Can You Be Both Hypothyroid and Hyperthyroid?

When You Seem to Have Symptoms of Both Conditions

by Mary J. Shomon

Frequently, readers write in frustration, stating that they have been diagnosed as hypothyroid, but have symptoms of both hypothyroidism and hyperthyroidism.

I'm gaining weight, exhausted all the time, and my hair is falling out, but I'm also having high blood pressure, my heart is racing all the time, and I get diarrhea. Can I actually be hypo and hyper at the same time?

The answer is yes. While you should always see your doctor regarding any concerns with blood pressure, heart rate, or other symptoms, here are some important factors to consider.

You Have Both Hashimoto's and Graves'

Some patients actually have both Hashimoto's and Graves' disease antibodies, which puts the thyroid into a push-pull situation, where it cycles up and down through hypothyroidism and hyperthyroidism. This is not a very common situation, but hypothyroidism patients who frequently have hyperthyroidism symptoms should ask their doctors for full antibody profiles to detect the presence of both Hashimoto's thyroiditis and Graves' disease.

Your Symptoms Aren't Textbook

Everyone who has hypothyroidism doesn't follow the typical course of symptoms. Some hypothyroidism patients will, for example, lose substantial amounts of weight - rather than gain weight. And others will have anxiety or panic attacks as a symptom of their condition.

You Have Dysautonomia

Imbalances in the autonomic nervous system - known as dysautonomia - are more common in autoimmune thyroid disease. In dysautonomia, the sympathetic system - part of the autonomic nervous system that controls the body's "fight or flight" reactions - becomes unbalanced. Symptoms of dysautonomia can include anxiety attacks and rapid heartbeat, among many other symptoms.

You're Having a Thyroiditis Flare

Some patients who have the autoimmune condition known as Hashimoto's thyroiditis are diagnosed during a period when they are hypothyroid. But in a thyroid that is failing due to autoimmune disease, the thyroid can frequently sputter into overdrive, then back into underactivity, and into overdrive again, as it "burns itself out" over time. You can, therefore, experience periods of overactivity - hyperthyroidism - even while your thyroid is underactive over time and generally on its way to burning itself out. So, you can experience hypothyroidism symptoms, but periodically have hyperthyroidism symptoms that also appear. And remember...hyperthyroidism symptoms don't "cancel out" your hypothyroidism symptoms...they more often are added to them.

At the same time, Hashimoto's can also mean that periodically, the thyroid experiences a flare-up, or "attack" of thyroiditis, which is frequently accompanied by symptoms such as palpitations. Noted thyroid expert Stephen Langer, M.D., who coauthored the popular thyroid book Solved: The Riddle of Illness with James Scheer, refers to thyroiditis as like an "arthritis of the thyroid." He explains that just as arthritis attacks the joints with pain and inflammation, thyroiditis can mean pain and inflammation in the thyroid for some sufferers. And in particular, during a thyroiditis attack, common symptoms you might experience are anxiety, panic attacks, heart palpitations and problems sleeping. - all common hyperthyroidism symptoms - as well as swelling in the thyroid area, and problems swallowing.

What Can You Do?

Generally, whatever the cause, some patients find relief from palpitations and rapid heartrate with beta blockers. Antianxiety drugs may also be a help in panic attacks and anxiety. Some patients find that they require treatment for particularly troublesome hyperthyroidism symptoms. For example, during periods when palpitations or high pulse become bothersome, drugs such as beta blockers - which lower heart rate and blood pressure and can slow or stop palpitations -- can be prescribed to help control symptoms. Sometimes, anti-anxiety drugs can be a help, and in some people, temporary use of sleeping pills may also be of assistance. On the natural end, some patients find that yoga, biofeedback, or breathing exercises can help with palpitations or rapid pulse.

One of the best treatments for dysautonomia symptoms is regular physical exercise, which calms down and regulates the autonomic nervous system. Palpitations are also responsive to acupuncture treatments. From a more nutritional medicine perspective, Dr. Langer suggests that patients experiencing thyroiditis and having trouble sleeping take calcium/magnesium, which are nutrients that have a sedative effect, along with a pain reliever to relieve inflammation -- buffered aspirin or ibuprofen -- before you go to bed, this might help. He's found that this helps about two-thirds of his patients suffering from nighttime thyroiditis symptoms.