Hypothyroidism and Hashimoto's Disease: The Difference

by Mary Shomon Patient Advocate

What is the difference between hypothyroidism and Hashimoto's?

Hypothyroidism and Hashimoto’s are not interchangeable terms. Hypothyroidism — an underactive, non-functioning, or missing thyroid gland — is a condition with many causes. Hashimoto’s disease — also known as Hashimoto’s thyroiditis — is an autoimmune disease, and is the most common cause of hypothyroidism in many parts of the world. Some people have Hashimoto’s disease — evidenced by elevated thyroid peroxidase (TPO) antibodies — without being hypothyroid. Most people with Hashimoto’s disease, however, do eventually become hypothyroid over time.

Hypothyroidism concept, digital pad and stethoscope.

Other triggers of hypothyroidism

In addition to Hashimoto's disease, other common causes or triggers of hypothyroidism include:

  • Surgery to remove all or part of the thyroid
  • Radioactive iodine (RAI) ablation therapy for Graves’ disease, hyperthyroidism, nodules, goiter, or thyroid cancer
  • Iodine deficiency or excess
  • Congenital defects in the thyroid gland
  • Certain medications, such as lithium
Levothyroxine pill bottle for treatment of hypothyroidism.

Hypothyroidism treatment

Hypothyroidism is treated by replacing the missing thyroid hormone with a thyroid hormone replacement drug. These prescription drugs include levothyroxine (i.e., Synthroid, Levoxyl, Tirosint), liothyronine (Cytomel), and natural desiccated thyroid (NDT) drugs (Armour, Nature-throid.)

woman holding throat.

Hashimoto’s thyroiditis

Hashimoto's thyroiditis is the most common autoimmune disease — and also the most common cause of hypothyroidism — in the United States.

In Hashimoto’s disease, the body manufactures antibodies that attack proteins in your thyroid gland. These antibodies can eventually slow down and destroy your thyroid gland’s ability to produce thyroid hormone, making you hypothyroid.

Busy stressed out man.

Hashimoto’s signs and symptoms

Some common signs and symptoms of Hashimoto’s thyroiditis include:

  • Fatigue
  • Weight gain
  • Depression and anxiety
  • Body and muscle aches and pains
  • Neck pain, discomfort, and sensitivity
  • Problems swallowing

Hashimoto’s can be definitively diagnosed by the presence of thyroid peroxidase (TPO) antibodies via blood test, or via pathological examination of thyroid biopsy samples.

Prescription pills in pill bottles

Conventional Hashimoto’s treatment

Conventional medicine traditionally offers no treatment for Hashimoto’s thyroiditis, unless your blood tests confirm hypothyroidism. If you have Hashimoto’s and are hypothyroid, you will likely be prescribed a thyroid hormone replacement drug, such as levothyroxine (i.e., Synthroid, Levoxyl, or Tirosint.)

immune system on track concept.

Low dose naltrexone for Hashimoto's

Another treatment option for Hashimoto’s disease is low dose naltrexone, also known as LDN. LDN therapy uses very low doses of naltrexone — a drug used at much higher doses to treat addictions — to modulate the immune system and lower antibodies. LDN — inexpensive and available as a generic drug — is considered safe at low doses, with few side effects. This treatment approach, however, is not widely understood or used by conventional physicians.

Brazil nuts in bowl, rich in selenium

Selenium for Hashimoto’s

Selenium supplementation at appropriate doses—less than 400 mcg from all supplement and food sources — has been shown to lower thyroid antibodies and, in some cases, to improve the conversion of thyroid hormones. The richest food source of selenium is Brazil nuts. Using selenium to treat Hashimoto’s is not widely known or used by conventional physicians.

Gluten free concept photo

Dietary changes for Hashimoto's

Dietary changes, such as following a gluten-free diet, are sometimes recommended as a treatment for Hashimoto’s thyroiditis. In some cases, underlying gluten sensitivity or celiac disease may be the trigger Hashimoto’s disease. In a subset of these patients, following a strict gluten-free diet may lower antibodies and put Hashimoto’s disease into remission. Other protocols, such as Phoebe Lapine's food-based approach to Hashimoto's, may be effective.

Mary Shomon
Meet Our Writer
Mary Shomon

Mary Shomon is a patient advocate and New York Times bestselling author who empowers readers with information on thyroid and autoimmune disease, diabetes, weight loss and hormonal health from an integrative perspective. Mary has been a leading force advocating for more effective, patient-centered hormonal healthcare. Mary also co-stars in PBS’ Healthy Hormones TV series. Mary also serves on HealthCentral’s Health Advocates Advisory Board.