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Hashimoto’s Vs Hypothyroidism: Key Differences, Symptoms, And Treatments

09/03/2024 | by

Hashimoto’s and hypothyroidism are two diseases associated with impaired thyroid hormone production. Most cases of hypothyroidism are caused by Hashimoto’s thyroiditis due to the immune system’s attack on thyroid cells. While Hashimoto’s and hypothyroidism are closely connected, they are not the same disorder and require diagnosis. Due to their shared symptoms, blood tests and an ultrasound are used to evaluate whether you have either disease. In the majority of cases, thyroid hormone replacement is prescribed to treat both Hashimoto’s and primary hypothyroidism. In some instances, hypothyroidism may be due to hypothalamus or pituitary gland dysfunction.

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What is Hashimoto’s Disease?

Hashimoto’s belongs to a class of illnesses called chronic autoimmune disorders. Autoimmune disorders are illnesses in which the immune system fails to recognize cells or tissues in the body and attacks them.

Hashimoto’s can develop in anyone of any age, yet it is more likely in individuals assigned female at birth (AFAB) between the ages of 30-50.

In Hashimoto’s disease, the immune system attacks a small butterfly shaped gland in the front of our throat called a thyroid. Antithyroid antibodies and cell-mediated attacks lead to a fibrosis or scarring of the thyroid tissue. These attacks suppress the thyroid’s ability to properly produce thyroid hormones and decrease metabolic function as a result.

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Your thyroid is an important part of your endocrine system, responsible for producing hormones that regulate a myriad of bodily functions, including metabolism, digestion, and fertility.

What is Hypothyroidism?

Hypothyroidism is a condition with mainly mild and often unnoticeable symptoms. Hypothyroidism is the generalized term when there is too little thyroid hormone in your system. While hypothyroidism is characterized by low thyroid hormone levels, its causes and manifestations can vary widely in those who have been diagnosed with it.

In its most common form, hypothyroidism is associated with an underactive thyroid that is unable to produce the needed amounts of thyroid hormones. In very rare cases, hypothyroidism can be due to issues in the brain despite a normally functioning thyroid. Hyperthyroidism has causes that can develop in any stage in life including before and during birth. However, despite congenital and other causes of hypothyroidism, it is mostly prominent in both those AFAB and those over the age of 60.

No matter the type, hypothyroidism can significantly impact your health and quality of life. Thyroid hormones regulate processes such as metabolism, growth, development and brain activity. Understanding the difference between hypothyroidism and Hashimoto’s is important to identifying what you may be experiencing.

Key Differences Between Hashimoto’s and Hypothyroidism

Hashimoto’s and hypothyroidism are both associated with low thyroid hormone levels; however, the origin of each disorder is not identical.

Hashimoto’s is autoimmune in origin, meaning it is caused by the immune system recognizing thyroid cells as foreign. Antibodies attack the thyroid cells while white blood cells collect and begin to build up in the thyroid. While specific antibodies and other cells are still being identified, the mechanism involves the fibrosis of thyroid cells, reducing thyroid hormone production. Although the development of Hashimoto’s is still unclear, research suggests that genes and environmental triggers are responsible.

Hypothyroidism has two main causes: either underactive thyroid or impaired pituitary or hypothalamus function. In cases with underactive thyroid, the thyroid is unable to produce the adequate amount of thyroid hormones. Alternatively, when your hypothalamus or pituitary gland’s function is impaired, the brain can no longer send thyroid stimulating hormone to regulate the thyroid’s hormone production. Both primary and secondary hypothyroidism have multiple causes, including Hashimoto’s thyroiditis, radiation therapy, thyroid surgery, and a brain tumor.

Hashimoto’s and hypothyroidism can often share identical symptoms due to most primary hypothyroidism being caused by Hashimoto’s thyroid. If you’re feeling a combination of the following symptoms, you might want to reach out to a doctor:

  • Acne
  • Weight gain
  • Sudden and urgent mood changes (especially depressing or saddened thoughts)
  • Irregular menstrual cycles
  • Tiredness and/or extreme fatigue
  • Muscle and/or Joint pain

Because hypothyroidism can instead be indicative of a suppressed hypothalamus or pituitary gland, be mindful of the symptoms like:

  • Headaches
  • Nausea
  • Dizziness
  • Vision loss

Can You Have Hashimoto’s Without Hypothyroidism?

While Hashimoto’s is the main cause of primary hypothyroidism, it doesn’t always result in an underactive thyroid. In rarer cases of Hashimoto’s, the inflammation of the thyroid results in a temporary overactive thyroid or hyperthyroidism. This is almost always temporary, and most individuals with Hashimoto’s develop hypothyroidism over the course of the disease.

Diagnosing the Conditions

How to Diagnose Hashimoto's Disease

Diagnosis of Hashimoto’s usually begins with a discussion of symptoms followed by a series of tests. Diagnostic tests look for the primary indicators associated with an inflamed and underactive thyroid as well as an autoimmune response. Blood tests in those with Hashimoto’s show raised TSH levels in response to the low T4 thyroid hormone levels.

Additionally, antithyroid antibodies are present in 90% of Hashimoto’s cases; along with thyroid-specific antibodies and C-reactive protein, which would both increase as a result of thyroid inflammation. The size of your thyroid might also be assessed through a physical examination or ultrasound.

How to Know if You Have Hashimoto's or Just Hypothyroidism

If you’re experiencing symptoms associated with either of these diseases or you’ve recently been diagnosed with one of them, you may be wondering how connected they are. Differentiating between Hashimoto’s and hypothyroidism should always be a conversation between you and a trusted physician.

Because Hashimoto’s thyroiditis and hypothyroidism can share symptom profiles, diagnostic tests are used to help determine which disorder is present. Providers usually perform all the tests associated with Hashimoto’s to identify primary hypothyroidism. If the diagnostic results show low to normal levels of TSH and normal antibodies, it is usually indicative of a functioning thyroid and immune system.

Treatment Approaches

Standard treatment for primary hypothyroidism replaces thyroid hormone through medication. An oral prescription of thyroid hormone replacement should improve symptoms related to low T4 levels. Treatment options in cases of hypothyroidism with other causes require identifying and addressing the root disorder – for example, a CT scan revealing a tumor pressing on the hypothalamus.

The primary treatment for Hashimoto’s is to replace the low levels of T4 thyroid hormone. The common medication – levothyroxine – is biochemically identical to the T4 hormone produced by the thyroid. Alternative non-medicated treatments are often focused on avoiding dietary inflammation through nutrition.

Due to Hashimoto’s autoimmune origin and limited research on this option, it may not be suitable for everyone. Nonetheless, managing this condition can be improved through hormone balancing practices such as good nutrition and regular physical activity.

Frequently Asked Questions

How Does Treatment for Hashimoto's Differ from Hypothyroidism?

Because hypothyroidism doesn’t always involve an autoimmune response or thyroid inflammation, replacing thyroid hormone replacement therapy is not a treatment option for every case of hypothyroidism.

What Test Confirms Hashimoto's Disease?

Hashimoto’s is confirmed by the combination of multiple metrics in a blood test. These include high levels of TSH, low levels of T4 thyroid hormone, and positive inflammation markers (thyroid antibodies and C-reactive protein).

Conclusion

Hashimoto’s is an autoimmune disorder in which the immune system attacks the thyroid. The inflammation of the thyroid most often manifests as a suppression of thyroid hormone production. Hypothyroidism is usually classified by an underactive thyroid and the insufficient amount of thyroid hormone in the bloodstream.

In the majority of cases, Hashimoto’s develops into hypothyroidism, and the two disorders share a significant amount of symptoms. While some groups are more likely to develop these conditions anyone can and the causes are still being understood.

If you are experiencing some of these symptoms or have a family history of thyroid issues it’s important to discuss this with a trusted physician. Due to the most common mechanism of these diseases, the standard treatment option for primary hypothyroidism and Hashimoto’s thyroiditis is the prescription of levothyroxine to replace T4 levels.

However, hypothyroidism due to impaired hypothalamic-pituitary function is fixed through treatment of the primary disorder. The close interactions between these diseases makes it critical to consult with a healthcare provider for accurate diagnosis and treatment. Pinpointing any issues with your health and having informed guidance on treatment options can protect your medical autonomy and improve your quality of life.

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