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Originally published on 24th April 2018 Last updated on 21st February 2021
I’ve been very open about my experiences with acne, over the years. As a teenager, I didn’t have any more pimples than my peers, and as a young adult, although I would get a few here and there, it was never an alarming amount.
It wasn’t until I decided to come off the combined contraceptive pill in December 2015, after being diagnosed with hypothyroidism and Hashimoto’s and starting NDT thyroid medication, that my skin started to go crazy with acne.
By unearthing a sex hormone imbalance (oestrogen dominance), a leaky gut and gluten sensitivity, I was able to slowly piece together the puzzle as to why my skin had broken out so badly.
I was originally somewhat nervous showing the following photos of my acne, but I also know that we need to normalise normal skin. And I remain loyal to my oath to always be honest, open and realistic about my experience of living with Hypothyroidism and Hashimoto’s. And the acne is a part of that.
The following are the most common causes for acne in thyroid patients.
1. A Sex Hormone Imbalance and Adrenal Issues
Driving my hormonal imbalance was high cortisol. Many of us with hypothyroidism also seem to have adrenal issues. When high cortisol remains high for a long time, the body can start converting progesterone in to more cortisol to try and sustain this stress response, creating a sex hormone imbalance of too much oestrogen.
This sex hormone imbalance gave me irregular periods and mood swings, as well as the sudden and very painful cystic acne on my cheeks, jaw, neck, chin, chest, shoulders and back.
I gave progesterone cream a go but saw little improvement, so stopped after six months or so. I soon realised I needed the help of a more integrative practitioner (more on that below).
High androgen levels (testosterone) can also be the cause of acne in many with hormonal imbalances. See info about PCOS below.
See more information on oestrogen dominance here and adrenal dysfunction here.
2. A Gluten Sensitivity (or other diet issues)
Having Hashimoto’s, as 90% of us with hypothyroidism do , I decided to give a gluten-free diet a go and, within just a few weeks, I noticed great changes in my skin.
(A lot of people with Hashimoto’s see an improvement in many thyroid symptoms on a gluten-free diet.)
As well as a huge improvement in my acne, brain fog and heart palpitations, I felt healthier overall. I’ve inserted before and after photos of being gluten-free for three weeks below. My periods also became regular once again.
Related Article: 9 Thyroid Symptoms That Improved by Going Gluten-Free
Six months in to being gluten-free and I rejoiced at my skin being left with mostly scarring which was fading with time.
For other people, food sensitivities causing them skin complaints can include dairy, soy, sugar and more. Removing something from your diet for some time to see if it makes any difference can be well worth it. I was astounded at the change in my skin from removing gluten.
More information about the elimination diet can be found in this book.
3. Poor Gut Health
I have also worked with a functional medicine practitioner for help with my acne, among other thyroid symptoms.
She confirmed that I had leaky gut with yeast overgrowth (candida) driving my adrenal fatigue, which in turn was driving the sex hormone imbalance (oestrogen dominance). Going gluten-free was a great first step for my gut health but it was never going to fix everything. This is why I saw such an improvement but not complete riddance of the acne.
(a UK test for Candida can be found here and a US test here)
Essentially, through having Hashimoto’s and hypothyroidism, this led to adrenal fatigue due to a leaky gut and inflammation in the body, which then led to the sex hormone imbalance (oestrogen dominance). And the oestrogen dominance was worsening the adrenal fatigue. I was stuck in a vicious cycle!
So, What Did We Do?
I needed a targeted approach to the yeast overgrowth, working on killing this off and eliminating it from the body and then also improving my gut and digestive function at the same time. Grapefruit Seed Extract was recommended by my functional medicine practitioner for the yeast.
Taking digestive enzymes, drinking bone broth and kefir were recommended and so, desperate to rid myself of the mounting symptoms and acne, I jumped to it and implemented everything the functional medicine practitioner suggested.
It was a little slow to begin with but my gosh, the results were amazing. More energy, better mental health and an improvement in acne.
The photos below show before and after three months on kefir, using Grapefruit Seed Extract to target the candida and digestive enzymes. In the before photos (left), I have a lot of red, sore spots. The after photos (right) show mostly scarring a few months after starting gut health targeted treatment.
4. The Wrong Skincare Products / Regimen
Different lifestyles and types of skin require different ingredients in skincare products and different skincare regimens.
After reading the following books, I was armed with great knowledge regarding which ingredients to avoid and look for in my skincare items, and how to build a skincare regimen that helped me to reduce the acne and scarring associated with it.
Skincare: The ultimate no-nonsense guide and Sunday Times No. 1 best-seller
The Skincare Bible: Your No-Nonsense Guide to Great Skin
Love Your Skin: The Ultimate Guide to a Glowing Complexion
Around 1 in 10 females of childbearing age have the condition known as PCOS (Polycystic Ovary Syndrome).
On average, women with PCOS tend to have higher TSH levels and be subclinically (borderline) hypothyroid when compared to controls of the same age without PCOS. 
Hypothyroidism, and in particular, Hashimoto’s thyroiditis, is more common in women with PCOS than in the general population. High levels of thyroid antibodies (Hashimoto’s) are found in one in three PCOS patients .
If a person has either Hashimoto’s or PCOS, the chance of being diagnosed with the other increases up to ten fold! , 
Therefore, if you experience acne and have Hashimoto’s or hypothyroidism, it is not unreasonable to request to be checked for PCOS too.
More information on this here.
For a PCOS Blood Test, click here.
6. Low Vitamin / Mineral Levels
It’s worth being checked for low vitamin and mineral levels and considering supplementation if you have skin complaints also.
Ones to look include include:
Vitamin D (UK test option here. Worldwide test option here.)
B12 (Worldwide test option here.)
Folate/Folic acid (Worldwide test option here.)
Ferritin (Worldwide test option here.)
Iron, T.I.B.C., Transferrin Saturation (Worldwide test option here.)
Magnesium (UK test here, US option here.)
RBC Potassium (US test here.)
Zinc (UK test here, US test here.)
More information on vitamins and minerals here.
7. Poor Thyroid levels
Low thyroid hormones Free T4 and Free T3, and high thyroid antibody levels can also contribute to skin complaints, including acne, eczema and itchy skin.
If your doctor will not check all of these then it is worth knowing that you can order thyroid tests yourself from online laboratories. (You can see a UK lab here and a worldwide lab here.)
Once you have your results, checking to ensure they are optimal and not just ‘in range’ in crucial.
In my case, and I believe in many thyroid patient’s cases, a sex hormone imbalance is going to be behind their acne when they have thyroid issues.
The delicate balance of hormones in the endocrine system, such as thyroid hormones, adrenal, sex hormones and more, can all impact each other and when one goes out of balance, so can others. By addressing the system as a whole, calming the adrenal fatigue, fixing gut health and so on, improvements in the skin and overall health can be seen.
I hope the seven key areas mentioned above give you some starting points to explore the cause/s behind your own acne. Just know that you’re not alone.
Have you had experience with acne? Feel free to share in the comments below.
You can click on the hyperlinks in the above post to learn more and see references to information given.
The book Be Your Own Thyroid Advocate: When You’re Sick and Tired of Being Sick and Tired, which builds on this article in detail. Reclaim your thyroid healthy life and banish your symptoms.
KristinaJuly 22, 2021 at 11:38 am
Hi there! I’ve had acne all my life but my acne cleared when I went hypothyroid and now have hashimotos. Funny thing being low made my skin clear
Now I’m on thyroxine and I’m slowly breaking out .. would you happen to know which imbalance was causing my acne
Mary Jo SipesMarch 4, 2021 at 2:12 pm
I am on aromatase inhibitors, they remove the estrogen from your body. I’m wondering if this is causing my adrenal glands to work overtime? In general, would this spark more acne?
AnitaFebruary 26, 2021 at 5:38 pm
for Acne, wash your face with any oatmeal based soap. Works great. once/day is enough
for gut health, take an acidophyllus capsule, it cleans up your gut in 3 days.
AnnFebruary 25, 2021 at 6:27 pm
I associate my cystic acne with oxalates. My cysts are small hard stones, often with sharp edges, that cause pain and wake me up at night as they emerge. Going lower on oxalates results in “dumping” of stored oxalates from organs, bones and tissues. As a young adult I had more normal acne, but this is different. I’m almost 70 and still experiencing it, though now that I’ve gone so low oxalate and rid myself of much of the stored oxalates, the cysts are much less frequent.
JeanneApril 29, 2022 at 4:51 pm
I began having the same kind of acne when I was 64…(about a year after I began to somewhat reduce my oxalate intake). I am 69 now. As time has gone by, I have gone through many oxalate dumps and yet the acne remains. I guess that when my body has rid itself of enough oxalate, then my skin will clear up. No amount of topicals have been able to clear the zits. This is truly “an oxalate thing”.
AnitaFebruary 25, 2021 at 6:10 pm
Acne: wash face with oat meal soap. Great for skin!
gut health: take an Acidophillus tablet – clears up gut problems in 2 days.
My brother in law was a health person.
RabiaSeptember 23, 2020 at 7:57 am
Dairy kefir is OK to have with hashis?
Rachel HillSeptember 23, 2020 at 8:14 pm
Depends on the person. Some thyroid patients say they feel better dairy-free, some don’t notice a difference.
Shailashree RamannaApril 30, 2020 at 4:43 pm
Your write ups are very informative.
Many have not just thyroid but combo of problems. Good to know about the remedy for these.
In my case, I have irregular bowels ,acnes and dry skin due to malabsorption.I notice lactose intolerance. Sometimes gluten🤔.
Please share your views on this.
You can send it to my mail ID.