Why Hypothyroidism Causes Acne & What to do About it

Why Hypothyroidism Causes Acne & What to do About it

Acne can be tricky to treat unless you know exactly what is causing it. 

And figuring that out can be a problem - especially if your approach has been to just throw different kinds of lotions and creams all over your skin. 

You see:

Acne is a condition that usually reflects a problem that is happening INSIDE of your body, not what is happening to your skin directly.

So if you approach the problem as one that can be solved with topicals and creams, you may never actually treat the root cause of your acne.

In fact, one of the most common reasons for acne that I've seen is due to thyroid hormone imbalances. 

Yes, other hormones can cause acne (we will talk about those as well) but thyroid problems tend to be more tricky to diagnose and treat so patients with this kind of acne tend to stick around for a while. 

In this article, I'm going to walk you through the best treatments that I've found to treat acne, from the inside and the outside...


Is Your Acne Hormonal?

If you've been suffering from acne by now I'll bet that you've done research on what you can do to clear your skin. 

You've probably tried multiple skin care products, lotions, creams, gels, etc.

What you might not have realized is that if your acne is due to a hormonal imbalance then placing topical creams and gels on your skin will most likely NOT reduce your acne.

So the question then becomes, what is actually causing your acne?

When it comes to hormones everyone is aware of the "traditional" hormonal acne: breakouts on your jawline or hairline and very oily skin (usually accompanied by excess hair growth). 

skin microbiome and acne

This type of pattern is usually attributed to estrogen/progesterone imbalances. 

That's why pharmaceutical companies target birth control pills as a potential treatment for acne.

And the crazy part is they do sometimes work, but usually, they stop working at some point (and this is usually when patients come to see me).

I want to make a point here to say that while yes estrogen/progesterone imbalances can certainly lead to acne and breakouts - I think that acne due to hypothyroidism (1) is MUCH more common.

And this becomes a problem because hypothyroidism is missed and/or mismanaged ALL the time. 

It's also VERY common with a prevalence of around 5-10% of the population (2) (depending on which study you look at). 

So if your acne is due to hypothyroidism and you are taking birth control pills to try and fix it, it will never go away.

Not only that but remember that hypothyroidism leads to a number of hormone imbalances that could each lead to acne by themselves. 

Hypothyroidism causes:

The main issue in these conditions is the underlying cause which is usually hypothyroidism. 

Which means that in order to properly treat acne if it is due to hypothyroidism is to boost thyroid function either naturally or with the addition of thyroid hormone.

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Hypothyroidism and Acne

How do you know what is causing your acne?

Well, that can get tricky and it does require some investigative work.

I will generally order all hormones when evaluating patients for acne and other symptoms.

Usually, the main complaint isn't acne by the time someone comes to see me, but it is usually pretty high up on their list of important things they want to get taken care of.

I've noticed that acne from hypothyroidism has a few characteristics:

  • It usually resolves or improves with the addition of thyroid hormone
  • It's usually cystic in origin (hypothyroidism causes cystic acne)
  • It's usually not cyclical - it's just present all the time (but may get worse due to times of stress) 
  • Generally not associated with the menstrual cycle
  • Generally accompanied by multiple other symptoms: fatigue, weight gain or weight loss resistance, changes in nails and hair (brittle/dry/etc.)
  • The acne may be distributed over your entire body (not just localized to the face)

If your acne follows this pattern then it may be due to hypothyroidism and NOT another hormone imbalance. 

Though it's worth pointing out that hypothyroidism can make hormonal acne worse as well if not treated appropriately.

I'm going to go over what to do if you believe your acne is due to hypothyroidism at the end, but first, we need to talk about GI function and acne. 

Acne and the Gut

Another huge and often overlooked cause of acne is due to gut imbalances or issues in the GI tract. 

It turns out that changes in the bugs in your gut can lead to changes in your skin, including acne (5) (but also many other skin conditions). 

And here's where things get interesting:

acne and SIBO

Hypothyroidism frequently leads to a condition known as SIBO.

As many as 50% of hypothyroid patients (6) may have this condition (without knowing it).

So now we have a triple whammy:

Hypothyroidism itself can cause acne by itself. 

Hypothyroidism can lead to hormonal changes that can lead to acne. 

Hypothyroidism can cause changes in the GI tract or gut that lead to acne. 

Do you see the common denominator here? (No, we aren't going back to math...)

This is how hypothyroidism may be wreaking havoc on your skin and leading to acne. 

The next step is obviously figuring out how to treat the problem...

5 Steps to Treating Acne

The treatment of your acne will largely depend on what is causing it. 

Let's say your problem is hypothyroidism but you also have GI issues contributing to your acne.

In this, case you would need to address the hypothyroidism and address the gut issues as well.

Generally treating the thyroid by itself may not enough if multiple imbalances are contributing.

Have said that let me go through how I treat acne in my clinic including the steps you need to take next if you aren't sure where your acne is coming from:

1. Treat Hypothyroidism if present

How do you know if your acne is caused by hypothyroidism?

Follow the guidelines above:

Generally, this type of acne follows a particular pattern and is associated with other systemic symptoms (listed above).

The problem becomes how do you know if this is the case?

You need to run the proper tests and then you need the proper treatment:

I've written extensively on how to diagnose hypothyroidism through lab tests (and why lab tests really aren't the best way to diagnose hypothyroidism) that you can read about here

But as a quick primer below is the list of tests you need to properly evaluate your thyroid:

  • TSH - Your TSH should be < 2 (anything higher is a problem and anything lower is not necessarily normal)
  • Free T3 - If not on medication this should be in the upper 50% of the reference range
  • Free T4  - If not on thyroid medication this should be in the upper 50% of the reference range
  • Reverse T3 - Should be < 15
  • Sex hormone binding globulin - If not on birth control medication it should be in the 70-80 range (note that OCP will make this test less reliable)
  • Thyroid antibodies (especially important to evaluate for Hashimoto's!) - These should be as close to zero as possible

If you fall outside of these ranges AND you are symptomatic then your acne may be due to hypothyroidism. 

If that's the case then treatment would include naturally increasing your T3 and hormone levels or taking thyroid hormone.

You can find a post on how to naturally increase your thyroid function here.

For many of you, you will probably need thyroid medication to fix your acne. 

If you carry a diagnosis of hypothyroidism and you are currently being treated with Levothyroxine, then you may ultimately benefit from switching to a medication that contains T3. 

Often times patients do not convert T4 to T3 very well and despite being "treated" with T4 only medications (like levothyroxine and Synthroid) their target tissues may not be getting the proper amount of thyroid hormone.

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If that is the case then switching to medications like Nature-throid, Armour thyroid, NP thyroid or WP thyroid may be best. 

It's also possible that other factors may be playing a role in your acne (which we will go over below) so don't get down just yet. 

2. Balance Progesterone and Estrogen Levels

The second place you want to look is directly at your estrogen and progesterone levels.

Specifically, I'm talking about your estrogen/progesterone ratio.

Generally the higher your level of estrogen (either in the serum or at the receptor level (7)) the more likely you are to develop acne.

If you have hypothyroidism (especially if you have hormonal issues like PMS/PMDD) then an important part of treating your estrogen/progesterone levels will be treating your thyroid properly. 

Most women know if their acne is due to hormonal issues because it tends to come and go with their cycle, their mood and it is in a very distinct distribution on the body. 

The main priority then becomes treatment:

If high estrogen levels make your acne worse then you need to focus on balancing your progesterone levels and increasing the metabolism of estrogen in your body.

This will allow you to simultaneously bring DOWN your estrogen while you bring UP your progesterone.

So how do you do this?

  • Focus on foods that help metabolize estrogen down the "protective" 2-OH-estrone pathway (8) - You can do this by eating cruciferous vegetables which are high in indoles (9) that help your body get rid of estrogens
  • Consider supplementing with indole 3 carbinol or DIM to improve estrogen metabolism
  • Support liver function and metabolism
  • Make sure you don't have methylation issues and if you do then consider supplementation (methylation is required for proper estrogen metabolism)
  • Consider adding bio-identical progesterone to your regimen (do not take if currently taking OCP) 

3. Balance Androgens (Testosterone and DHEA)

Androgens include DHEA, Testosterone and Testosterone Metabolites.

Women with high levels of any of these may present with acne (10), oily skin and changes in mood or behavior.

What you may not have realized is how to properly treat testosterone issues. 

Most of the time high testosterone in a woman is due to changes in insulin levels.

High insulin = high testosterone = acne

So the treatment of acne due to high testosterone is usually directed at the underlying cause - in this case, high insulin levels. 

Women who fall into this category usually know because they have signs and symptoms of PCOS in addition to acne:

Extra hair growth on the face, discoloration of the skin (usually dark), changes in mood, weight gain or weight loss resistance and acne. 

You can check to see if your insulin is playing a role in your testosterone levels by simply checking both in the serum:

  • Total testosterone - Should be in the middle of the reference range if you have acne
  • Free Testosterone - Should be in the middle of the reference range if you have acne 
  • Fasting insulin - Should be < 5 (higher levels indicate issues with insulin regulation)

The treatment then comes addressing insulin resistance and improving testosterone metabolism AWAY from the DHT (the most potent androgen). 

Treatment for acne due to high testosterone:

  • Consider supplements designed to metabolize testosterone AWAY from DHT: Zinc + Saw palmetto
  • Consider supplements designed to address insulin resistance: Alpha lipoic acid, Berberine, and Chromium
  • Address high insulin with intermittent fasting and a low carb diet (high in healthy fats)

4. Consider Supplements to help nourish the Skin

While there are many reasons for acne there is no denying that many people have basic nutrient deficiencies that can be preventing proper function in the skin. 

These can come from a variety of reasons (including malabsorption, hormone deficiencies, poor diet, etc.) - but the point is the same:

Your skin requires certain nutrients (11) to function properly and deficiencies in nutrients can lead to acne.

This may explain why changes in diet can improve acne (by providing these basic nutrients in the form of food). 

It's also why you see certain supplements being touted as the BEST natural acne supplement.

While there is no "magical acne cure" if you have acne it is certainly worth trying these supplements to see if it improves your skin:

  • Zinc - Zinc plays a key role in skin health and many patients are also deficient. It can help boost the immune system, acts as an anti-inflammatory and also helps testosterone metabolism. 
  • Omega 3 fatty acids + FCLO - Omega 3 fatty acids help reduce inflammation and have been shown to reduce inflammatory acne in some studies (12).
  • Vitamin A - Vitamin A deficiency is probably one of the most common nutrient deficiencies leading to skin problems (13) and I've successfully used vitamin A in isolation to help many patients clear up their skin. It packs a punch and it's a fat soluble vitamin so you need to be careful with dosing, but as a point, the drug Accutane is basically high dose internal vitamin A. 
  • Vitamin K2 - Vitamin K2 and other fat-soluble vitamins can dramatically improve complexion, promotes healing of scars, decreases pore size and reduce inflammation. Vitamin K2 is another nutrient that many people tend to be deficient in due to not eating enough organic, or grass-fed meats/dairy products. 

5. Fix your Gut

There's no question that imbalances in your gut can promote and perpetuate acne, pimples and other changes in your skin. 

But how do you know if your gut is involved in YOUR acne?

The great thing about gut imbalances is that you almost always have some sort of symptom.

That means if you have any of the following your gut is probably playing a role:

  • Gas or bloating
  • Abdominal pain
  • Chronic diarrhea or constipation
  • Bad breath
  • Abdominal distention
  • Acid reflux, indigestion or heartburn
  • Intense sugar cravings or carbohydrate cravings

The combination of symptoms above + acne (especially if cystic) paints a picture that your gut is involved. 

This is also very important when we talk about hypothyroidism.

Thyroid hormone is involved in promoting the constant motion of your GI tract known as peristalsis.

Low thyroid hormone (AKA hypothyroidism) promotes slower GI tract movement which sets the body up for constipation, small intestinal bacterial overgrowth, small intestinal fungal overgrowth, increased intestinal permeability and changes in the gut microbiome (bacterial concentration).

It's these changes that then lead to acne and skin changes. 

Sometimes it's enough to just fix thyroid function and that will often promote proper gut function which can then help acne.

Other times (I would argue most of the time) some sort of intervention is required to fix the damage caused by the changes from hypothyroidism.

This is worth spending a minute to explain:

Remember that the thyroid is involved in MANY different physiologic functions in the body, so low thyroid can impact MANY organ systems.

Patients and Doctors usually (wrongly) assume that by simply adding thyroid hormone back into the body all of those imbalances will fix themselves.

That turns out to be wrong for MOST patients.

And it's this kind of thinking that leads to the "thyroid as the cause of all problems in the body" mentality, which in turn makes patients feel that more thyroid hormone is the answer to all of their problems.

Don't fall into this trap.

So what can you do?

Below I'm going to go over some basic symptoms and what MAY be going on inside your gut and some options for treatment:

This isn't an exhaustive list, but it may help you to get on the right track.

  • Gas, bloating or constipation - This may be a sign of SIBO/SIFO so consider using herbal antibiotics or a combination of prescription antifungals and antibiotics (for a complete treatment guide see this post)
  • Abdominal pain - Usually a sign of inflammation from either food allergies/sensitivities -> consider delayed IgG food sensitivity testing along with antibody testing to celiac's
  • Chronic diarrhea - Think food sensitivities, decrease in good bacteria, overgrowth of parasites or problem with certain foods
  • Acid reflux, indigestion or heartburn - You may actually have too little stomach acid and therefore problems with digestion, changes in bacteria concentrations or decreased peristalsis due to other factors
  • Intense sugar cravings - Typically yeast overgrowth or metabolic in nature from extreme insulin/leptin resistance

If basic interventions don't work you may ultimately benefit from advanced stool testing to get a better idea of what is happening. 

These advanced stool tests can give you an idea of what you are dealing with and make treatment easy by showing you what yeast/bacteria/parasites are sensitive to.

6. Clean up your Lifestyle (Stress, Diet, Water intake, etc.)

This one goes without saying but I'm going to mention it anyway. 

If you aren't already eating organic, grass-fed or free-range it's time to make the change. 

That also means managing other lifestyle factors:

  • Stress - High levels of stress (14) are associated with WORSENING acne. Get that stress under control either by adding coping mechanisms or by eliminating the source from your life (if possible). 
  • Diet - That means organic, grass-fed, free-range types of food. Avoid foods that cause you physiologic problems (15). I can't tell you the number of people who tell me that dairy makes their stomach hurt and yet they still consume it. Why? If a certain food causes you issues, eliminate it from your diet!
  • Water - Drink 64-128 ounces of water PER DAY (more with activity). Cellular hydration is requisite for proper function, so don't miss out on the easy opportunity to hydrate and allow for proper cellular function. 
  • Exercise - I want you to stay active because I want you to sweat, sweating will help your body eliminate any unwanted metabolites that you may come into contact with. I'm specifically talking about halogens which can cause acne like pustules as they exit the body.

7. Use High-Quality Vitamin C Serum + Retinol Serums

In addition to putting the right things INSIDE your body, you will also want to place some high-quality vitamins and nutrients on the outside of your skin. 

The two vitamins I am referring to including Vitamin A (retinol) and Vitamin C.

There is no way for your skin to naturally produce Vitamin C unless you place it on your skin with certain substances.

Even if you consume Vitamin C your body will break it down and it will never actually make it to your skin cells.

For this reason, it's important to use a nourishing Vitamin C serum to get this vital nutrient directly into your skin cells. 

Vitamin A (retinol) is another very important nutrient that you can also directly place on your skin.

Retinol helps normalize sebum (oil) production and can also help reduce the effect of androgens on your skin (your hormones).

For these reasons, I recommend that you use 2 very high-quality serums that apply both Vitamin C and Vitamin A directly into your skin.

My recommendations include:

  • Vitamin C serum - For best results, this should be in the L-ascorbic acid form, with at least 15% concentration and at a pH of 3.5. Apply a few drops to your skin in the evening. 
  • iS Clinical Poly Vitamin Serum - This serum contains a number of natural and active ingredients which naturally improve the epidermis and build up the dermis below. Use 1-2 drops on your face in the morning (away from the Vitamin C serum). 

The Recap

If you are suffering from acne and it is debilitating to you, or you just haven't been able to get a handle on your acne after trying to "lotions and creams" approach then consider this approach:

Acne is usually a representation of what is happening on the INSIDE of your body, that usually means some sort of imbalance is perpetuating and causing acne. 

Treatment should then be focused on fixing the underlying problem, not adding topical treatment to the skin itself. 

Most cases of acne that I see are either due to hypothyroidism (or some other hormone imbalance) and/or a combination of gut imbalances. 

Fixing thyroid hormone may not fix your gut imbalance so it's important to consider other causes as well. 

If you are still struggling with acne make sure to use the 6 steps outlined above for maximum benefit.

I've personally used this approach on myself, my wife and on many patients with great success.

Now it's your turn:

Are you dealing with acne?

What has worked for you, what hasn't?

Is your acne caused by your thyroid?

Leave your answer below!

References (Click to Expand)

how low thyroid causes acne

About Dr. Westin Childs

Hey! I'm Westin Childs D.O. (former Osteopathic Physician). I don't practice medicine anymore and instead specialize in helping people like YOU who have thyroid problems, hormone imbalances, and weight loss resistance. I love to write and share what I've learned over the years. I also happen to formulate the best supplements on the market (well, at least in my opinion!) and I'm proud to say that over 70,000+ people have used them over the last 6 years. You can read more about my own personal health journey and why I am so passionate about what I do here.

P.S. Need more help? Check out my free thyroid downloads and resources.

62 thoughts on “Why Hypothyroidism Causes Acne & What to do About it”

  1. Hello,

    I have hashimotos and hypothyroidism. I am not on thyroid meds because while my TSH is higher my T3 T4 reverse T3 and such are in range. I was previously on thyroid medication armour thyroid and then WP thyroid and they made my acne worse actually… I read that thyroid medication raises testosterone and figure that’s why my skin got bad with it and worse each time dosage increased! what are your thoughts?

    • Hi Amber,

      Generally thyroid hormone helps to normalize hormones in the body. So thyroid hormone will only increase testosterone if your testosterone is low, likewise it can help bring down your testosterone if it is high. You may be reacting to an inactive ingredient in the medication itself, however.

      • Thanks! If I have high testosterone, DHEA, and DHEAS but normal ovulatory cycles what can I do to help? I have acne but every naturopath I have seen has only made my hormones worse! One told me to take nettles to lower testosterone and when I did I retested my testosterone and my free testosterone had gone from a 2.7 to a 9! I read online that nettles can lower SHBG which in turn increases your free testosterone. Have you heard of this?

  2. Dear Dr Child’s
    I wanted to say how excited I am that I found your website. I have been suffering with acne most of my life but as an adult its been so overwhelming not to mention embarrassing. Having to get ready when I go out takes twice as long due having to cover all my spots…frustrating too.
    I am on already on thyroid meds and recently had it adjusted and have noticed its gotten little better. Reading your information really helped me. Thank you so much.

    • Hi Melinda,

      I’m glad you found it helpful. Adult onset acne can be difficult to treat, but it’s certainly possible with the right approach. Make sure you also take a look at the posts which outline how to make sure you are getting enough thyroid hormone.

  3. I had thyroid cancer in 2015. I hope to be two years cancer free, soon. I have really severe cystic acne. It is all in my chin area. I had my thyroid removed and a parathyroid, due to the cancer. My acne is big, red, and painful. I am 33 years old, but want to cry because of what my face looks like.

    • Hi Michelle,

      If that’s the case you would want to start with a complete thyroid evaluation as well as sex hormones to help you understand what is going on in your body!

  4. I just want to say I’m so happy I found your page. All my life I have suffered from acne. I am a licensed esthecian so I know how to take care of my skin. But every topical skin care I’ve used has never truly helped. Change of diet has never helped. For a couple years now my Thyroid hormone test has been boarderline low, and I see my doctor tomorrow to discuss medicine for it now!

    • Hi Reniece,

      That’s actually a very difficult question to answer. Unfortunately there isn’t a regulating body that teaches this information to Doctors so they must learn it on their own and this severely limits how many physicians practice in this way.

  5. I have suffered from acne my entire life and it seems only to be getting worse! I have began using self prescribed supplements to treat this problem from the inside out. I live in NYC & should have access to an informed doctor??? Can you please tell me exactly what type of doctor I should be seeking out to address this issue. Up to now, they all seem to be reading off the same page and absolutely useless! Thank you for your wealth of information!!!

    • Hi JD,

      I’m glad you found it helpful! You might have better luck if you search for a doctor who practices integrative or functional medicine but realize that your mileage may vary and each physician may practice in a slightly different way.

    • Hi HB,

      If you purchase cheaper formulations of Vitamin E or Vitamin C then they simply don’t work as they aren’t at the right pH, the right concentration, etc. When it comes to Vitamin C & E you pretty much have to buy the high quality products if you want them to work.

  6. I’m finally on the right level of T3 and T4 after 7 years due to incompetent PCPs. But I’m still getting acne which hasn’t improved. My fasting insulin is 5, A1C is 5.6, Total Testosterone is 48 and Free Testosterone is 1.48. (Doc wanted to put me in spironolactone but I’mtTrying to get down naturally with spearmint tea) Should I also get my estrogen and progesterone levels checked?

    • Hi S,

      Yes! You definitely want to evaluate your sex hormones in conjunction with thyroid hormone and the other hormones you mentioned previously.

  7. My daughter is 18 she had a thyroidectomy 1 year ago and is suffering from horrible acne. Her alkaline is level.is only 50 woukd this cause her acne? She is taking levothyroxine .175mcg. This is very disconcerting and upsetting to her. She has never had acne before. Please help

    • Hi Danielle,

      The article above contains several steps that you can get started with right away, I would recommend that you start with these steps first.

  8. I have experienced hives due to thyroid being out of whack. But right now im getting something different and only on my belly area. Kind of spots but not acne and was wondering if this can be thyroid related? Thank you

  9. Hi! Just wanted to say I’m so relieved to read an article like this. It describes my symptoms and issues so accurately. I was told by my physician to stop taking Levo for 4 months – which wreaked havoc on my face, I’ve never had a pimple in my life and now I have cystic acne. Thyroid meds are definitely not worth messing around with 🙁

  10. Hi,
    I have been suffering from stubborn jawline acne for the past 6 months. I got my thyroid tested and tsh was 3.29 which my doctor considers normal. I am usually a healthy person with normal bmi, regular periods – 25-28 days cycle. But I was slightly on the hypothyroid side and I took levothyroxine 3 years ago during my pregnancy to correct thyroid. After that I was never prescribed thyroxine. I haven’t noticed a specific pattern in my acne. Itseems to occur any time during my cycle. Another thing I suspect is 6 months ago I applied hydrocortisone ointment for a week on my face for a skin allergy. It is only since then my acne worsened. I had very clear skin before that.Iam not sure if that has triggered this Do you think I am hypothyroid And this acne is due to that?

    • Hi Maya,

      You might want to touch base with a dermatologist to see if you have perioral dermatitis (instead of acne). You may also have issues with estrogen/progesterone or thyroid as you suggested so it’s worth getting a full panel to assess those as well.

    • Hi Jenna,

      Unfortunately I am not accepting patients right now but please feel free to read and use my blog posts for help! You can also ask some questions here as well and I will do my best to answer them 🙂

  11. Hi,

    Thanks for a great information, this sums up a lot. I have been thyroid patient for the last 12 years, I was on levothyroxin but only until last 3 months that I realized that I should be not eating/drinking until one hour later. I started doing that but I have started acne now, its kinda bad. My TSH is doing well but hoshumito anti bodies is bit elevated. I take fish oil, exercise 6 days, drink 3 liters of water,,have low sugar diet. It still does not help so much. Since my levels are getting better, should I just wait or is there anything else I can do? Did me making a change to not eat for an hour after medication impact this? Does any specific diet help with hypothyroidism symptoms? I am also fixing my gut.please help.

  12. Dr. child’s,
    I have suffered from acne since I was 13. I have been on azithromyacin, doxycycline, sprinolactone, and tons of topical washes and creams and lotions and cleansers. I have tried all natural washes and creams and nothing has worked. I have been trying to lose weight for years and have been unable to despite restricting my diet and cutting down to 1,500 calories. I just found out I have over 37 cysts in my thyroid and I’m so angry that I have had these issues for 6 years and no doctor has thought to put it all together. I don’t know what to do going forward but everything in this article seems to fit. How do I fix it?

  13. Hi Dr. Childs,
    I just found your post searching for acne and thyroid. Since August I have been taking Novothyral as my T3, T4 and TSH were very low. I had also been taking Iron, B and D vit that were extremely low. A couple of weeks of taking Novothyral I started with painful acne in the face and neck (I was never prone to acne), and it has come up and down since then. I have the feeling that when I go down with the Novothyral, the acne gets worse. Now my TSH is good so I decreased once again and the acne is worse than ever. Even after reading your post, I am very confused with what I observe in my case. Anything I am missing? (why the acne started with the medication and increases then upon decreasing slightly the dose…).
    Thank you very much in advance!

    • Hi Paola,

      It may have something to do with Novothyral. I’m not really sure if that’s a medication or a supplement but it may be the cause of your acne if it started after taking it.

  14. Hi Dr. Childs,

    Is Armour Thyroid/WP thyroid the best choice for levothyroxine alternative? Thank you for this amazing post I’m thinking about switch my medicine as soon as possible since I’ve been suffering from moderate acne for as long as I can remember, probably after I was diagnosed hypothyroidism when I was a teenager. It’s been really frustrating and heartbreaking.
    My physician brought it up once that maybe I can try off the medication since the dose is low;(levothyroxine 50mcg since I was diagnosed). Do you think I should give it a try? do you think it will make my acne worse?

    Thank you so much!!

    • Hi Wanda,

      WP thyroid is a great alternative but determining what is “best” should be done at the individual level. It would certainly be worth a try, though! Especially if you are suffering from the symptoms you mentioned.

  15. Hi, I been having weight loss and acne, my sex hormone is very high and my progesterone levels are low!! I had a hysterectomy when I was 40, due to ovarian tumors. I had an ultrasound about a year ago and had a cyst show up on my thyroid gland, or blew it off. I have never had acne this back, my other symptoms, are thinning skin and trouble sleeping, weight loss and a few heart palpitations. Oh, and my cortisol level came back high. Do you have any advice? Thanks, Kelly

  16. Hi! I recently started on desiccated Thyroid. I have had a flare up of back acne which cooincides with me starting to take this medication! Suggestion and help please!

  17. Hello dr. Childs!
    I have the same problem, just started on NDT couple of weeks ago and my skin broke out bad mostly on the chin and hairline.

    Do you recommend changing the therapy? I live in Europe and the only option I’ve got is this compounded NDT from pharmacy or synthetic thyroid medication.

    Thank you so much for you help!

  18. Hi Dr. Childs! I’m a medical student from India and i’ve been diagnosed with an underactive thyroid over 9 months ago. I just want to give you my whole history of the situation to know if it’s something familar to you and if i’m moving in the right path.
    December 2017 i had a throat infection which somehow lasted for 3 months ( it didn’t cause too much distress, just some sputum once in a while so i didnt really bother about it) But in February 2018 i finally decided to run some tests, i got my esr and thyroid profile(just randomly checked thyroid as i have family history of underactive thyroid). I wanted to get a sputum test done but surprisingly that morning i couldnt produce any sputum to run the test, so only my blood work was done. When i got the report back i had raised esr levels and slightly raised TSH levels. I wasn’t sure if i had to see a doctor yet and decided to wait. In march 2018 i got another thyroid profile done and in the report my TSH levels were 10 times higher. So i went to see an endocrinologist. He said my throat infection might have caused thyroiditis and decided to start me on thyroxine sodium 62.5 mcg and asked me to come back in 3 months. In May 2017 i got a thyroid profile done , my TSH levels were within limits so he asked me continue the same medication with the same dosage. Now my question is i never really understood if the medication has helped me at all or if i ever even really required it as i was never tested for the antibodies. When i initially started the medication i experienced slight palpitations when i used to workout. I’ve had good skin all my life but since i started with the medication i’ve been experiencing acne. I’m not too sure about the other symptoms like mood swings, heat intolerance or anything as they werent too prominent. But i definitely feel like something isnt right and i’m not sure what to do about it. Do i need to continue with this medication forever or not? and is there anything i can do for my acne?

  19. Hi Dr. Childs! I’m a medical student from India and i’ve been diagnosed with an underactive thyroid over 9 months ago. I just want to give you my whole history of the situation to know if it’s something familar to you and if i’m moving in the right path.
    December 2017 i had a throat infection which somehow lasted for 3 months ( it didn’t cause too much distress, just some sputum once in a while so i didnt really bother about it) But in February 2018 i finally decided to run some tests, i got my esr and thyroid profile(just randomly checked thyroid as i have family history of underactive thyroid). I wanted to get a sputum test done but surprisingly that morning i couldnt produce any sputum to run the test, so only my blood work was done. When i got the report back i had raised esr levels and slightly raised TSH levels. I wasn’t sure if i had to see a doctor yet and decided to wait. In march 2018 i got another thyroid profile done and in the report my TSH levels were 10 times higher. So i went to see an endocrinologist. He said my throat infection might have caused thyroiditis and decided to start me on thyroxine sodium 62.5 mcg and asked me to come back in 3 months. In May 2017 i got a thyroid profile done , my TSH levels were within limits so he asked me continue the same medication with the same dosage. Now my question is i never really understood if the medication has helped me at all or if i ever even really required it as i was never tested for the antibodies. When i initially started the medication i experienced slight palpitations when i used to workout. I’ve had good skin all my life but since i started with the medication i’ve been experiencing acne. I’m not too sure about the other symptoms like mood swings, heat intolerance or anything as they werent too prominent. But i definitely feel like something isnt right and i’m not sure what to do about it. Do i need to continue with this medication forever or not?

  20. I had a total thyroidectomy almost a month ago due to Graves’ disease. After surgery, I was (obviously and understandably) put on synthroid. I currently take 0.1 g/day. Since surgery/starting synthroid my formerly clear, smooth, and quite radiant skin has become dull, rough and I’m dealing with the worst acne I’ve ever had! I believe it must be related to the surgery/medication since nothing else has changed in my diet or lifestyle. Suggestions? I just want my former skin back!

    • Hi Colleen,

      If you think it’s related to your thyroid then changing up your thyroid medication may help. You’ll most likely need a combination of T4 + T3 thyroid medication to see improvement.

  21. Hi Dr. Childs,

    Like many others on this thread, I’ve also struggled with acne my entire teens/20’s. The only thing I’ve found that works so far is Spironolactone. I’ve also tried Doxycycline, Minocycline, BCPs alone and combined with spiro (worked okay when combined), creams and washes.

    I’m currently going through fertility treatments to freeze my eggs as I have found I have a very low AMH at 27 years old (between 0.1-0.8). This is impacting my ability to retrieve eggs for freezing (cycle #1 retrieved only one egg). I have a feeling it may be due to the fact that I’m still on Spiro, which I’ve read online can lower Testosterone and/or T3, and these are key hormones for the egg retrieval process. However, when I test my T, Free T, and T3 while on Spiro, all labs come back normal and the docs/lab assure me that taking the Spiro will not affect these lab results (i.e. I would have the same lab results while taking Spiro than I would without it, so lab results show thyroid issues), and likely won’t affect the fertility treatments (which rely on hormone stimulation medications – Lupron, Gonal-F, Menopur, and Novarel).

    My head is spinning trying to wrap my mind around what I’m finding on the internet (that Spiro does affect the hormone levels) and what my docs are saying (the labs shouldn’t differ due to being on Spiro and I do not have thyroid issues) and what my gut is saying (Spiro is affecting the egg retrievals and I need to find the root cause of the acne not just mask it with Spiro; maybe stop Spiro and retest hormone levels in a month or so?).

    Any suggestions would be greatly appreciated!!!

  22. I have cystic acne and have thyroid levels increased to 9.34.
    What should I do, I need to fix my face. Should I start thyroid medicine ? or should I take birth control pill to control my acne?
    Please help

  23. Please help.

    On armour thyroid, I experienced increased acne. Then I took a combination of T4/T3 (compounded) and had acne. Now I am on levothyroxine only and still having issues with increased acne. Why do thyroid medications cause acne for me? which have you seen better success with clearing acne?

  24. Hi Dr. Childs,
    I have been on 100 mcg of levothyroxine for the last 2.5 years. I’ve struggled since early adulthood with acne, but it got much, much worse on levothyroxine showing up mostly along my jawline, but really on my neck, shoulders, arms, back, etc. I also gained weight on the medication, about 10 lbs that I couldn’t shed. I tested the theory that the levothyroxine was the cause of these issues by stopping the medication for a month. The acne cleared up very quickly and my skin is now clearer than its been in years. The low thyroid symptoms, however, have returned along with new ones. Fatigue, heavy periods, constipation, etc. and my arms and hands have also felt numb for the past month, especially at night, likely due to worse circulation. When I brought up these side effects to my doctor, she dismissed them. I don’t know where to go from here. I know I need help with my thyroid, but I don’t know why I reacted so badly to levothyroxine. I’m worried I’m making something else worse and its showing up on my face. Where do I turn?

  25. HI, Dr. Westin Childs, ive suffered from acne and irregular periods since i was about 13 years old im 21 now and i feel as my acne is getting worst and ive been growing hairs in my chin and breast. other symptomps i have are, faitugue, gaining weight, recently ive noticed im forgetting stuff and i had brain fog, i get cold easily, amd have alot of migranes, i need help im sure im producing too much male hormones because of the hairs. i really want to get rid of my acne ive suffered from it too long. what test do you reccemond i take. or what do you think i have. Ive suffered from acne and irregular periods to long! but the rest of the symptomps are burly happening please help!!

  26. Hi Dr. Childs, Appreciate all of your helpful posts!
    Hoping you can help me with identifying the cause of my acne which I suspect is leptin and thyroid related. I was diagnosed with Hashimoto’s 10 years ago. I was put on NDT and have been on ever since. I also have low progesterone with estrogen dominance and take bioidentical progesterone. Right out of the gate after initially starting a low dose NDT, I started getting acne for the first time since I was a teenager. I never had any breakouts from 18 to 32 years old. Now I am 42 ,and I get new acne every day (with the exception of when I was pregnant, my skin was remarkably clear. ) It is so frustrating. I began a very strict dairy free diet 18 months ago which I attribute to bringing my TPO antibodies down from 300 to 60, Thyroglobin Antibody down from 22 to 3.6! I feel good energy wise but still have trouble losing these ten pounds and then keeping them off. I am 10-15 lbs overweight. My weight fluctuates wildly 10lbs and I feel hungry shortly after I eat as you mention in your podcast . I fast from 6:30pm till 9am each day and drink a Paleo protein non dairy smoothie for breakfast (and lunch most days). I am doing all the right things or at least I think I am. The acne is still a big issue and worsening. My practitioner put me on 25mg of Aldactone * 2 years ago when I told him about the acne. This acne is very different than teenage acne. It was mostly on my neck and chin. It has recently migrated to my forehead but still on neck and chin. It is a real inconvenience. Rarely on the rest of face. My fasting insulin is 7.4, which I understand is high according to your post. My Testosterone is 22, fasting Cortisol 9.5. My Hemoglobin A1C is 4.5. I am still taking the Aldactone daily. My reverse T3 has recently gone up to 24.4 which I know is high and I have gained 10lbs since the reverse T3 went up despite me having high T3 and Mid range T4. I am on 230mg of NP Thyroid a day (in 2 doses morning and afternoon). along with 25Mg of T4 only in am. I am considering dropping the Levothyroxine. My doctor said if my Reverse T3 is high next time he will drop it and consider Upping NDT or adding Cytomel.
    So my question is, do you think it would benefit me to try your Leptin Resistance supplement? Or should I wait for my doctor to run a Leptin test? I should add I also already take Berberine 1,000 mg a day. Thanks so much!

  27. Even though I had low T3 on Levo I didn’t have terrible acne. Since switching to natural desiccated I now have terrible acne on my face, neck and chest, including head and skin itching, and my face looks tired and worn. Not only do I have low T3 on NDT but now low T4. The only way I can reach a T4 over 1 on NDT and T3 in upper 3s is by taking 120mg, however it suppresses my TSH to 0 and I feel overheated. Even then that leaves my Total T3 still down at 118. I suspect my overall problem is not having enough circulating T3 throughout my day despite optimal appearing FT3 levels on Levo, which leads me to think just adding small amounts of T3 may not be beneficial to increase total T3 levels…or maybe it would. No one seems to know much on the issue.

  28. Hello Dr. Childs,

    First off thank you for that very informative post! I am a 24 year old female. I have been Thyroid NP for I believe 2 years now for my hypothyroid. My T3 and T4 have never been super off but my testosterone is at a 7 and it was lower than that before! With my T3 and T4 being a little off and my testosterone being very low it was enough for my endocrinologist to prescribe the medication. For the past year I’ve been struggling with adult hormonal acne. I’ve never had acne like this in the past and it’s only getting worse. I’ve tried everything naturally but I just recently got on Spironolactone because I don’t know what else to do. I also struggle with plenty of IBS problems which I’ve gotten food allergy tested for in the past. I guess my question for you is would you consider testosterone cream for a female at my age? Its just so low and I am constantly fatigued. I am just worried about possible fertility issues from it in the future. Thanks!

  29. Hi dr.
    Thanks for providing information to all.
    Actually im 18 years old and from last 2 years i have been having svere acne only on my chin and nose area.
    I have taken many antibiotics since then but after 2-4 days i again get acne. Please tell me what should i do. Im really upset. All school boys tease me. My self confidence is so low.
    Please take out time and reply me

    -From india

  30. Hello everyone,

    I am diagnosed with hypothyroidism, and before I was doing very well with armour thyroid. Now my orthomolecular doctor changed me first to bovine thyroid supplements but acne broke out all over my face, now I am on Thyreoidum, but same effect. CAn it be that a too high dose could cause severe acne?
    Or could I be allergic to these medicines?
    Feeling very bad, not sure what to do, but to stop with the medication for a while until acne reduces and start with a low dose then?
    Thank you very much!


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