Graves’ Disease vs. Hashimoto’s: What’s The Difference? A Functional Medicine Look

Thyroid disorders have a profound impact on millions of people across the world. Out of all of the forms of thyroid disease, 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 look at the key differences of Graves’ disease vs Hashimoto’s.

What is Hashimoto’s Disease?

Named after the physician who first discovered it in 1912, Hashimoto’s (also known as Hashimoto’s thyroiditis) 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 healthy thyroid cells and 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)

LISTEN: Hashimoto’s Deep Dive: Shocking Causes, Surprising Symptoms + Natural Remedies For This Autoimmune Thyroid Condition (Mentally & Physically!)

What Is 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 — though genetics and family history often play a role — 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
• Difficulty sleeping
• Irregular heartbeat
• Excessive sweating
• Shaky hands
• Weight loss
• Enlarged thyroid (goiter)
• Bulging eyes (thyroid eye disease or Graves’ ophthalmopathy)
• Irregular heartbeat
• Nervousness
• Irritability
• Anxiety
• Low libido

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

Distinguishing Graves’ Disease vs Hashimoto’s

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: 

Hormone levels

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

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.

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.

Treatment

Conventional medicine approaches treatment to these two thyroid conditions by focusing on symptoms rather than truly addressing the root cause. While treatment is aimed at the thyroid hormones, it isn’t necessarily getting to the reason why the thyroid hormones are operating the way that they are in the first place.

Hashimoto’s treatment

In conventional medicine, Hashimoto’s disease is managed primarily with hormone replacement therapy designed to stimulate hormone production, such as levothyroxine.

Graves’ disease treatment

On the flip side, the common conventional treatments for Graves’ disease focus on anti-thyroid drugs like methimazole or propylthiouracil, beta-blockers to manage symptoms, radioactive iodine therapy to reduce thyroid hormone production, or surgery to slow down and regulate thyroid function. Goiters (when your thyroid is enlarged due to inflammation) are a key characteristic of this condition and can be surgically removed if a person is not able to take anti-thyroid medication.

A functional medicine approach to both

Since both conditions are classified as autoimmune disorders, a lot of what we focus on in functional medicine is lowering inflammation — a hallmark of most all autoimmune conditions. A functional medicine practitioner will take into consideration your thyroid levels, current diet, nutrient deficiencies, toxin exposure, and overall lifestyle to determine what is happening underneath the surface and exactly how to address it. Natural supplements, an elimination diet, food medicines, and detox protocols are all things that may be incorporated into a comprehensive healing plan.

SHOP: For those struggling with Hashimoto’s or a sluggish thyroid, I know how difficult it can be to find a high-quality supplement to support your thyroid hormones. That’s why I specifically formulated Thyroid Complex, a comprehensive BSE-free, bovine, multi-glandular, mineral and herbal formula to support healthy 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 and comprehensive blood tests 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)

READ MORE: Thyroid Health: Your Complete Functional Medicine Guide To Supplements, Diet & More

Risks of Both Conditions

If not managed properly, both Graves’ disease and Hashimoto’s can develop into more serious complications. Since every single cell of your body needs thyroid hormones to function, this is certainly not a complete list of all the areas of your health these conditions can affect, but these are some of the most immediate, and life-threatening. complications.

Hashimoto’s complications

When hypothyroidism is allowed to continue, over time it can lead to high blood pressure, high cholesterol, heart disease, an increased risk for thyroid cancer, and in rare cases myxedema, a type of hypothyroidism that results in slow pulse, decreased body temperature, cognitive impairment, and even death.

Graves’ disease complications

Unchecked Graves’ disease can lead to osteoporosis, impact fertility and pregnancy, cause a decrease in muscle strength and mass, and result in cardiovascular problems like stroke, heart failure, and blood clots. If thyroid levels reach a certain level for too long, it can also lead to thyroid storm — a condition marked by extreme symptoms of hyperthyroidism that require immediate medical attention such as high fever, racing heart above 140 beats per minute, shaking, confusion, and martial fibrillation.

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. 

Photo: Unsplash.com

Sources

• National Institute of Diabetes and Digestive and Kidney Diseases. (2021, March). Hypothyroidism (underactive thyroid). https://www.niddk.nih.gov/health-information/endocrine-diseases/hypothyroidism
• National Institute of Diabetes and Digestive and Kidney Diseases. (2021, June). Hashimoto’s disease. National Institutes of Health. https://www.niddk.nih.gov/health-information/endocrine-diseases/hashimotos-disease