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Hashimoto's vs. Hypothyroidism: What's the Difference?

A Look at Autoimmune Thyroid Disease and Underactive Thyroid Conditions

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Updated May 29, 2014

Written or reviewed by a board-certified physician. See About.com's Medical Review Board.

Hashimoto's vs. Hypothyroidism: What's the Difference?
Hashimoto's disease is a disease, and hypothyroidism is a condition. Hypothyroidism is most commonly caused by Hashimoto's disease, but the two terms are not interchangeable. Here is more information to help understand the difference.

HASHIMOTO'S DISEASE

Hashimoto's disease, sometimes known as Hashimoto's thyroiditis, autoimmune thyroiditis, or chronic lymphocytic thyroiditis, is an autoimmune disease. In Hashimoto's, antibodies react against proteins in the thyroid gland, causing gradual destruction of the gland itself, and making the gland unable to produce the thyroid hormones the body needs.

Diagnosis

Hashimoto's disease is typically diagnosed by clinical examination that demonstrates one or more of the following findings:

  • Enlargement of the thyroid, known as a goiter
  • High levels of antibodies against thyroglobulin (TG) and thyroid peroxidase (TPO), detected via blood test
  • Fine needle aspiration of the thyroid (also known as a needle biopsy), which shows lymphocytes and macrophages
  • A radioactive uptake scan, which would show diffuse uptake in an enlarged thyroid gland
  • Ultrasound, which would show an enlarged thyroid gland
Symptoms

Symptoms of Hashimoto's can vary. Some people have no symptoms whatsoever, and will have no demonstrable symptoms of the underlying condition. For many Hashimoto's patients, the thyroid becomes enlarged, a condition known as a goiter. The goiter can range from slight enlargement, which may have no other symptoms, to a substantial increase in size.

Some people with Hashimoto's, especially those with a larger goiter, may feel discomfort in the neck area. Scarves or neckties may feel uncomfortable. The neck may feel swollen or uncomfortably enlarged, even sore. Sometimes the neck and/or throat is sore or tender. Less commonly, swallowing or even breathing can become difficult if a goiter is blocking the windpipe or esophagus.

Hashimoto's typically involves a slow but steady destruction of the gland that eventually results in the thyroid's inability to produce sufficient thyroid hormone -- the condition known as hypothyroidism. Along the way, however, there can be periods where the thyroid sputters back to life, even causing temporary hyperthyroidism, then a return to hypothyroidism. This cycling back and forth between hypothyroidism and hyperthyroidism is characteristic of Hashimoto's disease. So, for example, periods of anxiety/insomnia/diarrhea/weight loss may be followed by periods of depression/fatigue/constipation/weight gain.

In some cases, the onset of Hashimoto's and elevation of antibodies will be accompanied by a variety of symptoms, including anxiety, difficulty sleeping, fatigue, weight changes, depression, hair loss, muscle/joint aches and pains, and fertility problems, among others.

Treatment

If a goiter causes difficulty swallowing or breathing, or is a cosmetic problem, then thyroid hormone replacement drugs (i.e., levothyroxine or natural desiccated thyroid) will usually be given to help shrink the thyroid. If drug treatment does not work, or the goiter is too invasive, then surgery to remove all or part of the thyroid may be recommended.

Except in the case of a goiter, most endocrinologists and conventional physicians will not treat Hashimoto's disease, as diagnosed by elevated antibody levels, unless other thyroid function tests such as TSH are outside the normal range.

There are, however, some endocrinologists, as well as holistic MDs, osteopaths and other practitioners, who believe that Hashimoto's disease -- as confirmed by the presence of thyroid antibodies -- along with symptoms, are enough to warrant treatment with small amounts of thyroid hormone.

The practice of treating patients who have Hashimoto's thyroiditis but normal range thyroid function tests is supported by a study, reported on in the March 2001 issue of the journal Thyroid. In this study, German researchers reported that use of levothyroxine treatment for cases of Hashimoto's autoimmune thyroiditis where TSH had not yet elevated beyond normal range (people who were considered "euthyroid") could reduce the incidence and degree of autoimmune disease progression.

In the study of 21 patients with euthyroid Hashimoto's Thyroiditis (normal range TSH, but elevated antibodies), half of the patients were treated with levothyroxine for a year, the other half were not treated. After 1 year of therapy with levothyroxine, the antibody levels and lymphocytes (evidence of inflammation) decreased significantly only in the group receiving the medication. Among the untreated group, the antibody levels rose or remained the same.

The researchers concluded that preventative treatment of normal TSH range patients with Hashimoto's disease reduced the various markers of autoimmune thyroiditis, and speculated that that such treatment might even be able to stop the progression of Hashimoto's disease, or perhaps even prevent development of the hypothyroidism.

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