hypothyroidism v hashimotos

Let’s wrap up Thyroid Awareness Month by shining some light on the three conditions that can affect your thyroid: Hyperthyroidism, Hypothyroidism, and Hashimoto’s.

Your thyroid is one of the most important organs in your body. This small, butterfly-shaped gland located at the front of your neck below the Adam’s apple is responsible for producing the hormones that regulate your energy, mood, and metabolism, along with several other bodily functions. Basically, the thyroid is the powerhouse of your body!

Every cell has a thyroid hormone receptor on it, which means that when your thyroid isn’t functioning well (whether it’s underperforming or over-performing), there are vast impacts body-wide. Let’s talk about what that can look like symptom-wise, and what we can do to help the body once we’ve determined whether Hyperthyroidism, Hypothyroidism, or Hashimoto’s is the culprit at play.

The 3 H's

What is Hyperthyroidism?

Hyperthyroidism is where the body produces too much thyroid hormone. This condition is actually more rare than hypothyroidism or Hashimoto’s. One of the most common causes of hyperthyroidism is Graves Disease: an autoimmune disorder in which the immune system attacks the thyroid and causes it to produce too much thyroid hormone. Additionally, inflammation of the thyroid, taking too much iodine, or having overactive thyroid nodules can all lead to the overproduction of thyroid hormone.

When our thyroid is overactive, typically we see symptoms including anxiety, diarrhea, weight loss, hair loss, excessive sweating, irritability, and sometimes eye inflammation (such as bulging and redness). Hyperthyroidism can also hugely impact the heart. It can lead to an elevated heart rate, changes in blood pressure, or palpitations, which can be uncomfortable and problematic for the heart long-term. If you’ve been experiencing long standing anxiety along with these physical symptoms, it’s important that your mental health and cardiovascular health are properly assessed when evaluating for hyperthyroidism!

What is Hypothyroidism?

Contrary to hyperthyroidism, Hypothyroidism is the condition where your thyroid doesn’t create enough thyroid hormones. While this condition can affect anyone at any age, women are more likely to have symptoms of hypothyroidism than men. It is also more common for hypothyroidism to develop in postmenopausal women.

Symptoms of hypothyroidism tend to develop slowly — it’s unfortunately quite common for this to go undiagnosed for years. It can also be difficult to get a proper diagnosis, because these symptoms can easily be confused with other conditions. With an underactive thyroid, and thus a slowing metabolism, we typically notice fatigue and weight gain symptoms first. Other symptoms include constipation, sensitivity to cold, muscle weakness, dry skin, brittle hair and nails, slowed heart rate, depression, and irregular menstrual cycles.

Hypothyroidism vs Hashimoto's

The most common cause of hypothyroidism is Hashimoto’s disease (aka Hashimoto’s Thyroiditis) — an autoimmune disease in which the immune system attacks the thyroid and prevents it from producing enough thyroid hormone.

It is estimated that 90% of hypothyroidism is actually undiagnosed Hashimoto’s thyroiditis, which oftentimes has MORE symptoms like joint or muscle pain, significant brain fog, sensitivity to environmental factors or medication, and an enlarged thyroid. Additionally, Hashimoto’s is hereditary, so if we think this is the case, or could be a potential risk for you in the future, it’s especially important that your physician evaluates your family history, runs a comprehensive thyroid lab panel, and checks for antibodies against the thyroid.

Getting a Proper Diagnosis

diagnosing hypothyroidism


A simple TSH will simply not do! This is not even a direct way to look at your thyroid function; TSH is merely a messenger hormone sent from the brain to the thyroid, asking the thyroid to do its job. Even if TSH is “normal” your thyroid function may still be sub-optimal or distinctly out of range. The best way to evaluate thyroid function is to look at the hormones being released by the thyroid in addition to the messenger hormone. At a bare minimum, we want to be looking at TSH, Free T4, and Free T3.

Additionally, if you have any family history or personal history of Hashimoto’s, Grave’s disease, or autoimmunity, it is valuable to assess for antibodies against the thyroid as well. Minimal antibody testing should include Microsomal Thyroid Peroxidase (TPO) Antibody and Thyroglobulin Antibody, which are the most commonly elevated antibodies. These are not the only antibodies that the body is capable of making against the thyroid, but it is a good starting point to consider.


There is also a ton of value in evaluating the appearance of your thyroid via imaging. A thyroid ultrasound is non-invasive, typically inexpensive, and can give us a lot of insight on the size of the thyroid, blood flow, and cell texture, and can help us to see if there are any cysts, nodules, or masses present on or within the thyroid. If we don’t know what your thyroid looks like, we could be missing an important piece of the puzzle! Evaluating via ultrasound can help us to determine the best treatment strategies for your specific needs.

Putting a Plan in Place

Labs and imaging can give us part of the story, but not the whole story. It’s crucial to work with a healthcare provider who considers your whole health picture when putting together a treatment plan and knows the difference between all three conditions! With hyperthyroidism, for example, we may want to consider alternatives to thyroid medications and use other botanical or pharmaceutical options to suppress thyroid hormone production.

If we determine that hypothyroidism does not have an autoimmune component, we would want to continue assessing the thyroid and digging deeper to find where the symptoms are actually coming from; It could be linked to your adrenal function instead! In the case of Hashimoto’s, we would want to implement a treatment strategy that reduces antibody levels and thus reduces long-term damage to the thyroid so it remains functional for our lives.

Happy Thyroid, Happy Life

thyroid relief

To say the thyroid is important is an understatement. It is crucial for living a happy, healthy life! If you are experiencing symptoms of hyperthyroidism, hypothyroidism, or Hashimoto’s, it’s important to get a proper diagnosis so we can get your thyroid back on track for its executive job. Find a doctor who is well-versed in the 3 H’s, understands the intricacies of each, and can help you to navigate treatment strategies that will work for your lifestyle. If you’re ready to get some answers to your thyroid concerns, consider becoming a patient with us!