What’s The Difference Between Hashimoto’s + Graves Disease? A Functional Medicine Look At These Two Common Thyroid Problems

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Thyroid disorders have a profound impact on millions of people across the world. Out of all of the various thyroid conditions, Hashimoto's disease and Graves' disease are two of the most prevalent thyroid problems that I see in my telehealth functional medicine clinic. While both disrupt thyroid function, they differ significantly in their symptoms, mechanisms, and treatments. So in order to start healing with the appropriate tools, it’s important that we break down the key differences between these two conditions.


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Hashimoto's Disease

Named after the physician who first discovered it in 1912, Hashimoto’s is an autoimmune disease that occurs when your body's immune system mistakenly attacks your thyroid, resulting in an underactive thyroid (also known as hypothyroidism) and impaired thyroid hormone production. Around 5 in 100 (1) Americans struggle with hypothyroidism, with Hashimoto’s being the most common. (2)

One of the tell-tale signs of Hashimoto's disease is the presence of specific antibodies including anti-thyroid peroxidase (TPO) and anti-thyroglobulin antibodies. These antibodies, produced by your immune system, attack the thyroid tissue, resulting in its inflammation and dysfunction over time. Symptoms of Hashimoto’s disease include:

  • Constipation
  • Fatigue
  • Weight gain
  • Brain fog
  • Poor concentration
  • Brittle hair and nails
  • Cold sensitivity
  • Muscle aches and pains
  • Anxiety or depression
  • Pale and dry skin
  • Hair loss
  • Heavy periods
  • Enlarged thyroid gland (goiter)

For a complete deep dive on Hashimoto’s disease, listen to my episode of The Art Of Being Well.

Graves' Disease

In stark contrast, Graves' disease is an autoimmune thyroid condition that results in an excessive production of thyroid hormones. Instead of an underactive thyroid as in the case of Hashimoto’s, Graves’ disease is characterized by an overactive thyroid - more commonly known as hyperthyroidism. 

While researchers don’t know exactly what causes Graves’ disease, they do know that with Graves’s disease there is a malfunction in the body’s immune system that produces antibodies that act like TSH (thyroid stimulating hormone). In healthy individuals, TSH directs your thyroid as to what to do. However, these “fake” antibodies masquerading as TSH can lead to an overproduction of thyroid hormones. Symptoms of Graves’ disease can include:

  • Muscle weakness
  • Trouble sleeping
  • Irregular heartbeat
  • Excessive sweating
  • Shaky hands
  • Weight loss
  • Enlarged thyroid (goiter)
  • Irregular heartbeat
  • Irritability
  • Anxiety
  • Low libido

For a complete guide to treating Graves’ disease, read my article here.

Distinguishing Hashimoto's and Graves' Disease

As we’ve learned, both Hashimoto's and Graves' diseases involve the immune system targeting the thyroid, however there are several key differences that set them apart. Here is how to easily tell these two conditions conditions apart: 

1. Hormone levels

Hashimoto's disease primarily leads to hypothyroidism, causing reduced thyroid hormone levels, whereas Graves' disease causes hyperthyroidism, resulting in excess hormone production.

2. Antibodies

Hashimoto's disease is associated with anti-TPO and anti-thyroglobulin antibodies, which attack the thyroid and inhibit production, while Graves' disease involves TSIs or TRAbs that stimulate thyroid hormone production.

3. Symptoms

Although some symptoms in Hashimoto’s and Graves’ can overlap, Hashimoto’s is more often associated with fatigue, weight gain and cold intolerance whereas Graves’ disease is associated with opposite problems like weight loss, rapid heart rate, and heat intolerance.

4. Treatment

In conventional medicine, Hashimoto's disease is managed primarily with hormone replacement therapy designed to stimulate hormone production, but instead the common treatments for Graves' disease focus on anti-thyroid drugs, radioactive iodine therapy, or surgery to slow down and regulate thyroid function.

Functional medicine thyroid labs

Since everyone’s biochemistry is unique and the fact that a lot of symptoms between these two thyroid conditions can overlap it can be difficult to make a diagnosis on symptoms alone. Therefore, running labs is the best way to determine with more certainty which of these conditions you are facing.

Unfortunately, most conventional thyroid labs still don’t give you an accurate picture of what’s really going on beneath the surface. They typically only look at a few thyroid biomarkers and their reference range is based on the statistical average of the population of that particular lab - which just happens to be other sick people. So even though your doctor might say your results are “normal”, it doesn’t mean you are in the clear. In functional medicine, we look at a narrower reference range in order to detect underlying thyroid dysfunctions as early as possible. Here is what we look for in an expanded thyroid panel:

  • TSH: Optimal range (1.8-2.5 mlU/L)
  • Total T4: Optimal range (6.0-12.0 mcg/DL)
  • T3 Uptake: Optimal range: (28-38%)
  • Total T3: Optimal range (100-180 ng/DL)
  • Free T4: Optimal range (1.0-1.5 ng/DL)
  • Free T3: Optimal range (3.0-4.0 pg/mL)
  • Reverse T3: Optimal range (9.2-24.1 ng/DL)
  • Thyroid Peroxidase (TPO) Ab: Optimal range (0-15 IU/mL)
  • Thyroglobulin Ab: Optimal range (0-0.9 IU/mL)

To learn more about thyroid labs and supplements, read my article here.

The Takeaway

Knowledge is power when it comes to your health, and understanding the many nuances between Hashimoto’s and Graves’ disease is vital for an accurate diagnosis and appropriate treatment. While both conditions are rooted in autoimmune thyroid dysfunction, the specific imbalances going on beneath the surface are distinct and often require a different approach for healing. 

In my telehealth functional medicine clinic, we look at the entirety of your health case, taking into consideration all aspects of your health case to uncover the root cause behind your thyroid problems. Through expanded thyroid panels and other labs, natural supplements, dietary changes, and lifestyle tools, we can help you overcome thyroid problems and put you on a path toward long-term, sustainable healing.

If you are struggling with any of these symptoms of thyroid dysfunction, schedule a telehealth consultation today to learn more about how we can help you with functional medicine. 

As one of the first functional medicine telehealth clinics in the world, we provide webcam health consultations for people around the globe.

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  1. National Institute of Diabetes and Digestive and Kidney Diseases “Hypothyroidism (Underactive Thyroid) Accessed January 2024. https://www.niddk.nih.gov/health-information/endocrine-diseases/hypothyroidism
  2. National Institute of Diabetes and Digestive and Kidney Diseases “Hashimoto’s Disease” Accessed January 2024. https://www.niddk.nih.gov/health-information/endocrine-diseases/hashimotos-disease


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Dr. Will Cole, DNM, IFMCP, DC is a leading functional medicine expert who consults people around the globe, starting one of the first functional medicine telehealth centers in the world. Named one of the top 50 functional and integrative doctors in the nation, Dr. Will Cole provides a functional medicine approach for thyroid issues, autoimmune conditions, hormonal imbalances, digestive disorders, and brain problems. He is the host of the popular The Art Of Being Well podcast and the New York Times bestselling author of Intuitive Fasting, Ketotarian, The Inflammation Spectrum and the brand new book Gut Feelings: Healing the Shame-Fueled Relationship Between What You Eat and How You Feel.

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