What’s the difference between Hashimoto’s disease and hypothyroidism? You may have been told that you have one or the other, so I wanted to put together this helpful article to help you understand each and the differences between them.
The tricky part is that conversations around either are often overlapping and filled with many different nuances. So let’s add some clarity to the discussion!
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Let’s start with a little bit of context setting. Your thyroid gland is a small gland that sits just below our Adam’s apple, and it makes hormones (mostly T4 and T3). These hormones are important because they end up helping control how well we:
That all sounds pretty important, right? It is, but the issue is that the gland can make too little hormone. The amounts of thyroid hormone are microscopic, but they are critical.
Key Insight: The amount of thyroid hormone you may need is microscopic, but it could be lethal not to have it. Even in these tiny amounts, it affects your overall health and ability to function. The exact amounts are critical.
If you have too little hormone, we call that hypothyroidism. To understand the kind of effect that hypothyroidism can have, let’s start by thinking about what the thyroid does best.
If our thyroid controls our energy production and ability to burn fat if we lack that, we are tired – including subjective fatigue or not enjoying exercise.
We may even be able to see muscle pain or mood changes. Your brain is tired, so you’re not as enthusiastic, or you simply feel like you lack energy all the time.
Along with that poor energy production, you may also have cold intolerance. But hypothyroidism can be the culprit behind many symptoms, including:
The less common causes of hypothyroidism will most typically include thyroid surgery (the gland being removed), radioactive ablation of the thyroid, and certain medications. Still, in nearly all cases, the cause of hypothyroidism is something we call Hashimoto’s thyroiditis.
Hashimoto’s disease gets to the root of how most hypothyroidism occurs. It shows that immune cells, called lymphocytes, build up within the thyroid and destroy some tissue. Now, your thyroid is unable to operate as it should – causing issues with hypothyroidism.
We can see when Hashimoto’s is present with some tests, but there is no test that for sure rules out Hashimoto’s (or suggests that it is completely absent). Current estimates suggest that 95-97% of people with hypothyroidism are struggling with Hashimoto’s disease.
Key Insight: We know that Hashimoto’s is present if there are measurable thyroid antibodies. This means measuring things like anti-TPO or anti-thyroglobulin to get a definitive sense of whether Hashimoto’s is the core issue at hand.
Somewhere around a quarter of adults, a little bit more common in women and more common with age will present with an immune attack that can be directly attributed to Hashimoto’s. This is often done by measuring antibodies or evaluating the thyroid through ultrasound.
Here’s the thing about hypothyroidism. Sometimes, I wish we could start over and try out some new, more accurate names for these things. That’s because there are some very distinct degrees of hypothyroidism.
This means that, for as much as we use the term, there are many instances where we call something ‘hypothyroidism’ that should not be attributed to simply a lack of thyroid hormone. There are risks for an eventual lack, but the lack is not currently present.
Here’s the thing: Almost all versions lack that. This is where I want us to think in these different degrees, which include:
As you can see, these are three very different states. I’d love it if you only called the last bullet point true “hypothyroidism” – because calling the first two does not do them justice. And, in some cases, it can be dangerous to call them as such.
That’s because many people have Hashimoto’s, but only 1% of people or fewer have overt hypothyroidism. That is also the one situation where thyroid medications are irrefutably helpful.
The issue is that many doctors will give thyroid medications, even when the hormone is not lacking in them. While it might seem logical, there is so much evidence that suggests medications don’t help with symptoms and create their own set of risks.
Key Insight: Many people have Hashimoto’s, but very few of them have overt hypothyroidism. We need to expand how we think about hypothyroidism.
In the case of Hashimoto’s, you can lower thyroid antibodies by surgically removing the thyroid or by giving medications to suppress the immune system. While possible, that’s also a bit of a radical response to the situation.
That said, there is such good data that changes to diet, lifestyle, and supplements can meaningfully impact Hashimoto’s positively for your health. Even some clinical trials have shown that diet can reverse Hashimoto’s for almost 80% of people.
If you look at those who comply with the diet completely, that number jumps to around 95%. That’s a pretty high rate of success!
All of those symptoms that I mentioned stemming from hypothyroidism, you can experience the same even when you’re only struggling with Hashimoto’s. This is where confusion can typically crop up, but I want you to know that lifestyle and diet can help.
The truth is that hypothyroidism is usually not what you think it is, and in many cases, it is going to be more of a case of Hashimoto’s. The good news? We can fix that with a high degree of success; you only have to take the first step.
Here’s what you can do: Start by evaluating the state of your thyroid to get a real sense of what’s going on and what you can do about it. Then, I recommend starting to explore the changes you can make to positively impact your thyroid.
Some great places to start could be checking out The Thyroid Reset Diet, which I wrote with this exact situation in mind. Or, you can dive into my range of Thyroid Specific Supplements which can have a meaningful impact on your thyroid health.
In any event, I hope this article was helpful in outlining the differences between hypothyroidism and Hashimoto’s. If you’re struggling with your thyroid health, that gives you some renewed optimism and actionable steps you can take into the future.
P.S. Whenever you are ready, here is how I can help you now:
Dr. Alan Glen Christianson (Dr. C) is a Naturopathic Endocrinologist and the author of The NY Times bestselling Hormone Healing Cookbook, The Metabolism Reset Diet, and The Thyroid Reset Diet.
Dr. C’s gift for figuring out what works has helped hundreds of thousands reverse thyroid disease, heal their adrenals, and lose weight naturally. Learn more about the surprising story that started his quest.
