Sign of Hertoghe

Anne of Denmark in mourning

Sign of Hertoghe or Hertoghe's Sign is a clinical sign associated with hypothyroidism and some other conditions. It is characterized by the thinning or loss of the outer third of the eyebrows. The sign is named after Eugene Hertoghe, an early 20th-century Belgian physician who first described it. Hertoghe emphasized the importance of minor signs in the diagnosis of thyroid deficiency, among which the thinning of the eyebrows was particularly noted.

Clinical Presentation

Patients exhibiting Hertoghe's Sign may have sparse hair in the lateral third of the eyebrows, which can sometimes extend to complete loss in this area. This sign is often subtle and can be overlooked during a routine medical examination. However, it can be a valuable clue in the diagnosis of hypothyroidism, where it may present alongside other symptoms such as fatigue, weight gain, cold intolerance, and dry skin.

Pathophysiology

The exact mechanism behind the thinning of the eyebrows in hypothyroidism is not fully understood. It is believed to be related to the overall slowing of metabolism and reduced hair growth associated with low thyroid hormone levels. Thyroid hormones play a crucial role in the regulation of hair follicles, and their deficiency can lead to alterations in hair growth cycles, resulting in hair loss.

Associated Conditions

While Hertoghe's Sign is most commonly associated with hypothyroidism, it can also be seen in other conditions. These include:

• Dermatologic conditions that affect hair growth
• Nutritional deficiencies, such as iron deficiency
• Autoimmune diseases, such as alopecia areata
• Aging, where hair thinning is a common feature

Diagnosis

The presence of Hertoghe's Sign should prompt a thorough evaluation for hypothyroidism and other potential underlying conditions. This evaluation may include:

• Clinical examination and history taking to identify additional symptoms of hypothyroidism or other related conditions
• Blood tests to measure levels of thyroid hormones (TSH, T3, and T4)
• Examination of other areas of potential hair loss to assess for dermatologic or autoimmune conditions

Treatment

Treatment of Hertoghe's Sign involves addressing the underlying cause. In cases of hypothyroidism, thyroid hormone replacement therapy can help in restoring hormone levels, which may lead to the regrowth of eyebrow hair over time. For other conditions, specific treatments targeting the underlying cause should be pursued.

Conclusion

Hertoghe's Sign, while a minor and often overlooked feature, can be an important diagnostic clue in the identification of hypothyroidism and other conditions. Healthcare providers should be aware of this sign and consider it in the context of a comprehensive clinical evaluation.

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