can you Have Graves and Hashimoto's at the same... - Thyroid UK

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can you Have Graves and Hashimoto's at the same time

Allie20 profile image
10 Replies


I have a diagnosis of Graves which they can’t seem to stabilise.

Spoke to GP the other day and she said that I had a TPO test done in May 22 I was not aware of this and that result was:

TPO 1020 range (0-25)

I will go and get a full print out as can only access last 60 days results online.

Does this make sense to anyone. GP says you can have both TPO & TRAb antibodies at the same time? Any understanding gratefully received 🙏

10 Replies
SlowDragon profile image

Yes you can

Normally this is managed by an endocrinologist

Standard treatment is Block (with Carbimazole) and replace (with levothyroxine)

Have you definitely had Graves’ disease confirmed by high TSI or Trab antibodies

Hashimoto’s frequently starts with transient hyperthyroid results and symptoms before becoming increasingly hypothyroid

Often this is misdiagnosed as Graves’ disease is tested during hyper phase

ESSENTIAL to also regularly retest vitamin D, folate, ferritin and B12

Have you had coeliac blood test done

Are you on strictly gluten free diet

SlowDragon profile image

post from 5 months ago shows definitely Graves’ disease

But few months previously…..very hypothyroid

SlowDragon profile image

reading through previous posts…..

You had extremely low B12, well below bottom of range

Negative for Pernicious Anaemia

Now on B12 injections

Are you also taking daily vitamin B complex to improve low Folate and will help maintain B12 between injections

As you have B12 injections it’s recommended also to supplement a good quality daily vitamin B complex, one with folate in (not folic acid)

This can help keep all B vitamins in balance

Difference between folate and folic acid

Many Hashimoto’s patients have MTHFR gene variation and can have trouble processing folic acid.

B vitamins best taken after breakfast

Thorne Basic B recommended vitamin B complex that contains folate, but they are large capsules. (You can tip powder out if can’t swallow capsule) 

IMPORTANT......If you are taking vitamin B complex, or any supplements containing biotin, remember to stop these 7 days before ALL BLOOD TESTS , as biotin can falsely affect test results

In week before blood test, when you stop vitamin B complex, you might want to consider taking a separate methyl folate supplement

if not had coeliac blood test….push GP to run test now BEFORE considering trial on strictly gluten free diet

Allie20 profile image
Allie20 in reply to SlowDragon

sorry was PennyAnnie not u SlowDragon who responded the other day 🙂

Allie20 profile image

Thank you Slow Dragon for your response

I’ve been flipping between hyper and hypo since end of 2020 but due to covid only had GP on phone who wouldn’t test me for thyroid until June 2021 after 3st weight loss. They don’t seem to be able to stabilise me I did have TRAb antibodies tested but didn’t realise until 2 days ago about TPO being tested when spoke to GP again as they are concerned about my AIP levels in my liver . GP says can have both antibodies!

I will go to Surgery and get results printed this week or next. So can get more information

Yes had 2 weeks of B12 and that’s all they offered with a retest 6mths later. GP has agreed to test it again in October along with my ferritin, folate, magnesium,selenium, and zinc.

I was unaware about seriousness of the vits and their importance until the other day from SlowDragon . I’ve looked at some vits but don’t understand which are good as some seem a waste of time and money from H&B & supermarkets

I had a test for coeliac which came back negative

I get to see a Endo mid November who will talk about block and replace then.

This is all so complicated and is taking time to get my head around and absorb so much information.

Thanks for your time, sharing your knowledge and understanding very much appreciated 🙏

SlowDragon profile image
SlowDragonAdministrator in reply to Allie20

if you need B12 injections you will need them REGULARLY….usually one every 3 months (chosen purely arbitrarily)

Many people find they need B12 injection more frequently

But you might find that taking vitamin B complex is enough between 3 monthly injections

Or you might do fine on vitamin B complex and a separate B12 as well

Suggest you test full thyroid and vitamins 3 months after last B12 injection

SlowDragon profile image
SlowDragonAdministrator in reply to Allie20

Gluten intolerance is extremely common with Hashimoto’s and Graves’ disease

Hashimoto's affects the gut and leads to low stomach acid and then low vitamin levels 

Low vitamin levels affect Thyroid hormone working 

Poor gut function can lead leaky gut (literally holes in gut wall) this can cause food intolerances.

Most common by far is gluten.

Dairy is second most common. 

According to Izabella Wentz the Thyroid Pharmacist approx 5% with Hashimoto's are coeliac, but over 80% find gluten free diet helps, sometimes significantly. Either due to direct gluten intolerance (no test available) or due to leaky gut and gluten causing molecular mimicry (see Amy Myers link) 

Changing to a strictly gluten free diet may help reduce symptoms, help gut heal and slowly lower TPO antibodies 


As you coeliac test is negative you can consider trialing strictly gluten free diet 

Trying gluten free diet for 3-6 months. If no noticeable improvement then reintroduce gluten and see if symptoms get worse

Non Coeliac Gluten sensitivity (NCGS) and autoimmune disease

The predominance of Hashimoto thyroiditis represents an interesting finding, since it has been indirectly confirmed by an Italian study, showing that autoimmune thyroid disease is a risk factor for the evolution towards NCGS in a group of patients with minimal duodenal inflammation. On these bases, an autoimmune stigma in NCGS is strongly supported

In summary, whereas it is not yet clear whether a gluten free diet can prevent autoimmune diseases, it is worth mentioning that HT patients with or without CD benefit from a diet low in gluten as far as the progression and the potential disease complications are concerned

Despite the fact that 5-10% of patients have Celiac disease, in my experience and in the experience of many other physicians, at least 80% + of patients with Hashimoto's who go gluten-free notice a reduction in their symptoms almost immediately.

Allie20 profile image
Allie20 in reply to SlowDragon

Thankyou SlowDragon

This is a lot of information to take in I will need to read over the weekend to begin to get a understanding.

Thank for sharing your knowledge and understanding appreciated 🙏

Bluebell999 profile image

Yes you can! I was hypo for 18 years stable on 150 mcg when over the last four years the ranges were all out and levo gradually reduced and stopped. My TPO antibodies were 575, anything over 34 is positive. I finally saw an endo who ordered the TRAb test which was also positive.

So, I did have Hashis and now I have Graves, apparently rare but not unheard of. No levo but prescribed Carbimazole, (which is not agreeing with me at the moment with headaches, bone pain and nausea) I'm waiting for an ultrasound on my thyroid to find out what is going on.

Good luck on your journey. It sounds like we are both medical anomalies!

Allie20 profile image
Allie20 in reply to Bluebell999

Hi Bluebell999

Thank you for your response

Lol! Story of my life being an anomaly.

It just seems every few myths I flip between hyper & hypo. I was in carbimazole only 20mg which kept being reduced over time then it was stopped then 6-8 was of nothing GP hoping to see if thyroid would reset itself which it didn’t. Was then put on PTU. I’m just hoping that Endo will have some answers when I see them.

Thanks again for sharing your experience much appreciated 🙏

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