfeld WF, Calogeras E. The diagnosis and treatment of iron deficiency and its potential relationship to hair loss. J Am Acad Dermatol. 2006;54(5):824–844.
   5. Ghiya R, Ahmad S. SUN-591 Severe Iron-Deficiency Anemia Leading to Hypothyroidism. J Endocr Soc. 2019 Apr 30;3(Suppl 1):SUN-591. doi: 10.1210/js.2019-SUN-591. PMCID: PMC6552785.
   6. Winther, K.H., Rayman, M.P., Bonnema, S.J. et al. Selenium in thyroid disorders — essential knowledge for clinicians. Nat Rev Endocrinol 16, 165–176 (2020). https://doi.org/10.1038/s41574-019-0311-
   7. Mistry HD, Broughton Pipkin F, Redman CW, Poston L. Selenium in reproductive health. Am J Obstet Gynecol. 2012 Jan;206(1):21-3
   8. Severo JS, Morais JBS, de Freitas TEC, et al. The Role of Zinc in Thyroid Hormones Metabolism. Int J Vitam Nutr Res. 2019;89(1-2):80-88. doi:10.1024/0300-9831/a00026
   9. Schwalfenberg GK, Genuis SJ, Hiltz MN. Addressing vitamin D deficiency in Canada: a public health innovation whose time has come. Public Health. 2010;124(6):350-359. doi:10.1016/j.puhe.2010.03.00
   10. Forrest KY, Stuhldreher WL. Prevalence and correlates of vitamin D deficiency in US adults. Nutr Res. 2011;31(1):48-54. doi:10.1016/j.nutres.2010.12.001
   11. Botelho IMB, Moura Neto A, Silva CA, Tambascia MA, Alegre SM, Zantut-Wittmann DE. Vitamin D in Hashimoto’s thyroiditis and its relationship with thyroid function and inflammatory status. Endocr J. 2018;65(10):1029-1037. doi:10.1507/endocrj.EJ18-0166
   12. Ahi S, Dehdar MR, Hatami N. Vitamin D deficiency in non-autoimmune hypothyroidism: a case-control study. BMC Endocr Disord. 2020;20(1):41. Published 2020 Mar 20. doi:10.1186/s12902-020-0522-9
   13. Talaei A, Ghorbani F, Asemi Z. The Effects of Vitamin D Supplementation on Thyroid Function in Hypothyroid Patients: A Randomized, Double-blind, Placebo-controlled Trial. Indian J Endocrinol Metab. 2018;22(5):584-588. doi:10.4103/ijem.IJEM_603_17
   14. Ness-Abramof R, Nabriski DA, Braverman LE, et al. Prevalence and evaluation of B12 deficiency in patients with autoimmune thyroid disease. Am J Med Sci. 2006;332(3):119-122. doi:10.1097/00000441-200609000-00004

 

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