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
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