Hashimoto's causes hyperthyroidism?

[CraftyGamer19]

Hi, I was diagnosed with Hashimoto's thyroiditis nearly 2 years ago. My whole life I've had fatigue, depression, and constipation, but also periods of hot flashes, anxiety and sweating.

My endocrinologist explained it by saying that the thyroid gland is being destroyed by my body and every once in a while, that destruction causes a piece of tissue to break down, which releases a bunch of thyroid hormone into my body. He said that is why sometimes I feel hyperthyroid.

I didn't question that until I found out that a person can actually alternate between Hashimoto's and Graves' disease because they have the antibodies that indicate both disorders. So I started researching and I can't find anyone who has the same experience with Hashimoto's - alternating between hyper and hypothyroidism. So I'm starting to think maybe I have Graves' as well? I was tested for Thyroglobulin antibodies, which gave me the Hashimoto's diagnosis, but I was never tested for TSH antibodies, which would indicate Graves'.

So I guess I'm just wondering if anyone else has had the same experience? Is it true that someone with Hashimoto's can have hyperthyroidism and hypothyroidism?

[Buddy195 Administrator]

Hi CraftyGamer19, although a very small number of people have antibodies for both Graves & Hashimotos, this is very rare. I was initially diagnosed as Graves as I presented as ‘hyperthyroid’ (weight loss, palpitations, tremor, overwhelming anxiety, plus a diagnosis of Thyroid Eye Disease, which is more common with Graves). However, following forum advice to test antibodies privately, I actually am hypothyroid with Hashimotos. If my thyroid medication or key vitamins (folate, ferritin. Vit D and Vit B12) are not optimal my ‘hyper’ symptoms return, but this is not the same as hyperthyroidism. Can you share your recent thyroid blood tests, plus key vitamins and antibodies (if you have these), so members can best advise.

[Valarian in reply to Buddy195]

Do you have any recent results from a time when you were hyper ? It’s possible, but quite rare to suffer from both, but the thing is, even if you do have both Graves’ and Hashi’s, the only treatments available are to try to bring the hormone levels within reference range. For Graves’, that means antithyroid treatment to inhibit hormone production or ‘definitive’ treatment to destroy/partially destroy the thyroid. There seems little point in the latter when Hashi’s is doing the job anyway, so eventually the thyroid will be incapable of the uncontrolled levels of hormone production typical of active Graves’.

In healthy people, hormone production is regulated by TSH. When hormone levels are low, the pituitary gland will increase TSH levels which tells the thyroid to produce more hormone. When thyroid levels are normal or high, TSH levels will reduce, telling the thyroid to decrease or stop production. If you have Hashi’s, this signalling loop usually works fine, but the diseased thyroid struggles to meet the production level required. If you have Graves’ however, the antibodies effectively usurp the job of TSH (which is typically suppressed to the point where levels barely register). Unlike the TSH/pituitary loop, Graves’ antibodies carry on telling the thyroid to produce more hormones even when there is enough in the system. Antithyroid treatment works by inhibiting thyroid hormone production, but note it can’t do anything about the excess hormones already in the body.

As your GP explained, the hyper phases people with Hashi’s experience are caused by a lot of existing hormones from the diseased thyroid being dumped into the system at once. Antithyroid medication won’t help with this. Although antithyroid medication could prevent further production of new hormone, in most people with Hashi’s, the TSH/pituitary loop will deal with this anyway. Hyper phases in people with Hashi’s are self-limiting in that once the ‘dumped’ hormone is exhausted, normal hormone production will resume, albeit probably at a lower level than required, hence the need for levothyroxine.

If you have Hashi’s and Graves’ simultaneously, the hyper phase could be caused by either. There have been a few people here in the past confirmed to be in this position who may be able to advise, or at least explain how they were treated. Mostly it’s a case of treating whichever condition is dominating at a given period. Since your thyroid is being damaged by the Hashi’s, its ability to produce the massively over the range thyroid levels typical of untreated Graves’ is in any case likely to diminish over time.

[CraftyGamer19 in reply to Valarian]

Okay, thank you. I had before never read anything that says Hashi's patients frequently feel symptoms of hyperthyroid. I've only ever read that it causes hypothyroid symptoms, so it's helpful to know that I'm not the only one.

[Valarian in reply to CraftyGamer19]

I don’t know that it’s frequent, just that it does happen

[greygoose]

To be honest, I'm not quite sure what you're asking, here.

My whole life I've had fatigue, depression, and constipation, but also periods of hot flashes, anxiety and sweating.

That sounds like classic Hashi's - pretty much my experience, too - if you had Grave's, you would be permanently hyper. And your endo's explanation sounds pretty good - for a doctor! (I've heard a lot worse.) So, why do you think you might have Grave's?

[Zazbag in reply to greygoose]

This is what she is asking:

"So I guess I'm just wondering if anyone else has had the same experience? Is it true that someone with Hashimoto's can have hyperthyroidism and hypothyroidism?"

[greygoose in reply to Zazbag]

Thank you.

[tattybogle]

yes a very few people do have genuinely have 'both' and alternate between them for distinct periods in their life , but this is characterised by periods of becoming actually hyperthyroid .. and sometimes having periods of not needing any levo at all and remaining euthyroid without meds ... then going the other way again . It really is pretty rare.

If this was the case for you you would expect to be able to see it in your history...eg. periods of hyperthyroid (Graves )blood results .. very high T4/T3 levels /supressed TSH, accompanied by severe hyperthyroid symptoms bad enough to require treatment ( more than hot flashes /sweating/anxiety .. i'm talking ~unexplained weight loss/ tachycardia muscle wastage/weakness diarrhoea etc) ... then remission , then a hypothyroid diagnosis.. Raised TSH /low T4....then stability on levo for quite a long while , then appearing to become increasingly 'overmedicated' on levo with T4/T3 going over range .. requiring reducing, then stopping levo, but T4 /T3 continuing to be over range for months without taking any levo at all , and possibly needing carbimazole to reduce T4/3 levels .. then going into 'remission' and being ok for a bit with no meds at all .. then becoming properly hypothyroid again with over range TSH / low T4/3 .. and needing levo again .

This is not the same situation as 'feeling some hyper symptoms sometimes at the same time as having hypo bloods and being treated with levo ' .. or ' periods of having higher T4/T3 lower TSH as a result of autoimmune attack , needing frequent levo dose adjustment'..... these situations are much more common and do not indicate that someone has 'both' Graves and Hashimoto's .

However it's an interesting subject , about which not a lot is known, so if you have funds to get your TRab tested it would be interesting to see if you do have any TRab .

There are 3 sorts of TRab (Thyroid Stimulating Hormone Receptor antibodies) :

Stimulating (TSab )

Blocking (TBab )

and neutral/cleavage .

Most 'TRab' lab tests currently count both stimulating and blocking TRab antibodies in their result .. making it very difficult to get a test that actually confirms you have any of the blocking sort ... but a 'TSI' test does test for just the stimulating sort (Thyroid Stimulating Immunoglobulin assay )

Tania S Smith, writes very well on this subject ~ antibodies /the spectrum of autoimmune disease . etc on this 'Thyroid Patients Canada' site ... if you haven't already found it .. it's well worth having a look around some of their pages:

thyroidpatients.ca/home/sit... site-map ~look under 'category :Thyroid Autoimmunity'

eg:

thyroidpatients.ca/2020/04/...

remissions-and-fluctuations-trab/

thyroidpatients.ca/2020/04/... the-spectrum-of-thyroid-autoimmunity/

thyroidpatients.ca/2020/04/... the-spectrum-of-thyroid-autoimmunity/2/