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Have you ever observed a yellowish tinge to your skin, especially around your eyes, and wondered what it could mean?

Subtle skin color changes can be a sign of an underlying health condition. Yellow skin, for instance, may be due to a viral illness or even a thyroid condition, among other causes.

In this article, we’ll explore why skin turns yellow and its connection to thyroid conditions.

When the body has excess bilirubin, the skin can turn yellow—the medical term for this jaundice. Bilirubin is a yellowish-orange substance produced when your body breaks down red blood cells. Usually, the liver breaks down and gets rid of bilirubin. However, different factors can disrupt this process, leading to bilirubin accumulation and yellowing of the skin.

Symptoms of jaundice go beyond yellow skin. The white part of the eyes (the sclera) can turn yellow or brown in severe cases. The inside of the mouth can also take on a yellow tinge, and you may notice your urine is darker in color. In addition, whole-body itching commonly accompanies jaundice.

Jaundice is rare in adults, but several conditions may cause it. One primary cause is liver dysfunction, such as hepatitis or alcohol-related liver disease. Other causes of jaundice include:

• Blocked bile ducts, generally related to gallstones
• Pancreatic or gallbladder cancer
• Autoimmune disorders, including those affecting the liver
• Certain medications, such as oral contraceptives and excessive amounts of acetaminophen (Tylenol)

If your skin has a yellowish tinge, your healthcare provider will likely perform several tests. A bilirubin test is usually the first step in diagnosing jaundice. Aside from this blood test, other diagnostic tests your provider may order include:

• Viral hepatitis panel
• Liver function tests
• Complete blood count
• Prothrombin time
• Cholesterol levels
• Abdominal ultrasound and CT scan
• Endoscopic retrograde cholangiopancreatography (ERCP)

Your provider may also check other labs to rule out the cause of jaundice, including a thyroid function test. Often, thyroid function tests include thyroid stimulating hormone (TSH), thyroxine (T4), and triiodothyronine (T3.)

Different lab tests measure your T4 and T3 levels. A “free” level measures how much thyroid hormone is available to your cells. In contrast, a “total” level is the sum of how much thyroid hormone is bound to proteins and the free amount.

Liver dysfunction and thyroid function tests

Thyroid function tests don’t always reflect a person’s actual thyroid status when jaundice is present for two reasons.

First, the liver makes proteins, and the T4 and T3 hormones bind to those proteins. When thyroid hormones bind to these proteins, they become inactive, meaning your body can’t use them. Any changes to the production of these proteins can influence thyroid hormone levels. Examples of these proteins include albumin and thyroxine-binding globulin (TBG).

Chronic liver dysfunction reduces the amount of thyroid hormone-binding proteins, causing higher free T4 levels.

The second reason is that a high bilirubin level lowers T4’s ability to bind to thyroid hormone proteins. As a result, T4 levels rise. Remember - the liver breaks down bilirubin to rid it from the body.

Now, suppose you have your blood tested, and you don’t have jaundice, but you still have yellowing of your skin. In this case, yellow skin may result from a diet high in beta-carotene. Foods high in beta carotene are rich in yellow, red, and orange pigments and include:

• Carrots
• Tomatoes
• Dark leafy greens like spinach and romaine lettuce
• Spinach

This condition, called carotenemia, is characterized by yellow pigmentation of the skin and increased beta-carotene levels in the blood. Carotenemia usually results from prolonged and excessive consumption of carotene-rich foods such as carrots, squash, sweet potatoes, mango, papaya, pumpkin, tomatoes, and dark leafy greens like spinach, kale, and romaine lettuce.  Carotenemia is harmless, and the yellow discoloration of the skin gradually disappears over several weeks to months once the intake of carotene-rich foods is reduced or eliminated. The amount of carotene-rich fruits and vegetables that will turn the skin yellow depends on factors such as your metabolism, duration of consumption, and the specific carotene content of the foods consumed.

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Yellow skin around the eyes may indicate an underlying problem with the thyroid gland. But, to understand why this is, let’s dive deeper into understanding thyroid disorders.

The thyroid is a small, butterfly-shaped gland located at the bottom of your neck. Its primary role involves producing thyroid hormones, which help regulate various bodily functions. For instance, thyroid hormone helps regulate metabolism, digestive functions, and more.

Your body regulates thyroid hormone levels through a complex feedback loop called the hypothalamus-pituitary-thyroid axis. Any disruption in this loop can impact thyroid hormone production, resulting in a thyroid disorder.

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Hypothyroidism

Hypothyroidism occurs when the thyroid gland is underproductive, causing low thyroid hormone levels. Because of this, body systems slow down, causing hypothyroidism symptoms such as

• Weight gain
• Constipation
• Cold intolerance
• Muscle aches and pain
• Fatigue

Hypothyroidism also increases your risk for gallbladder disease, specifically the formation of a type of gallstone called common bile duct stones. These stones can impair the flow of bile, resulting in hyperbilirubinemia, another term for jaundice.

Researchers found those with hypothyroidism are at a higher risk for developing jaundice when they also have decreased bilirubin excretion, high cholesterol levels, and low muscle tone in the gallbladder. This triad heightens the likelihood of gallstone formation. And as we know, gallstones can increase bilirubin levels, resulting in jaundice.

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Hyperthyroidism

Hyperthyroidism occurs when the thyroid produces too much thyroid hormone. And Graves’ disease, an autoimmune disorder, is the primary cause of it.

In Graves’ disease, the immune system produces antibodies that mimic the action of TSH. These antibodies bind to the thyroid receptors and tell the thyroid to release more thyroid hormone. This action results in excessive production of thyroid hormone. Those with Graves’ disease often report symptoms of

• Weight loss
• Irregular or fast heartbeat
• Enlarged thyroid gland (goiter)
• High blood pressure
• Sweating
• Restlessness or anxiousness
• Trouble sleeping

Although rare, yellow skin around the eyes can occur and may be a sign of a life-threatening condition called thyroid storm. Thyroid storm occurs when thyroid hormone levels are dangerously high. Signs and symptoms include

• Fever
• GI upset, such as vomiting, diarrhea, or nausea
• Delirium
• Severe weakness
• Irregular or fast heartbeat
• Low blood pressure
• Seizures
• Coma

Thyroid storm is rare -- but serious -- and early diagnosis and prompt treatment are crucial for a positive outcome. So, if you or someone you know has symptoms of thyroid storm, you need to be aware that this can be a life-threatening complication of hyperthyroidism, and it requires immediate medical attention at the nearest emergency room. 

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Both hypothyroidism and hyperthyroidism can contribute to the development of jaundice. But Graves’ disease is the most common thyroid condition linked to jaundice.

Consistently high thyroid hormone levels can directly impact the function of the liver in various ways. And liver dysfunction can further affect thyroid hormone levels. Here’s how.

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Impact on thyroid hormone binding proteins

As mentioned, the liver makes TBG and albumin, both proteins that can affect thyroid hormones. These proteins help maintain the levels of free thyroid hormones in the bloodstream within a narrow range. This ensures that thyroid hormone is available for your tissues to use.

Since the liver makes these proteins, levels can be altered in those with liver disease or dysfunction. TBG levels decrease in the setting of liver dysfunction, further contributing to high thyroid hormone levels.

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Damage to liver cells

High thyroid hormone levels increase the liver’s oxygen demand. For the liver to get more oxygen, blood flow to the liver needs to improve. But, in this situation, blood flow to the liver doesn’t increase. Without enough oxygen, liver cells become damaged, impacting liver function.

Individuals are at a higher risk of liver damage when they have Graves’ disease and

• Preexisting liver impairment or
• Congestive heart failure or
• Heart rate greater than 90 beats per minute.

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Coexistence of Graves’ disease and autoimmune liver disorder

Although the occurrence is relatively small (1.8 to 6%), the coexistence of autoimmune liver disorder and Graves’ disease has been reported. The impact of these concurrent autoimmune disorders can be significant. Since the liver plays a crucial role in converting T4 (inactive form) to T3 (active form), excess T3 can induce liver cell death, further contributing to liver dysfunction.

Antithyroid medication-related liver toxicity

There are various treatment options for Graves’ disease, including antithyroid medications. Examples of thioamides include methimazole and propylthiouracil.

Antithyroid medications decrease the formation of thyroid hormone in the thyroid. Although rare, antithyroid medications can damage the liver, with an estimated amount of cases being between 0.1% - 0.2%. And this liver damage can contribute to jaundice. Individuals most at risk for liver damage are those on a high dose and those of an older age.

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The treatments for jaundice depend on the underlying cause.

If the yellow skin around your eyes is due to hyperthyroidism or Graves’ disease, managing the thyroid condition will improve jaundice. Remember, jaundice is a sign of severe thyroid disease, so treating the thyroid is the biggest priority if that is the cause of jaundice.

The main treatment options for Graves’ disease

• Antithyroid medication
• Radioiodine therapy
• Thyroid surgery

The treatment of choice depends on every individual’s unique needs, such as age, pregnancy, and other medical conditions.

As mentioned, antithyroid medications can cause liver abnormalities. Because of this, it is best to check liver function tests before starting these medications to establish your baseline function. Liver abnormalities usually appear within the first couple of months of treatment. If liver enzymes increase, stopping the medication will help improve liver function.

In contrast, jaundice related to hypothyroidism is likely rooted in an issue with the gallbladder, such as a block or restriction in the bile duct. If this is the case, you must see a medical provider trained to diagnose and treat gallbladder problems to help resolve the jaundice.

When it comes to managing hypothyroidism, thyroid hormone replacement medication like levothyroxine is the first-line option. These medications increase thyroid hormone levels to normal levels. Managing hypothyroidism may help prevent further formation of bile duct gallstones in this setting.

Jaundice isn’t common in adults unless there is an underlying medical problem causing bilirubin to accumulate in your body. You should seek medical care if you notice yellow skin anywhere on your body, including around your eyes.

If the underlying cause of your jaundice is related to hypothyroidism, consider partnering with one of our knowledgeable Paloma thyroid experts to manage it. Paloma’s thyroid providers take a holistic, evidence-based approach to managing hypothyroidism. We create a personalized treatment plan just for you. Schedule a free consultation today.

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