3 differences between hypothyroidism and Hashimoto’s

If you’re reading my nutrition blog, chances are you’ve been told you have hypothyroidism, Hashimoto’s autoimmune thyroiditis, or another chronic health condition that impairs your quality of life in one way or another. Maybe you’ve been told you have an underactive thyroid and to take medication for hypothyroidism, yet your most troubling symptoms haven’t resolved despite starting treatment. Or perhaps you suspect you could have Hashimoto’s and you’re interested in modifying your diet and lifestyle to reduce your risk of developing hypothyroidism in the future. 

These are all incredibly common scenarios — and they’re ones I see regularly in my nutrition practice. Thyroid patients are frequently told by physicians that their most troubling hypothyroidism symptoms are due to a thyroid hormone deficiency (in other words, an underactive thyroid gland); however, they’re not told why this is. They have no idea that Hashimoto’s — an autoimmune disease that causes the immune system to attack the thyroid gland — is at the root of about 90 per cent of hypothyroidism cases! 

As someone who has personally suffered from both Hashimoto’s and hypothyroidism, I know how confusing it is to be diagnosed with a thyroid-related medical condition. I also understand how scary and overwhelming it is to be diagnosed with an autoimmune disease. 

To clear up some confusion this Thyroid Awareness Month, this blog post discusses the three main differences between hypothyroidism and Hashimoto’s autoimmune thyroiditis. If you have additional questions and would like personalised guidance and support as you work to regain control of your health, please book a free 30-minute health review with me. 

Difference #1: Hashimoto’s as an autoimmune disease

This difference between hypothyroidism and Hashimoto’s thyroiditis is perhaps the most important to understand, as autoimmune thyroid diseases (such as Hashimoto’s and Graves’) must be approached differently than non-autoimmune thyroid conditions (like hypothyroidism and hyperthyroidism). There are a few reasons for this.

Firstly, Hashimoto’s autoimmune thyroiditis occurs when the immune system attacks the thyroid gland as if it were a foreign invader (examples of true foreign invaders include viruses, harmful microbes, and parasites). This causes the immune system to mistakenly create antibodies against its own cells (in this case, healthy thyroid cells). 

Secondly, over time these autoimmune attacks can damage the thyroid gland along with the thyroid cells responsible for producing and secreting the hormones we need for optimal thyroid function. This can eventually lead to hypothyroidism — an underactive thyroid gland — and a thyroid hormone deficiency (we’ll look at this a bit more closely in the next section). Once this happens, some of the more common hypothyroidism symptoms may begin to creep up on us (like fatigue, brain fog, dry skin, and thinning hair or eyebrows). 

Difference #2. Diagnosing hypothyroidism requires thyroid hormone testing

Since Hashimoto’s is an autoimmune disease and not a thyroid disorder, thyroid hormone testing alone can’t tell you whether your immune system is attacking your thyroid gland and contributing to your symptoms. Antibody testing is needed to answer this question, as these tests measure the levels of thyroid antibodies in your blood. In some cases, thyroid ultrasounds and biopsies are used as well. 

The antibody tests used to diagnose Hashimoto’s autoimmune thyroiditis include:

• Thyroid peroxidase (TPO) antibodies.
• Thyroglobulin (TG) antibodies.

However, to diagnose hypothyroidism — an endocrine disorder affecting the thyroid gland — thyroid hormone testing is needed. These tests are used to diagnose a thyroid hormone deficiency (an underactive thyroid) and determine whether hypothyroidism treatment is needed. 

Thyroid hormone tests are also commonly used alongside antibody tests to assess thyroid gland function during the diagnosis of Hashimoto’s.

The blood tests used to diagnose hypothyroidism and assess thyroid gland function include:

• Thyroid-stimulating hormone (TSH).
• Free triiodothyronine (FT3).
• Free thyroxine (FT4).

High or low thyroid hormone levels can indicate hypothyroidism, specifically when TSH levels are elevated but FT3 and FT4 levels are low. However, a rare type of hypothyroidism known as central hypothyroidism may be suspected when TSH levels are normal but FT3 and FT4 are low. 

To summarise, it’s best to run a full thyroid blood panel whenever hypothyroidism is suspected. Combining thyroid hormone testing with antibody testing can be used to determine whether someone has hypothyroidism, Hashimoto’s autoimmune thyroiditis, or both conditions. Thyroid hormone testing can also be used to confirm a diagnosis of hyperthyroidism (overactive thyroid). 

Difference #3. Treating Hashimoto’s autoimmune thyroiditis is more complex than treating hypothyroidism symptoms alone

While thyroid hormone replacement therapy is often an effective hypothyroidism treatment for many patients without autoimmune thyroid disease, medication alone typically isn’t enough when someone has Hashimoto’s. Treating Hashimoto’s autoimmune thyroiditis is much more complex and requires a multifaceted approach that includes medication, dietary and lifestyle changes, environmental toxin avoidance, detox strategies, targeted supplementation, and stress management. 

That said, managing the symptoms associated with hypothyroidism and Hashimoto’s depends largely on the root causes (for example, whichever factors are causing the immune system to attack the thyroid gland). Three main factors contribute to the development of autoimmune disease: genetic susceptibility; leaky gut (which may or may not be present when autoimmunity is triggered); and prolonged exposure to environmental triggers like inflammatory foods, moulds, viruses, and polluted water. 

Identifying and addressing our own unique triggers is the first step toward managing Hashimoto’s and hypothyroidism symptoms — and for many people — following an elimination diet like the Autoimmune Protocol (AIP) can be hugely beneficial at this stage. A recent study published in the Annals of Agricultural and Environmental Medicine found that Hashimoto’s patients were able to modify their thyroid parameters and decrease their body weight, thyroid gland volume, and symptoms of malaise after following the AIP diet for just 12 weeks! They also reported an improved quality of life overall. 

I can attest to the AIP approach to eating for hypothyroidism, Hashimoto’s, and other autoimmune diseases, as my nutrition clients experience a 74 per cent reduction in their autoimmune symptoms, on average!  

Modified AIP: less restrictive, just as effective

Although the AIP approach to eating for hypothyroidism and Hashimoto’s has traditionally consisted of removing all grains, dairy products, legumes, and seeds, I’m excited to announce a new, less-restrictive version of the original Autoimmune Protocol: Modified AIP. 

Unlike the original Autoimmune Protocol (known as Core AIP), Modified AIP includes foods such as rice, pseudo-grains, ghee, legumes (except for soy), and seeds (coffee and tea included). The inclusion of these foods makes this modified version of the diet much more accessible for many autoimmune patients, especially those experiencing barriers such as cost, accessibility, time, and dietary restrictions. 

Moving forward, clients interested in implementing the AIP diet can choose to embark on either version of the protocol. I can help them choose the best option based on their specific situation. The AIP approach to eating can benefit clients with Hashimoto’s disease, hypothyroidism, and other autoimmune conditions as well! 

Where to Go From Here

Since Hashimoto’s can damage your thyroid gland and increase your risk of developing hypothyroidism, knowing whether you have thyroid antibodies in your blood is super important — especially if you’re already experiencing thyroid symptoms. Having Hashimoto’s disease isn’t a guarantee that you’ll develop hypothyroidism in the future, but it does increase your risk. 

Plus, since Hashimoto’s thyroiditis also increases your risk of developing other chronic health conditions, knowing whether you have autoimmune thyroid disease can help you prevent hypothyroidism and reduce your risk of developing other, more serious autoimmune diseases as well. 

Are you ready to regain control of your health? Book your free 20-minute inquiry call let’s work together on a path to better health.