Since 2009 I have had a practice that focuses on thyroid and autoimmune thyroid conditions, and while I do work with people who have non-autoimmune thyroid conditions (i.e. toxic multinodular goiter), most people I work with have Graves’ disease or Hashimoto’s thyroiditis. Some people have the antibodies for both Graves’ disease and Hashimoto’s. Every now and then someone will ask what the difference is between these two conditions, and so I figured I’d put together a blog post that discusses the similarities and difference between Graves’ disease and Hashimoto’s.
Let’s first start out by discussing the differences between these two conditions:
What Are The Differences Between Graves’ Disease and Hashimoto’s?
1. They involve different autoantibodies. Those with Graves’ disease have elevated thyroid stimulating immunoglobulins [1], which is a type of TSH receptor antibody. Hashimoto’s thyroiditis is usually diagnosed when someone has an elevated thyroid stimulating hormone (TSH) in the presence of thyroid peroxidase and/or anti-thyroglobulin antibodies. However, it’s worth mentioning that many people with Graves’ disease also have elevated TPO antibodies, and some people have all three of these thyroid antibodies.
2. Hashimoto’s involves damage to the thyroid gland. Whereas Graves’ disease involves the thyroid stimulating immunoglobulins binding to the TSH receptors without causing permanent damage, this isn’t the case with Hashimoto’s. In Hashimoto’s there is damage to the thyroid gland. And while the thyroid gland can regenerate, it does so slowly, and sometimes the damage is so extensive that the person needs to remain on thyroid hormone replacement. Keep in mind that it can take many years before there is sufficient damage to the thyroid gland that results in an elevated TSH and thyroid hormones that are out of range.
3. Graves’ disease involves hyperthyroidism, and Hashimoto’s involves hypothyroidism. The truth is that not everyone with Hashimoto’s experiences overt hypothyroidism, as many times it’s subclinical. In other words, they might have an elevated TSH with the thyroid hormone levels within the lab reference range. It’s also important to mention that some people with Hashimoto’s experience hyperthyroidism due to Hashitoxicosis [2]. On the other hand, most people with Graves’ disease will experience overt hyperthyroidism, although there are exceptions.
4. The symptom management differs. Because most people with Graves’ disease experience overt hyperthyroidism, most endocrinologists will recommend antithyroid medication (i.e. methimazole, PTU) to their patients. Of course many will recommend radioactive iodine or thyroid surgery. With Hashimoto’s, thyroid hormone replacement is commonly recommended. This is true even if the thyroid hormone levels are looking good, as many medical doctors will go by the TSH alone.
5. Unmanaged hyperthyroidism is arguably a greater risk than unmanaged hypothyroidism. The truth is that there are risks of both unmanaged hyperthyroidism and hypothyroidism. But arguably unmanaged hyperthyroidism is a greater risk, as it can lead to heart arrhythmias, decreased bone density, and in rare cases thyroid storm, which is a life threatening situation. On the other hand, myxedema is a severe form of hypothyroidism that can be life threatening, although it’s very rare.
6. The autoimmune triggers can differ. While there is an overlap of certain triggers, there can also be different triggers for different autoimmune condition. For example, while stress can be a factor with both Graves’ disease and Hashimoto’s, in the research it shows that it’s a greater factor with Graves’ disease. And while there is a case report suggesting that Blastocystis Hominis [3] might be a trigger of Hashimoto’s, nothing in the research suggests that it’s a potential trigger of Graves’ disease.
What Are The Similarities Between Graves’ Disease and Hashimoto’s?
So now that you know some of the differences between Graves’ disease and Hashimoto’s, let’s take a look at some of the differences:
1. They are both autoimmune thyroid conditions. Both Graves’ disease and Hashimoto’s are autoimmune conditions that affect the thyroid gland.
2. Most medical doctors don’t do anything to address the underlying cause of either condition. Every medical doctor knows that Graves’ disease and Hashimoto’s are autoimmune conditions, yet they never do anything to address the autoimmune component. Of course this comes down to their training in medical school, and fortunately some medical doctors are open minded enough to look into underlying causes, although not nearly enough.
3. It’s possible to reverse the autoimmune component. Although there are genetic factors behind autoimmune conditions, it still is possible to reverse the autoimmune component of both Graves’ disease and Hashimoto’s. This admittedly isn’t easy to do, as one needs to find and remove the autoimmune triggers, and since a leaky gut is a factor with autoimmunity it is also necessary to heal the gut.