Urticaria and Thyroid Test Results: Key Insights

Q: Urticaria and Thyroid Test Results: Key Insights

Hello, thank you for your question. <br>Here are my responses：<br>1. <br>Is there a connection between urticaria and slightly elevated TSH levels? Do I need to see a rheumatologist for an examination? --> In cases of long-term urticaria, we sometimes check thyroid function. <br>Y

Urticaria and Thyroid Testing

After catching a cold at the end of February (with symptoms of sore throat and general weakness), I began to develop hives all over my body, particularly around my eyes and neck.
I visited a clinic where I was prescribed steroids and received an injection.
After finishing the medication, I encountered a holiday, and the hives started to flare up again.
The next day, I returned to the clinic, received another injection, and the doctor prescribed three days of steroids and four days of antihistamines (to be taken after the steroids).
Two days after completing the steroids, the hives flared up again.
That day, I immediately went to a large hospital's dermatology department, where the doctor prescribed steroids and allergy medications again.
While the medication prevented the hives from swelling and itching, they remained red.

Two weeks ago, the doctor conducted blood tests that showed a TSH level of 4.87 (normal range: 0.17-4.05) and a Free T4 level of 1.32 (normal range: 0.89-1.79).
Currently, the dermatologist has advised me to try immunomodulatory medication (to reduce inflammation) while gradually tapering off the steroids.
I have reduced the dosage to one steroid pill per day, but the frequency of red hives is increasing, and they are starting to itch.

I would like to ask the doctor:
1.
Is there a connection between the hives and my slightly elevated TSH level? Should I see a rheumatologist or immunologist for further evaluation?
2.
The dermatologist advised me to monitor my diet to identify potential allergens, but I might eat something today without issue and then react to it the next day.
I am unsure what I can safely eat now.

3.
Do non-steroidal medications for treating hives that are covered by insurance have significant effects on liver function? The dermatologist suggested that I consider self-paid medications, which may be more effective and have less impact on the liver, but the costs are prohibitively expensive.

Niming, 20~29 year old female. Ask Date: 2023/04/20

Dr. Gao Jiankai reply Internal Medicine

Hello, thank you for your question.
Here are my responses:
1.
Is there a connection between urticaria and slightly elevated TSH levels? Do I need to see a rheumatologist for an examination? --> In cases of long-term urticaria, we sometimes check thyroid function.
Your TSH is only slightly elevated, and your free T4 is normal, so it should not be related.
2.
The dermatologist advised me to pay attention to my diet and avoid foods that may cause allergies, but I might eat something today without any issues and then react the next day, so I’m unsure what I can eat now? --> Please avoid seafood, as it can contain allergenic components if not fresh.
Also, try to avoid spicy foods, as heat can exacerbate urticaria.
3.
Do non-steroidal medications for treating urticaria that are covered by health insurance have a significant impact on liver function? The dermatologist suggested I take a self-paid medication for better treatment efficacy and less liver impact, but the cost is really high...
--> Immunomodulatory drugs do indeed carry a risk of liver damage, so caution is advised, and this should be clearly explained.
If you have concerns, you might consider consulting a rheumatologist to evaluate the necessity of using immunomodulatory medications, such as anti-inflammatory agents.
The Allergy, Immunology, and Rheumatology Department at Changhua Hospital is here to support you.

Reply Date: 2023/04/20

More Info

Understanding urticaria (hives) and thyroid test results can be quite complex, especially when symptoms and lab results seem to interrelate. Let's break down your concerns systematically.

1. Urticaria and TSH Levels
Urticaria is a skin condition characterized by raised, itchy welts that can appear anywhere on the body. It can be triggered by various factors, including allergens, medications, infections, and even stress. Your thyroid-stimulating hormone (TSH) level of 4.87 is slightly above the normal range (0.17-4.05), while your Free T4 is within the normal range (1.32, with a reference of 0.89-1.79).
While there is no direct correlation between mildly elevated TSH levels and urticaria, thyroid dysfunction can sometimes contribute to skin issues. Autoimmune thyroid conditions, such as Hashimoto's thyroiditis, can lead to skin manifestations, including urticaria. If your symptoms persist or worsen, it may be beneficial to consult with a rheumatologist or an immunologist to rule out any underlying autoimmune conditions.

2. Dietary Considerations for Urticaria
Dietary triggers for urticaria can be quite individual. Common allergens include shellfish, nuts, eggs, dairy, and certain fruits. However, as you noted, you may not react to the same food consistently. Keeping a food diary can help identify potential triggers. Document what you eat and any subsequent reactions, which can provide valuable insights for you and your healthcare provider.

In addition to avoiding known allergens, consider eliminating common irritants such as alcohol, caffeine, and spicy foods, which can exacerbate symptoms. It may also be helpful to focus on a diet rich in anti-inflammatory foods, such as fruits, vegetables, whole grains, and lean proteins, while avoiding processed foods.

3. Non-Steroidal Treatments for Urticaria
When it comes to treating urticaria, non-steroidal options include antihistamines, which are often the first line of treatment. While some antihistamines can have side effects, including potential impacts on liver function, most are considered safe when used as directed. It's important to discuss any concerns about liver health with your dermatologist, especially if you have pre-existing liver conditions or are taking other medications that may affect liver function.

Your dermatologist's suggestion to consider self-paid medications that may be more effective but less taxing on the liver is valid, but it’s essential to weigh the cost against the potential benefits. If you are struggling with the financial aspect, discuss this with your doctor; they may have alternative recommendations or be able to provide samples.

Conclusion
In summary, while your mildly elevated TSH may not be directly linked to your urticaria, it’s worth monitoring and discussing with your healthcare provider. Keeping a detailed food diary can help identify dietary triggers, and exploring non-steroidal treatment options with your dermatologist is crucial. Always communicate openly with your healthcare team about your symptoms, concerns, and any financial constraints regarding medications. They can help tailor a treatment plan that is both effective and manageable for you.

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