Can you Be Hyperthyroid & Hypothyroid At the Same Time?

Can you Be Hyperthyroid & Hypothyroid At the Same Time?

Thyroid Hormone Status Explained In Plain English

Is it possible to be both hyperthyroid and hypothyroid at the same time?

I'm going to give you the answer now and then explain why that is the case in more detail. 

The short answer is no. 

It is not possible for the same cell or the same tissue in your body to be both hyperthyroid and hypothyroid at the same time. 

Does that mean that you cannot have both hyperthyroid and hypothyroidism symptoms simultaneously? 

No, that is very possible and I will explain why later in this article. 

But for now, we need to have a discussion on thyroid hormone status. 

The reason that a single cell or tissue cannot be both hyperthyroid and hypothyroid at the same time has to do with how thyroid hormone impacts your cells. 

Each cell has a receptor for thyroid hormone, usually located in the nucleus of the cell (1), which must be turned on. 

This nuclear receptor, when activated, turns on genetic transcriptions and results in changes to the enzymes that are being produced by your cells. 

These enzymes then leave the cell and have the desired effect that you are looking for such as increasing your metabolism, helping your hair follicles grow, balancing your mood, and so on. 

What you need to understand is that this system can either be turned on or not. 

It can either be stimulated or not. 

It cannot be both stimulated and not stimulated at the same time which means that you can't be both hyperthyroid and hypothyroid in the SAME tissue at the SAME time. 

Having said that, how is it possible for some people to experience SOME symptoms of hyperthyroidism and SOME symptoms of hypothyroidism at the same time?

The answer is quite simple and it has to do with the thyroid hormone status of individual cells and tissues. 

Another common reason for changes in your symptoms has to do with alternating thyroid function and confusion regarding your symptoms. 

If you are experiencing both hyper and hypo symptoms then these next two sections are REALLY important to understand. 

As we talk about them you should be able to figure out which group you fall into which should then help explain how you are feeling. 

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Conditions which Cause Alternating Thyroid Function

The first group of people who experience both hyper and hypo symptoms are those who have conditions that result in variable thyroid function. 

What I mean by that is this:

Some conditions which impact your thyroid can cause you to experience hypothyroid symptoms for a period of time but then switch to hyperthyroid symptoms. 

As you might imagine, this can be incredibly confusing for thyroid patients. 

Here's why:

Thyroid function exists on a scale between hyperthyroid, normal thyroid, and hypothyroid. 

Consider this scenario...

On day 1 you are experiencing hypothyroid symptoms with fatigue, weight gain, and constipation. 

On day 4 you have normal thyroid function and your previous symptoms are subsiding. 

On day 8 you have hyperthyroid symptoms and now you are experiencing heart palpitations, diarrhea, and heat intolerance. 

On day 14 you have normal thyroid function and now you notice that your previous symptoms are improving again. 

And then on day 20, you go back to hypothyroid symptoms and now you are starting to experience the SAME symptoms you did 20 days ago including fatigue, weight gain, and constipation. 

Over a 20 day period your thyroid has swung back and forth between hypo, hyper, and normal thyroid function. 

Can you see how confusing this can be if you aren't actually keeping track of your symptoms exactly? 

It would be really easy to just assume that you are experiencing both hyper and hypo symptoms at the same time even though that isn't actually the case. 

Instead, what is happening is that your body is alternating between hypo and hyper states so quickly that it's hard to keep track. 

When you add in the fact that it can take a while to get to the doctor to check your thyroid lab tests, even these aren't necessarily reliable. 

While it may feel that you are both hyper and hypo at the same time, I can assure you that you are not. 

Instead, you are alternating quickly (or not) between these two states. 

And only a handful of thyroid conditions cause this issue. 

They include:

  • Thyroiditis of any type - Thyroiditis simply refers to inflammation of the thyroid gland and this can be caused by a number of conditions. Trauma, bacterial infection, viral infection, pregnancy, and so on, can all lead to inflammation in the thyroid gland itself. Most cases of thyroiditis cause fluctuating thyroid hormone but do resolve over time. Official names include subacute thyroiditis, postpartum thyroiditis, silent thyroiditis, and medication induced thyroiditis. 
  • Hashimoto's thyroiditis - Hashimoto's is the most common cause of hypothyroidism and it is also the most common cause of thyroiditis. Unfortunately, Hashimoto's typically does NOT go away like the other types of thyroiditis. Alternating thyroid function in Hashimoto's only occurs in about 10-15% of patients (2) so it's not super common but it does happen. 
  • Thyroid Medication - Thyroid medication can cause you to shift between being hypo and hyper and is actually more common than you think! In fact, most of the symptoms that people experience while taking thyroid medication are caused by changes in their dose. Taking too much thyroid medication may lead to hyper symptoms and taking too little may lead to hypo symptoms. Because there is a lag time between taking thyroid medication and feeling better (about 6 weeks on average), it's not uncommon for impatient people to prematurely adjust their dose and experience either hypo or hyper symptoms. 
  • Antithyroid medication - Just like thyroid medication, antithyroid medication can also impact your thyroid status. Antithyroid medication is primarily used to treat hyperthyroid conditions but you can imagine that it's fairly easy to cause confusion for patients. Taking a high dose of antithyroid medication can cause hypothyroidism (even though you are technically 'hyperthyroid') and not taking enough may leave you feeling hyperthyroid. 

Before moving on to the next section, check to see if your symptoms can be explained by your thyroid condition or the thyroid medication you are taking. 

If this doesn't explain your symptoms then the next section will. 

Tissue Sensitivity to Thyroid Hormone

This section is all about tissue sensitivity to thyroid hormone and this problem explains why many people feel they are experiencing both hyper and hypo symptoms at the same time. 

What you need to understand here is that not every tissue in your body is equally sensitive to thyroid hormone. 

Put another way, some tissues and organs in your body are MORE sensitive to thyroid hormone compared to others. 

From the perspective of thyroid hormone, your body is a big place. 

The hormone that is secreted by your thyroid gland must make it to pretty much every single cell in your body. 

Skin cells, heart cells, liver cells, brain cells, and so on all have a need for thyroid hormone. 

But, as you can imagine, thyroid hormone will make it to some tissues faster than others (just based on proximity from where it is released) and some tissues are more resistant to thyroid hormone compared to others. 

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This may lead to some tissues getting OVER stimulated and other tissues getting UNDER stimulated even though they are both exposed to the SAME dose of thyroid hormone. 

Let me give you a practical example to help this sink in:

As it turns out, your heart is quite sensitive to thyroid hormone (3), especially compared to other tissues. 

Thyroid hormone that is taken by mouth is absorbed in the GI tract, taken through the liver, and straight to the heart to be pumped throughout the body. 

Heart cells have different thyroid receptors compared to other cells in the body, though. 

And these cells are on the outside of the cell (4). 

When these receptors are triggered they cause your heart to beat stronger and faster (with more force). 

This is often felt as either a rapid heart rate or as a heart palpitation. 

Knowing this, imagine taking a dose of thyroid medication by mouth which goes straight to your heart and causes heart palpitations and a rapid heart rate for a short period of time. 

For this short moment, your heart is experiencing overstimulation of thyroid hormone but it will take WEEKS for that same dose of thyroid hormone to impact your other cells to help your hair grow back and to help provide you with energy. 

It's not necessarily that your dose of thyroid medication was too high but instead that one of your tissues is more sensitive to thyroid hormone compared to the rest. 

This phenomenon allows you to experience hyperthyroid symptoms in one specific tissue even though you are more hypothyroid overall in the rest of your body than hyperthyroid. 

As you might suspect, this is the source of MUCH confusion for thyroid patients!

And the heart isn't the only tissue that this occurs in. 

Below you will find a list of tissues or organs in your body which tend to be either resistant or sensitive to thyroid hormone: 

  • Heart Tissue - We already discussed why your heart cells tend to be more sensitive to thyroid hormone compared to other areas of the body. 
  • Brain Tissue - With the exception of the pituitary gland (5) (which is very sensitive to thyroid hormone) the brain tends to be a little bit resistant to thyroid hormone. This typically manifests as symptoms such as depression, anxiety, and even bipolar disorder. When taking thyroid medication by mouth, you may notice that these mood related issues take a lot longer to resolve compared to other hypothyroid symptoms in your body. When it comes to managing these symptoms, thyroid medications that contain T3 tend to work best. 
  • Skin Tissue - The skin is another tissue that tends to be resistant to thyroid medication. This usually manifests as cystic acne in people who experience this problem. This type of acne is often related to the thyroid and can be very hard to treat unless the right dose of thyroid medication is used. 
  • Hair Follicles - Attached to the skin are hair follicles that are also sensitive to thyroid hormone. Too little thyroid hormone and too much thyroid hormone can both cause issues with hair loss, hair growth, and the quality of the hair. Many women with thyroid problems continue to have issues with their hair even when other thyroid symptoms have resolved. 
  • Metabolism - Another big area is your metabolism. Your thyroid regulates a huge percentage of your overall metabolism which means that low thyroid leads to weight gain. But let me ask you this: you probably gained weight before you were diagnosed with hypothyroidism but did you lose that weight when you started taking your thyroid medication? Probably not, as persistent weight gain is a huge problem for many thyroid patients. This is because the metabolism lags behind other tissues and indicators of thyroid function in the body. I've seen numerous women who have near complete control of their thyroid symptoms but still struggle to lose weight. 

Wrapping It Up 

Figuring out what is happening in your body with your thyroid may require some investigative work but it will be well worth the effort. 

If you are experiencing symptoms that coincide with both hyperthyroidism and hypothyroidism then a deeper look is warranted. 

As you do this, ask yourself these questions:

Is it possible that your thyroid CONDITION is causing the swings in your thyroid status from hypothyroid to hyperthyroid?

Or do you think that it is more likely that some of your tissues are being overstimulated by thyroid hormone (or thyroid medication) and other tissues are being understimulated? 

In my experience, the second situation tends to be more likely than the first but they both can and do occur!

Now I want to hear from you:

Are you experiencing BOTH hyper and hypothyroid symptoms?

If so, what type of symptoms are you experiencing?

Do you feel it's related to your thyroid function or to your thyroid medication?

Or do you think it's related to the different sensitivities of thyroid hormone in your tissues?

Leave your questions or comments below! 

References (Click to Expand)

is it possible to be both hypothyroid and hyperthyroid at the same time?

Dr. Westin Childs

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 45,000+ people have used them over the last 4.5 years. You can read more about my own personal health journey and why I am so passionate about what I do here.

14 thoughts on “Can you Be Hyperthyroid & Hypothyroid At the Same Time?”

  1. Hello Dr Child’s,
    Regarding your article on too much thyroid hormone and how it can cause osteoporosis, how high would your levels need to be in order to develop this? My PCP allows my t3 levels to be at the higher end of the range…which is a blessing…most doctors want you in the middle, but could this cause osteoporosis…I have osteopenia and am only 58 yrs old. I would appreciate it you could clarify. Thank you

    Reply
  2. That’s me me .
    I have TT but often feel that having symptoms of both hypo and hyper .I have read most of your PDF articles very informative.I have tried a lot to convince my doc to have test about T3 and reverse t3 but my TSH level is high .so she is not convinced to .let me have that test.as usual said TSH ts the only thing to be considered.

    Reply
  3. This article describes my experience for the past two years. In 2018 Naturethroid stopped working for me (and many people). Over the past 2.5 years I have been on NP, WP, compounded T3 and Levoxyl, and now (since 9/2020) on Armour. Over this period I have had ongoing heart palpitations, which seem to be worse on Armour and the synthetics. In addition, I have hair loss, fatigue, dry skin, and some depression. I also finally convinced my MD to test my adrenal function with the saliva test. My daytime cortisol was too high, out of range, and my afternoon cortisol was too low, also out of range. My doc put me on DHEA 5mg daily and licorice drops. Been taking these for 5 months.) I have also had shortness of breath that seems to be worse on Armour, but it’s been present for most of the last two years. (I have had heart tests–nothing abnormal.) I am totally at a loss…and feel defeated. Yesterday was the first day I had ZERO heart palps in almost a year. I attribute this to changing my Armour from divided doses to one total dose (45mg) in the morning. My doc has ok’d me to raise my Armour dose to 60mg in the morning, and I intend to do that in a few days. (One grain of Naturethroid taken in the morning worked great for me for years, until it changed.) Any thoughts you may have would be greatly appreciated. So, yes, definitely possible to have symptoms of hypo and hyper thyroid at the same time. Thank you.

    Reply
  4. Can the hyper and hypo last for years or months?
    I am 55 and I had NEVER been tested at all, never had a blood test from any Dr all my life until I paid for one for bio identical hormones after menopause this past December. Then I found that my TSH was high and what that meant. I then learned after reading Dr. Mark Starr’s book on Hypothyroidism that Meniere’s disease is a symptom of hypothyroidism! I have been battling this since 1992! and no one looked at hormones at all. They put me on lasix and valium and told me to stop using salt. I read in 2014 that iodine and removing fluoride from your water could help Meniere’s and once I did that, over a few months, my Meniere’s went away! I no longer get dizzy and fall down or anything! I stopped going to my neurologist completely. For over 6 years now.
    I had also stopped smoking at age 40 and gained a bunch of weight over the years since. I assumed this was all because I stopped smoking. But then, in 2019, I lost a bunch of weight, about 25 lbs, my hair got better, my skin got better, I felt better! I don’t know what exactly changed.
    Then again, after Dec of last year, I am starting to gain the weight back and noticing some hypothyroid symptoms but didn’t even know about hypothyroid. I thought it was menopause and that maybe bio identical hormones would help as well as with hot flashes.
    Now, I’ve been on a pellet for testosterone and estradiol plus a progesterone pill each night. After my first 3 months, my cholesterol is now up 100 points, my TSH went from 7 to 93 and I have worse symptoms of hypothyroid than I ever had. They also checked me for antibodies and now say I have hashimoto’s.
    I’m wondering if I am swinging back and forth between hypo and hyper thyroid over months at a time and also wondering if this pellet is making my thyroid issues worse. Plus I’m getting hives when I take the NP Thyroid. I have not been able to take this NP Thyroid more than a week now before I break out so I can’t say if it makes me better or not.
    I’ve asked my Dr to change the NP Thyroid to the Armour brand since I had read that the Acella brand has caused others to break out. I have always had weird allergies all my life too but not like this.
    I feel like just stopping everything for a couple of months to see what my body wants to do but I don’t want to gain all the weight I just lost back. I’ve already gained more than half of it. I’d like to go back to where I was in 2019 but I don’t know what changed then…
    This is all very new and confusing to me. I’ve always thought of myself as healthy and have always worked out all my life, other than the smoking.
    I’ve never looked at gluten or dairy in my diet and the year I lost all the weight, I even ate out more than usual and ate more ice cream than ever 🙂

    Reply
    • Hi Tina,

      It’s possible but the best option would be to get tested to know for sure what is going on with your thyroid.

      Reply
  5. Is it possible to experience central hypothyroidism caused by some type of malfunction in the pituitary/hypothalamus region that is ”masked” and interpreted as hyperthyroidism by elevated excretions of T3 *or* T4 due to thyroid adenomas? And how dangerous could it be to get treated for the wrong issue?

    Reply
  6. Good evening Dr. Childs. I had part of my thyroid removed several years ago because of a nodule that was suspicious. Thankfully it was benign. I have blood tests on my thyroid ever so often, but normally it is just the TSH. It always comes back within the normal range. I have recently been diagnosed with SIBO and have read that it could possibly be linked to thyroid issues. I have both the symptoms of hyperthyroid and hypothyroidism. (Hair loss, weight loss, tremors, neuralgia, dizziness, joint pain, headaches, rapid heart rate, fatigue, etc.) At first I thought it might be lingering side effects from my partial hysterectomy surgery back in October, but it hasn’t gotten any better. Which tests would be best to determine if I have either one? Thank you.

    Reply
  7. My labs are all over the place. I had RAI 8/19 and since have had a lot of stress (ie suicide in family, household issues, single parent, etc). I was on synthroid 137.5 and switched to Armour 60 to get the T4 and T3 along with the fact I feel more comfortable taking a more natural medication with less fillers. I felt horrible a month after switching and asked to be bumped up because I feel I was undermedicated. My doctor did not feel comfortable but did up to 90. I slowly upped it more to 150 and was feeling great (and honestly still do besides not being able to lose weight and horrible headaches which I have had for years) but I went back down to 90 about a week and a half before new labs because I new my TSH would be low and that is all anyone ever looks at (I feel better when it is closer to 0.0 I have realized). But I just got labs back yesterday and they are actually all over the place and a bit confusing. I did have sex hormones checked at the end of March and they were normal. I take zinc, selenium, vitamin D3, B12 and calcium.
    TSH .01
    FT3 4.1
    T3 total 1.84
    TPO 2208
    Cortisol 27.5
    Reverse T3 11
    My concern is I have a pituitary or adrenal gland issue. With my numbers the way they are above would I be in line to ask to have those things checked? I apologize for the long message I am just so confused because my doctor wants to lower me back down to 60 of Armour and I am scared because I almost didn’t make it out of January. I was very depressed and in horrible pain with my quality of life in shambles.
    thank you
    Marissa

    Reply
  8. Yes it seems I have both! It’s like my thyroid corrects itself. I can gain or lose 20 lbs quickly. I take no medicine. By the time my primary Dr refers me to endo Dr my numbers are back in “correct range”. I also have a goiter for the past 30 years. Right now I’m going for more testing at endo Dr for being extremely hot, even though my hormone levels are where they should be according to my obgyn. I am 57 years old

    Reply

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