Hashimoto’s vs Graves’ Disease: Differences & Similarities

Hashimoto’s vs Graves’ Disease: Differences & Similarities

Let me start off by saying that both Graves’ disease and Hashimoto’s thyroiditis are completely different disease states. 

Despite there being a big difference between these two disease states there is a surprising amount of overlap between them as well. 

This is why many patients probably get confused. 

Perhaps the most simple way to think about these conditions is that one results in hyperthyroidism (Graves’ disease) and the other results in hypothyroidism (Hashimoto’s thyroiditis). 

And while this is a simple way to look at these conditions it doesn’t account for the nuances in both conditions and can still leave patients somewhat confused. 

Perhaps a better way to understand these thyroid conditions is to look at their similarities and their differences. 

And today we are going to do just that. 

You are going to learn…

  • The major differences between Graves’ disease and Hashimoto’s
  • Where there is significant overlap in these two thyroid conditions and where they deviate
  • Why the long-term consequences of both conditions tend to lead to the same condition (low thyroid)
  • The symptoms found in both conditions
  • More about the overlap in treatment options for both conditions
  • And more

Let’s jump in: 


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Both Conditions Are Similar and can Evolve Into One Another

To make matters more complicated, you should be aware that Hashimoto’s can turn into Graves’ disease and Graves’ can turn into Hashimoto’s. 

This has led many researchers to believe that these conditions are really two sides of the same coin.

To give you an idea of what I am talking about, consider these similarities: 

And while these similarities are quite profound, there are definitely some differences between the two: 

Hyperthyroidism vs Hypothyroidism: It’s Not That Simple

Unfortunately, as I mentioned previously, it’s not as easy as just looking at thyroid function to determine which condition you have. 

Instead, you must look at a combination of your symptoms, the trend of these symptoms, your antibody status, and even some other lab tests

The reason is simple:

BOTH conditions can result in hyperthyroidism. 

Graves’ disease is characterized by hyperthyroidism which means that almost everyone who has Graves’ disease (untreated) will experience HYPERthyroid symptoms

If you tried to determine which thyroid condition you had just on the basis of your thyroid hormone status you would be wrong a large percentage of the time. 


Because patients with Hashimoto’s can ALSO experience HYPERTHYROID symptoms even though that disease is primarily characterized by hypothyroid (low thyroid) symptoms. 

Any condition which results in damage or inflammation to the thyroid gland, regardless of the antibodies present, may cause hyperthyroid symptoms. 

And because Hashimoto’s is an inflammatory condition of the thyroid gland, there are some people who experience bouts of hyperthyroidism. 

And while the percentage of patients with Hashimoto’s who experience hyperthyroid symptoms is low, it still does happen. 

Which can make diagnosis difficult. 

Because of this, you should never use your symptoms as a means to diagnose which thyroid condition you have. 

In addition to your symptoms, you should also look at your thyroid antibody status. 

Antibodies that are typically associated with Graves’ disease include antibodies to the TSH-R whereas antibodies typically associated with Hashimoto’s thyroiditis include anti-TPO antibodies and thyroglobulin antibodies

Common Symptoms found in Graves’ Disease

While you would never want to use your symptoms alone, they can still be valuable. 

Because Graves’ disease is associated with the TSH-R antibody it tends to ACTIVATE the thyroid gland. 

This activation results in the overproduction of thyroid hormone from the thyroid gland. 

As this thyroid hormone is pumped out of your body you will begin to experience the symptoms of hyperthyroidism. 

And this is where things get interesting:

Thyroid hormone status exists on a spectrum. 

This means that each person who has Graves’ disease will not experience the exact same symptoms. 

Instead, the severity of their symptoms will depend on how much thyroid hormone is being pumped out of their thyroid gland. 

Some people with Graves’ experience significant hyperthyroid symptoms whereas other people experience more mild symptoms. 

One thing is for sure, though, as your thyroid turns on you will tend to experience these symptoms to some degree:

  • Anxiety and irritation
  • Heart palpitations and/or a rapid heart rate
  • Tremors in your hands and extremities
  • Hair loss including fine brittle hair
  • Diarrhea or frequent bowel movements
  • Weight loss and increased metabolism (it’s not as good as it sounds)
  • Heat intolerance with warm hands/feet
  • Soft nails which damage easily
  • Insomnia or difficulty sleeping
  • Frequent menstrual cycles (usually less than normal)
  • Infertility or inability to ovulate
  • Fatigue or low-energy
  • *Bulging eyes
  • Enlarge thyroid (from damage and inflammation)

These symptoms all indicate that you have TOO much thyroid hormone in your body and it’s important to remember that it’s possible to experience SOME of these symptoms if you have Hashimoto’s. 

The biggest exception in the symptom list is that of bulging eyes. 

Thyroid eye disease (1) tends to be reserved for people with Graves’ disease and occurs due to a different mechanism. 

So if you have that symptom then there’s a high probability that you are suffering from Graves’ disease and not Hashimoto’s. 

Common Symptoms found in Hashimoto’s Thyroiditis

Hashimoto’s thyroiditis tends to be associated with a different set of symptoms compared to that of Graves’. 

While both thyroid conditions can cause a fluctuation in thyroid symptoms, Hashimoto’s tends to be more frequently associated with LOW thyroid symptoms. 

Here’s how it happens:

Hashimoto’s thyroiditis results in damage to the thyroid gland. 

The more that your thyroid gland is damaged the less likely it is to produce a sufficient amount of thyroid hormone. 

Imagine smashing your finger with a hammer. 

What happens?

It swells up and while you can still bend it, it doesn’t bend quite as well as it used to before you smashed it. 

Now think about smashing your finger every day for 10 years. 

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That’s basically what is happening to your thyroid gland if you do not stop the damage and inflammation from the thyroid antibodies in Hashimoto’s. 

Eventually, all of this damage and inflammation is permanent and the thyroid can no longer produce enough thyroid hormone

This ultimately results in HYPOTHYROIDISM or low thyroid function. 

Just like Graves’ disease, the severity of your hypothyroid symptoms depends largely on how much damage has been done to your thyroid gland. 

If we line up 10 people and ask them about their symptoms we will no doubt hear that each one of them is fatigued

But the severity of that fatigue could range from mild fatigue that makes some people feel a little run-down to the kind of fatigue that keeps you stuck in bed. 

This applies to all of the following symptoms which are commonly found in Hashimoto’s. 

These symptoms are the exact opposite of those found in hyperthyroidism, by the way:

  • Fatigue or low-energy
  • Weight gain
  • Hair loss (usually dry and easily broken)
  • Dry skin
  • Constipation
  • Depression
  • Cold intolerance
  • Menstrual irregularities (lack of ovulation)
  • Infertility
  • Joint or muscle pain
  • Eyebrow hair loss
  • Slower than normal heart rate
  • Slowed metabolism
  • Enlarged thyroid which is usually not painful

There is some minor crossover in the symptoms of Graves’ disease including things like hair loss and fatigue, but for the most part, the symptoms are the exact opposite. 

You can typically identify which condition you have just by your symptoms alone. 

But remember:

In the early stages of Hashimoto’s, these symptoms can fluctuate over time. 

One month you may be hyperthyroid and the next month you may be hypothyroid. 

Ultimately, though, you will almost always end up with persistent hypothyroid (low thyroid) symptoms in the long run. 

Treatment Overlap in Both Conditions

Even though it may sound counterintuitive, there is quite a bit of overlap in terms of the treatment of these disease states. 

Don’t get me wrong, there are also big differences, but if you are attempting to address the root cause of both conditions then you will be focusing on the same system. 

And that system is the immune system or immune function. 

BOTH Graves’ disease and Hashimoto’s thyroiditis are, after all, autoimmune diseases (2). 

And these diseases stem from problems that occur in your body’s ability to accurately identify itself from other tissues. 

This component, the autoimmune component, is different from the treatment for the thyroid component. 

The thyroid component is where the treatments differ, but when we are talking about the immune system treatment, that’s where we see a lot of overlap. 

hashimoto's and graves are more similar than you think

Unfortunately, conventional doctors don’t have many good therapies available to address immune function. 

The best they have are steroids which naturally suppress immune function and other medications that attempt to shut down the immune response. 

Because of this, they typically will often ignore the immune component and skip straight to the thyroid hormone management area

When it comes to improving your immune system, you pretty much have to use more natural therapies. 

We will talk about the medications that are used to treat Graves’ disease and Hashimoto’s in a second so stay tuned for that. 

Natural Therapies to Boost Immune Function

Because doctors do not use medications to treat the immune component of Graves’ and Hashimoto’s, you will have to turn to more natural therapies.

But don’t worry because these natural therapies are actually quite effective and incredibly safe. 

Some therapies that I’ve seen work particularly well include:

  • Using zinc (over-the-counter supplement) – Zinc is involved in regulating your immune system (3) but it also plays an important role in thyroid function. While you are supplementing with zinc you might as well grab additional nutrients that help your thyroid function found in this multivitamin. 
  • Increasing your vitamin D level – Vitamin D also plays a very important role in immune function and most people with autoimmune problems have very low Vitamin D levels. You can easily improve your Vitamin D level with a vitamin D3 supplement
  • Reducing your exposure to chemicals and other environmental compounds – Chemicals require removal from your body and can cause inflammation and damage if they are stored or sequestered into your fat cells. Look at the type of soaps you are using, what types of makeup you are using, etc. to see all of the chemicals that you are inadvertently putting into your body. 
  • Eliminating or reducing your stress levels – Stress has been shown to suppress immune function! (4) Manage your stress levels to the best of your ability. 
  • Eating healthy organic whole foods – Organic whole foods provide your body with healthy nutrients as well as additional ingredients that reduce inflammation. Buying organic reduces your exposure to chemicals found on and in certain plants. 
  • Taking fish oil – Taking the right kind of fish oil can help improve your omega-3 fatty acid ratios and reduce inflammation. 
  • Avoiding a diet high in inflammatory industrial seed oils – Industrial seed oils, such as corn oil and canola oil, can cause inflammation and weaken certain cells in your body. Avoid these fats as much as possible. 

These therapies are EASY to implement and VERY safe. 

Medications Used to Treat Graves’ Disease and Hashimoto’s

This is where the therapies and treatments start to diverge. 

Therapies used to treat Graves’ disease focus primarily on LOWERING thyroid function while therapies used to treat Hashimoto’s primarily focus on INCREASING thyroid function. 

Treatments for Graves’ disease include:

These therapies are all designed to reduce or slow down thyroid function. 

Treatments for Hashimoto’s disease include:

  • The use of prescription medications that contain thyroid hormone (including medications like levothyroxine, Synthroid, NDT, and so on)

These medications are meant to INCREASE thyroid function. 

The one thing to notice with these medications is that while they do impact thyroid hormone levels in the body they really don’t do anything to treat the underlying cause of each condition. 

They are more of a management type of treatment as opposed to a “cure”. 

Final Thoughts

Even though both Hashimoto’s and Graves’ disease have a lot of similarities, they are still different disease states and often present with the exact opposite symptoms. 

Whether you have Graves’ disease or Hashimoto’s you should know that BOTH conditions result from an impaired immune function and this is the area that you should focus on when it comes to treatment. 

This is also the area most ignored by conventional doctors such as endocrinologists and family practice doctors which means you may have to do a lot of the heavy lifting on your own. 

But rest assured knowing that you CAN impact your disease state and it may even be possible to reverse your condition (if you catch it early enough). 

Now I want to hear from you:

Are you confused about your thyroid condition?

Do you have Graves’ disease or Hashimoto’? 

What type of symptoms are you experiencing right now? Do you find your symptoms confusing?

What type of treatments or therapies are you currently using? Are they working for you? Why or why not?

Leave your questions or comments below! 

Scientific References

#1. https://pubmed.ncbi.nlm.nih.gov/30124533/ 

#2. https://pubmed.ncbi.nlm.nih.gov/29083758/ 

#3. https://pubmed.ncbi.nlm.nih.gov/29324654/ 

#4. https://pubmed.ncbi.nlm.nih.gov/24798553/

the biggest differences between graves' disease and hashimoto's

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About Dr. Westin Childs

Hey! I'm Westin Childs D.O. (former Osteopathic Physician). I don't practice medicine anymore and instead specialize in helping people like YOU who have thyroid problems, hormone imbalances, and weight loss resistance. I love to write and share what I've learned over the years. I also happen to formulate the best supplements on the market (well, at least in my opinion!) and I'm proud to say that over 80,000+ people have used them over the last 7 years. You can read more about my own personal health journey and why I am so passionate about what I do.

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27 thoughts on “Hashimoto’s vs Graves’ Disease: Differences & Similarities”

  1. I’ve been taking Np 60mg for now 3 weeks, it was a lower dosage for 6 weeks. Recently diagnosed with Hashi. My Endo said a few months back, when I felt like I had the symptoms that unless I start gaining a lot of weight then I am a terrible candidate.

    I had a thyroidectomy last year, half my thyroid was removed die to a nodule. The nodule was not cancerous, but when they scanned that half of my thyroid, there was a tiny speck of cancer. My Ob is the one who diagnosed the Hashi- I didn’t have a chance to tell him my symptoms! He told them too me. I had these symptoms for the last few years. I used to be a workout craze person, i have slowed down so much. When I walk fast or run or even walk a lot of treadmill- my lower part of my body feels like a million electronic shocks all over- like electric spasms.

    Just exhausted from trying so hard to feel normal. I do have more energy, not needing naps.. but my appetite has increased and I crave bad foods then I feel tired again ‍♀️ Just want help!

  2. I am really confused about what type of thyroid problem I have. Until I got on 15 m of t3 in addition to 30 t4 I was loosing weight. Now I am gaining around the middle and adding fat only, loosing what muscle I had. What should I do?

    • Hi S Bell,

      I would need more information to help. It sounds like you probably have hypothyroidism since you are taking T3 medication but even that isn’t clear based on the information provided.

  3. While pregnant last year I was diagnosed with Graves’ disease. I was able to stay off medication through out my pregnancy and for about 8 months postpartum but am now on 10mg of methimazole. My levels have leveled out so I’ve been told that’s where I need to stay. I do not want to stay on it for long, if possible. If I start with some of the supplements you recommend, how do I know if it’s making a difference if I’m also on the methimazole?

    • Hi Robin,

      You won’t really know unless you try to get off of the methimazole which is something you should always be aiming to achieve. Methimazole causes a lot of problems in the body and is never meant to be used long-term so your goal should be to get off of it as quickly and safely as possible.

  4. I was told that I have Hashimoto’s a Graves disease in 2016 and I have not had any treatment at all the muscular ,tens in my leg not up so bad that I have trouble walking .And I’m like that right now and it’s been 13 days can you please help me with this problem.And I have been using my heating pads it helps some but I I’d stay on my left leg only for
    2,3minute ‘s ,I was reading about this disease and one can cripple you the other can kill you now I have been reading that you cure this disease ‘s that I have.

  5. Hi,
    I was having heart palpitations investigated and as a incidental finding on ultrasound my thyroid was noted to be hyper vascular thyroid. The endocrinologist I saw thinks I have hashimotos because my TSH is high and T4 is low. However I am unsure because apart from the bulging eyes I have all of the graves symptoms. My TSH level fluctuates on my follow up blood tests. I am a 23 year old female ans unsure whether I should start taking thyroxine.

    • Hi Jana,

      It would be very obvious if you needed to stop taking thyroxine as you would have all of the symptoms of low thyroid function.

  6. I have Graves and have been on methimazole for 2 1/2 years. I definitely think I have adrenal fatigue. I have cut out many inflammatory foods and added in lots of fruits and vegetables. Still often feel fatigued. Is it ok for those with Graves to take the adrenal complex supplement?

  7. I’m a bit late reading this article, but my story is very complicated. I was originally diagnosed with Graves’ disease as a 24-year-old in 2005. I was diagnosed by outstanding endocrinologists at a very reputable medical group, who made the diagnosis based on labs (TSH, T3, T4, but did not conduct antibody tests), symptoms (palpitations, conjunctivitis, and a 40-lb weight loss without trying to lose weight), age, and family history of autoimmune disease. I was subsequently put on methimazole. Two years later, when I moved to another city, my doctor there was not confident that I had Graves’, so she order a RAIU test, which confirmed Graves’ disease. Fast forward to 2014, and during a routine thyroid check, I was diagnosed with hypothyroidism. Antibodies were checked for the first time ever (TPO), and they were very high. I was then placed on Synthroid and remained on it until now (although there were a couple times I tried to wean myself off of it by adjusting my diet to try to control my condition(s)).

    Ever since 2014, my TSH has been up and down. When I was pregnant, it stayed around 1.5-2.0, as I was taking my meds faithfully. After giving birth in 2017, it dropped to 0.01. I stopped the meds because I was afraid I was becoming hyperthyroid. Two months after stopping the meds, I checked my TSH and it was 179. To make a very long and sordid story short, in recent years (last couple of years to be exact), my TSH has remained elevated if I do not take the Synthroid. A week ago, I had a thyroid stimulating immunoglobulin antibody test, which revealed a level consistent with Graves’ disease (I also still have a TPO of over 6,000).

    To answer your question about whether I have Graves’ or Hashimoto’s, I simply don’t know. My confusion is really whether I have Graves’ that is now manifesting as hypothyroidism (read a case study about this), or if I have both conditions.

    • Your story sounds much like mine. You can have both Graves & hashis as evidenced by testing positive for both Graves and hashi antibodies Your immune system basically fights over which condition prevails. Initially I went into Graves disease at about 4mo pregnancy but it was not discovered until son was 14 mo old. I was treated by 1st endocrinologist for 8 mo with PTU & finally had remission & returned to euthyoid state. 2 yrs later with 2nd pregnancy I went into hashi’s and at about 8 wks gestation I had to start synthroid. The abrupt change to my system caused me to miscarry. At that time my new Endocrinologist told me I never had Graves disease but I had Hashis. Thyroid antibody testing for Graves disease wasn’t done 29 yrs ago. I supposedly stayed in Hashis for next 24 yrs but NEVER felt good. Then a 8 yrs after menopause started I discovered I had BOTH hashish AND Graves buy my spine degenerated thru whole situation. My advice is to get tested for both Antibodies for both conditions.

  8. I was diagnosed with hyperthyroidism October 2021 and Jan lab test came that it’s grave deases.the meds are working fine until last week I had a problem with my eyes and the doctor gave me meds to ease the eye problem, I’m much better though my eyes are blurry sometimes and I wish to conceive. At what level is it safe to try to conceive or is there another way to get rid of this deases..Iam not comfortable taking a 2nd dose of vaccine since then I’m falling sick now and again previously tested positive after vaccine but b4 vaccine I was very sick with bronchitis but I tested neg.

  9. Hi
    I was diagnosed as hyperthyroid in 2001 and put on carbimazole. By chance around 2012 I found out those meds were temporary so checked with gp who told me to just come off them (no other advice) resulting in hyperthyroidism once again. My eyes had always been bad; light sensitive to the extent of wearing sunglasses on work night shifts. I had also tried numerous anti histamines to try and assist in allergies. Always sneezing on a morning (chemical probably) The hospital gave me a choice of RAI or Removal. I asked if i could go back on Carbimazole but they did not appear to want this. They also didnt believe there was anything wrong with my eyes but I knew how they had changed how they looked. I was niaive not finding out things, later finding out if eyes are bad prior to RAI, they will be bad after and yes they were resulting in steroid treatment to get the buldging down and them accepting diagnosis Graves. Since then ive accepted anxiety as normal accepted menopause heat sweats at night, accepted dry skin, accepted brittle dry hair, all as normal.
    Due to what ive now found out re medical industry i so wanted to go down a natural route. I didnt realize that there is info around and ive been foolish in not actually looking into this more and understanding these T numbers. But to get to the point i reduced my 75mg Thyroxine on Jan 20th to half for 2 weeks and came off and felt brilliant, my eyes even looked ok on Feb 12 as i actually put some make up on (perhaps it was that? But by 20th my eyes started taking a real turn for the worse the skin was dry and im back on Levothyroxine I had also started taking Bladderwrack/ sea kelp and vitamins after stopping altogether too (perhaps that too) but it scared me. I had always had regular blood tests prior but none over last couple of years.
    Typical they called me for one after doing this but ive not gone. Its scary but great reading your story going to read sone more just dont know what to do at mo re taking as it feels too much with feeling irritable anxiety and palpitations today im blaming everything especially stress but my eyes say it all
    Thank you

  10. I believe I was misdiagnosed with Graves 2 1/2 years ago. It was based on my TSH and T4. No antibody test done. Than in January of 2020 I changed doctors and she did the TRab and TPO. TRab was normal TPO was high. Still told me I have Graves. Fast forward to March 2022 saw a new doctor and had the antibodies tests redone. Same results but this doctor says I probably never had Graves. I have all the symptoms of Graves and am on 2 1/2 mg methimazole. I’m so confused on why I’m taking this medication if I have Hashimotos. Won’t it make it worse?

  11. I am confused with my symptoms. I have low tsh and 144 tpo antibodies, most symptoms are for hypo, but I am loosing weight. 1 year ago I had radiation treatment due to breast cancer. When I put iodine on my skin it diseaper in like 4 hours. Please help me figure out what supplements to take. When I am taking supplements that has an iodine, my heart palpitations increase, but not when I putting on my skin

  12. I have been diagnosed with PCOS lean at 21 years old. I’ve struggled with extreme fatigue, joint pain, anxiety since I was 13 or 14 years old. Over the years I’ve done multiple blood tests, like iron, RA, CPR, TSH, ANA and all came back normal.

    I’ve recently lost hope in my GP and gynaecologist and decided to visit a homeopath who did a few more blood tests and found that I’m highly Vitamin-D deficient, have insulin resistance, low iron and my Anti-TG antibody was 293.1 IU/mL.

    My doctor has given me a diet plan that removes inflammatory foods, increased certain supplements like magnesium and prescribed a natural medicine to treat my thyroid.

    However, I’m confused on whether I have Graves Disease or Hashimoto’s. Most of my symptoms are of Hashimoto’s except I’m under weight and my TSH levels are normal.

    I also have an adams apple looking lump by my throat and inflamed glands under my right and left ear as well at the back of my neck.

    Do I have Graves or Hashimoto’s and I do I need to see and Endocrinologist and do an ultrasound of those glands?

    Please help. Your insight will be dearly appreciated.

  13. My thyroid journey started with a fluid build up around my eyes. I have none of the other usual symptoms. I was put on Synthroid .075 mg and the puffy eyes gradually disappeared. I have had ptosis of the left eye develop gradually whereby it’s become a nuisance for my sight line when looking down or up. Is eye ptosis connected to hypothyroidism? Can it be reversed. I am currently waiting my turn to have the levator muscle controlling the eyelid tightened.
    Thank you


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