Many patients with Graves’ disease experience hair loss, and while this might not be the most concerning symptom someone with this condition has, it is still very distressing for many people. This is especially true since Graves’ disease (as well as most other autoimmune conditions) is more common in women, and I can tell you that over the years I have worked with many women with Graves’ disease who were stressed out the most over their hair loss. I’ve written other blog posts and articles on hair loss, but I wanted to put together an updated post that focuses on Graves’ disease and hair loss, because while I do see hair loss in people with hypothyroidism and Hashimoto’s thyroiditis, it is more common in those with hyperthyroid conditions.
When I begin working with someone who has Graves’ disease, of course I want to address the underlying cause of their condition, but initially I want to make sure the person is safe since it’s quite common to have an elevated resting heart rate. Many endocrinologists will try to lower the person’s resting heart rate through the use of antithyroid medication (i.e. methimazole, PTU) and/or beta blockers (i.e. propranolol, atenolol). Natural antithyroid agents such as bugleweed and high doses of L-carnitine are also an option to lower the thyroid hormone levels, while herbs such as motherwort and hawthorn can act as natural beta blockers.
It’s worth mentioning that sometimes taking antithyroid medication or herbs will help to decrease the person’s hair loss, while other times the person will experience more hair loss upon taking these. I’ll talk more about this later in this post, but before we specifically discuss Graves’ disease and hair loss I want to make sure you have taken the necessary steps to start lowering your thyroid hormone levels. So if you have uncontrolled hyperthyroidism then this needs to be addressed first.
Why Do People With Graves’ Disease Commonly Experience Hair Loss?
The main reason why people with Graves’ disease experience hair loss is due to the thyroid hormone imbalance. While either high or low thyroid hormone levels can result in hair loss, as I mentioned earlier, it seems that high thyroid hormone levels more commonly result in hair loss. Based on what I just said here, it might seem obvious that in order to stop the hair loss you simply need to lower the thyroid hormone levels. While normalizing the thyroid hormone levels will usually cause the hair loss to stop, it frequently will take a good amount of time for this to happen.
The Impact of Antithyroid Medication and Herbs on Hair Loss
I’ll add that taking antithyroid medication such as methimazole or PTU can either improve or exacerbate the hair loss. I’ve worked with Graves’ disease patients who took methimazole and had an improvement in their hair loss, while others had their hair loss worsen upon taking antithyroid medication. Some people with Graves’ disease don’t experience any hair loss until they start taking antithyroid medication. Frequently what happens is that the person takes too high of a dosage of methimazole, which can make them hypothyroid, and this can also cause hair loss.
Bugleweed is an antithyroid herb that can also help to lower thyroid hormone levels. Because this herb isn’t as potent as antithyroid medication it’s less likely to cause a huge “swing” in thyroid hormone levels over a short period of time. As a result, taking bugleweed usually doesn’t cause hair loss as much as antithyroid medication does, although you also need to keep in mind that bugleweed isn’t effective in everyone with hyperthyroidism. In other words, taking bugleweed doesn’t always lower thyroid hormone levels. Antithyroid medication is more effective, but there is also a greater risk of side effects.
As I’m sure you know, antithyroid drugs and herbs don’t do anything to address the cause of the problem, and so while they might help with hair loss by lowering the thyroid hormone levels, it’s still important to address the underlying cause of the condition. In other words, if all you do is take antithyroid medication or herbs, this might temporarily help with hair loss associated with Graves’ disease, but once you stop taking these thyroid hormone-lowering agents the hyperthyroidism is likely to return, along with the hair loss.
What Are Other Causes of Hair Loss?
Although elevated thyroid hormone levels are the most common cause of hair loss in people with Graves’ disease, this doesn’t mean that there can’t be other causes as well. Let’s look at some of the other common causes of hair loss in people with Graves’ disease:
- Nutrient deficiencies. Nutrient deficiencies are common in those with Graves’ disease, and nutrient deficiencies can cause hair loss in general. In fact, many people who are suffering from hair loss will take nutritional supplements on their own to see if they will help. Some of the nutrient deficiencies that can cause or contribute to hair loss include zinc, iron, selenium, biotin, and gamma-linolenic acid (1). When looking to address nutrient deficiencies, it’s important to look into factors that can cause these deficiencies. Remember that Graves’ disease is an autoimmune condition, and since most of the immune system cells are located within the gastrointestinal tract, having a healthy gut is necessary for optimal immune system health. But many people with Graves’ disease have an unhealthy gut, which in turn can affect nutrient absorption. For example, H. pylori is a potential trigger of Graves’ disease, and numerous studies show that H. pylori can affect iron absorption (2) (3), which can result in hair loss. Other causes of malabsorption (i.e. Celiac disease, inflammatory bowel disease) can also affect the absorption of nutrients that play a role in hair loss. It’s also important to mention that overdosing with certain nutrients can cause hair loss. This includes selenium, vitamin E, and vitamin A (4). So while it’s important to correct nutrient deficiencies, you want to make sure not to take very high doses of certain nutrients, especially over a prolonged period of time, as this can lead to a toxicity that results in hair loss.
- Sex hormone imbalances. Imbalances of the sex hormones (estrogen, progesterone, testosterone) can cause hair loss. Elevated thyroid hormone levels will commonly cause sex hormone imbalances. Frequently correcting the hyperthyroidism will resolve the sex hormone imbalance, although sometimes additional action will be required to balance the hormones.
- Alopecia areata. Alopecia areata is an autoimmune condition that causes hair loss on the scalp, face, and sometimes on other areas of the body. A 2018 study showed that alopecia areata is significantly associated with Graves’ disease and Hashimoto’s thyroiditis (5). However, it’s important to mention that frequently alopecia areata will develop first, many times in childhood, although it’s also possible for thyroid autoimmunity to precede alopecia areata.
Please keep in mind that it’s very possible for those with Graves’ disease to have more than one factor causing hair loss. For example, while hyperthyroidism is the most likely cause, the person might also have nutrient deficiencies that are a factor. In this situation not only will the thyroid hormone levels need to be balanced, but the nutrient deficiencies need to be addressed as well. As I mentioned earlier, if someone has hyperthyroidism that leads to sex hormone imbalances, lowering the thyroid hormone levels may resolve the sex hormone imbalances, although this isn’t always the case.
Can Diet Alone Help With Hair Loss?
I mentioned how nutrient deficiencies are a potential cause of hair loss. Because of this you may wonder if eating a nutrient dense diet can correct such nutrient deficiencies, and thus resolve the hair loss problem. Although it’s important to eat nutrient dense foods, many times supplementation is necessary to correct nutritional deficiencies, and then once this has been accomplished the goal should be to maintain healthy nutritional levels through diet (although I’ll add that sometimes supplementation is still necessary). Just remember that having a healthy gut is necessary for the optimal absorption of nutrients.
How Long Does It Take To Reverse Hair Loss?
As for how long it takes to reverse hair loss, this of course depends on the person, as well as the cause of the hair loss. If hyperthyroidism is the sole cause of the person’s hair loss it can take a few weeks to a few months before the hair loss stops. The same thing applies to sex hormone imbalances. Moderate to severe nutrient deficiencies will take time to correct, and so if this is responsible for the hair loss then it will usually take longer for the hair loss to stop and grow back. Based on what I’ve said here, while some people start noticing their hair loss improving within a few weeks of taking measures to correct their hyperthyroidism, for some people it will take a few months before they notice a significant improvement.
What Can You Do To Help With Graves’ Disease Hair Loss?
After reading this post you probably have a pretty good idea what you can do to help with your hair loss, but I’ll list them below in bullet point format:
- Correct the hyperthyroidism. This is the most common cause of hair loss in those with Graves’ disease, but of course even if someone isn’t experiencing hair loss it’s important to lower the thyroid hormone levels.
- Balance the sex hormones. Once again, correcting the hyperthyroidism many times will help to balance the sex hormones. But when this isn’t the case you might need to do other things. One thing I didn’t mention earlier when discussing sex hormones is that having healthy adrenals is important in order to have healthy sex hormones. And many people with Graves’ disease have adrenal problems. So while many doctors will resort to giving bioidentical hormones to their patients with sex hormone imbalances, evaluating the adrenals is a good first step before doing this.
- Correct nutrient deficiencies. I’ve also discussed how many people with Graves’ disease have nutrient deficiencies, and certain nutrient deficiencies can cause hair loss. I also explained how it’s important to address the cause of the nutrient deficiencies, and how overdosing with selenium, vitamin A, and/or vitamin E can cause hair loss.
What’s Your Experience With Hair Loss?
If you have Graves’ disease and have dealt with hair loss please feel free to share your experience in the comments section below. Are you still experiencing hair loss, and if not, how long did it take for your hair loss to stop and grow back? If you took antithyroid medication, did this improve or worsen your hair loss? Did you take any nutritional supplements, or do anything else naturally that helped? Thank you so much for sharing your experience with everyone.
I have Grave’s disease and have gone through 3 bouts of hair loss. Two were from PTU and the latest was from methimazole. I never had hair loss when I was unmedicated, only when I was on the medications. My dietitian friend said this time around it was probably because my hair was stressed because of my graves and then going on the meds just pushed it passed it’s limit. I’ve probably lost half my hair since the first fallout but over the years it has somewhat grown back. When this latest fallout begin I was freaking out because honestly if I had as much fallout as the other ones I would go bald. I tried everything. Different essential oils in my shampoo, going gluten free, taking biotin, taking iron. Nothing helped except going off the anti-thyroid pills. This time when it started falling out I looked and looked and looked for something different. I found some pills especially for hair on Amazon and started reading reviews and there were lots of people who had medicine induced hair loss that said it helped. I’ve been taking them for about 2 months and they have reduced my hair loss by about 75%. It’s been the only thing that’s worked.
I also had very significant hair loss from Methimazole. I felt better after taking the drug almost immediately, but I looked awful. It also makes your face swell and you gain weight very rapidly. What is the name of the pills you took for hair loss? Are they safe? Are you still on Methimazole or PTU? Thank you for your response.
It’s called Hairfluence. Mostly just vitamins and hair things like collagen and keratin and biotin. Yes, I am still on Methimazoe, a very low dose, 10mg a day. I was lucky, the hair fallout has been the only side effect. No swelling or weight gain.
Thanks for sharing your experience Angie, as I’m sorry that you have had 3 bouts of hair loss. So just to clarify, stopping the antithyroid medication helped to stop the hair loss, but your hair didn’t start growing back until you took the supplement, which I assume had nutrients to help with the hair loss?
I was diagnosed with Graves in 2008 and started off with methimazole but it gave me hives so I took PTU for about 18 months but then went in to remission. No problem with hair loss. Went back on PTU in 2015 and within about 9 months started to lose hair. Like 300 strands a day. Physician at the time said it’s probably the PTU let’s take you off it and within 3 months it stopped. Thyroid acted up again but I tried using natural solutions for about a year because I didn’t want to go on PTU again. Hair loss stopped that whole time. Nothing really worked so I went back on PTU and within 4 months hair started to fall out again. Went off it and within 3 months it stopped falling out. Spent another couple years trying to do the natural solutions and I actually felt pretty good with acupuncture and Chinese medicine but I did lose weight and I did have some muscle weakness. And my labs were never normal. Started a with a new endo and asked if I could try methimazole again and she started me on a very low dose with antihistamines and I did fine with it. Except within 3 weeks my hair started to fall out. (I do not want to do RAI or a TT. It seems like that can just lead to another set of problems. Plus it seems like all the underactive thyroid medicines can cause hair loss too!) I just happened to find the hair vitamins on Amazon and decided to give them a try. When I am not on any antithyroid drugs I lose around 10-20 hairs in the shower and blowing drying etc. When I was on PTU I lost about 300 and I think it was telogen effluvium caused by the PTU. With the methimazole, I was losing about 125-150 and it happened so fast I’m not sure it was telogen effluvium, I think it was just from the medication. Within two weeks of starting the vitamins I was losing about 70, now I’m losing about 30-40. Which is still is more than normal but I don’t feel like I’m going to go bald anymore!
I started losing my hair as 25 maybe 26; noticed the thinning then and it steadily got a little worse every year. I’m a stubborn person who always seems to think i don’t have time to do things i probably, definitely should. Like going to the doctor, i never thought hair loss could really be a symptom of anything. It was just something that was. I’ll regret that decision for some time after. it wasn’t until i was over 30 that i was diagnosed with grave’s disease. I might not have triggered graves in those previous days, but i like a fool, waited till i had the shakes so bad i couldn’t separate a piece of paper, with a heart rate so fast it was scary. I did end up taking anti-thyroid medication and beta blockers until i was so hypothyroid i could barely stay awake i don’t know if it worsened as i was too used to shedding. i haven’t seen a lot of improvement after stopping the medication and choosing a natural approach with a naturopathic doctor. Though i have noticed little to no shedding after changing my diet and taking supplements. My hair is still thin but i figured out i look pretty fine with a faux hawk. one day it may just grow back 🙂
Thanks for sharing your experience J.M. It sounds like the antithyroid medication wasn’t the main factor in your case, and based on what you said the hair thinning might not be related to the thyroid hormone imbalance, or at least it didn’t seem like the main cause.
I experienced two very mild instances of alopecia that preceded my Graves diagnosis by about 5 years. Both instances my hair grew back within a few months. Within 9 months of my Graves diagnosis I experienced a 6″x6″ area of complete hair loss on the temporal side of my head, along with some diffuse thinning on the top of my head. In this instance I had regrowth within 4 months.
I had my full head of hair back for 6 months, before experiencing yet another episode of even more severe hair loss: approx 50% complete loss, with various smaller areas of diffuse thinning. My hair was naturally long and plentiful, so I “worked with it”, but this particular experiencing was devastatingly stressful. The regrowth phase took longer, about 8 months. I cut my hair short. It was thick and “normal” again, and I enjoyed my short hair (and confidence) for a full 9 months. Then, just after New Year 2017, my hair started falling out at a pace I never experienced. I lost all the hair on my head within less than a month, my body hair within 3 months, and the ultimate kicker: my eyebrows and eyelashes within 6 months. I have had no hair on my body for over a year. The Graves + Alopecia ordeal lasted an excruciating 2.5 years. I’m still entirely hair free.
I was diagnosed with Graves in March 2015, and for a full year I committed to natural/supportive modalities to attempt managing the Graves, along with seeing an endocrinologist regularly. I have no doubt that modifying my diet, proper supplementation with minerals, probiotics, omega 3s, etc. as well as taking measures to keep sex hormones in balance (which they did) was beneficial and overall supportive..but the bottom line was that the TRAB antibodies were raging through my system. My FT3/FT4 levels would fluctuate between high normal/just out of range high, TSH remained barely detectable in my labs. The antibodies however told the real story. A year after my Dx I began taking Tapazole as I was developing Graves eye disease. I took Tapazole (bw 5 – 10mg/day) for 3 years and just had a thyroidectomy last month. It was too long to be on the medication. In the 4 years I struggled with Graves, I experienced ongoing joint pain, severe alopecia, and later, muscle tremor on exertion along with muscle weakness, and vision problems that ultimately and finally lead to the thyroidectomy. A rheumatologist I was seeing last year for the joint issues and lupus like symptoms (including the hair loss and vasculitis under my nails) strongly suspects an antibody reaction to the Tapazole, as I tested negative for lupus (thank God). He strongly advocated for the surgery.
It is worth mentioning that I’m an otherwise healthy 42 year old woman who had no prior comorbidities pre-Graves diagnosis. I’m otherwise strong, athletic and fit woman who lives a clean, reasonably low stress life and have been mindful of my health as long as I can remember. In retrospect I feel that for myself personally, having the Graves barely managed for the first year after my diagnosis created additional stress and vulnerability in my body…it facilitated an autoimmune snowball effect that was very very difficult to manage in the longer term. In a nutshell, I experienced hair loss both before and after medical management of Graves. I believe that the key with Graves is reducing the stress load on the body ASAP. Homeopath, naturopath, endocrinologist, and rheumatologist are all in agreement on this point. How this goal is achieved with success will look different for every individual. Thank you for reading and wishing you well!
Thanks for sharing your experience Catherine, as without question I agree that reducing stress is a big key. Emotional stressors can be a big factor, but we also need to consider the impact of other stressors, such as infections.
Hello Dr. Eric. It’s been 4-5 years since you helped me to restore my thyroid after having been diagnosed with hyperthyroidism (I wasn’t specifically diagnosed with Grave’s Disease, just hyperthyroidism.) My hair loss with hyperthyroidism was severe, I thought it would correct itself after my thyroid and hormone levels came into balance again. But my hair loss never really recovered and has continued to this day. I just had my basic thyroid levels tested: TSH is 2.31, T3 is 1.06 and T4 is 10.5. All seem to be within normal range. Ferretin is 70. Since coming to Chile I haven’t had access to good quality supplements, so I depend on whole foods for nutrition.
It’s great to hear from you Diane! I hope all is going well with you and your husband in Chile! The TSH is well within the lab reference range, although a little higher than optimal. But I’m guessing that this isn’t responsible for the hair not growing back, and so you might want to look to address nutrients other than iron, along with sex hormone imbalances.
Hi. I was just diagnosed with Graves, but in 2017, being ignorant of probably having hypothyroidism, I gained so much weight that instead of going to a ND, I took a supplement (metacarbo complex) that caused me to lose weight: like over 30 pounds even after I stopped taking it. My famous thick, curly hair thinned down. Frantically I went online and bought Renew, (skin research institute). After a bottle, about a month later, my hair started to come in but there are still patches and hair loss now that I went from Hyp to Hyper. I suggest Renew with all its vitamins and herbs. And I also suggest going to a ND if overweight. My family doctor had no clue. She just said, You need to lose a little weight.
Now I’m taking propranolol and I hate it. Can’t wait to start this program!!