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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.
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.
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.
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.
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.
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.
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.
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:
B12 (Worldwide test option here.)
Folate/Folic acid (Worldwide test option here.)
Ferritin (Worldwide test option 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.
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.
Rachel Hill is the highly ranked and multi-award winning thyroid patient advocate, writer, speaker and author behind The Invisible Hypothyroidism. Her thyroid advocacy work includes writing articles, authoring books, producing her Thyroid Family email newsletters and speaking on podcasts, as well as being a founding board member for the American College of Thyroidology. She is well-recognised as a crucial contributor to the thyroid community and has a large social media presence. Her books include “Be Your Own Thyroid Advocate” and “You, Me and Hypothyroidism”.