Hypothyroidism vs. Hyperthyroidism

Though they sound similar, these conditions affect the body in different ways.
Hypothyroidism vs. Hyperthyroidism

The thyroid is a butterfly-shaped gland at the base of your next that produces hormones to regulate your body’s energy use, along with many other important functions - including: our breathing, heart rate, body weight, muscle strength, body temperature, menstrual cycles in women, nervous system, and more. When the thyroid does not produce the correct number of hormones that we need, our bodies may feel out of whack, producing a host of symptoms. But what do these symptoms mean? Is our thyroid working too fast or too slow? How can we tell?


Signs of hyper- and hypothyroidism are essentially on opposite ends of the spectrum: one slows down your body’s processes, and the other speeds up. Hypothyroidism leads to a decrease in hormone production; hyperthyroidism leads to an increase in hormone production.


Hypothyroidism


Hypothyroidism is when the thyroid is underactive. When thyroid production drops, your body’s processes slow down and change. Hypothyroidism can affect many different systems in your body, including:


Brain fog: Hypothyroidism can affect your memory and ability to think clearly. This mental fuzziness is sometimes called “brain fog.” 


Thinning hair: The effects of hypothyroidism can cause you to lose hair on your scalp, face, and body.


Peripheral neuropathy: Hypothyroidism that isn’t treated can interfere with how the nerves send signals to and from your brain, spinal cord, and body.


Mental health issues: Low thyroid hormone levels can contribute to depression and sadness.


Eyebrow thinning: Hypothyroidism can make you lose eyebrow hair. The hair loss usually starts at the outer edges of your brows.

Jaundice: Infants born with hypothyroidism may have jaundice, yellowing of the skin and whites of the eyes. 

Goiter: A goiter is an abnormally enlarged thyroid gland that can happen in people with diseases like Hashimoto Thyroiditis.

High blood pressure: Low thyroid hormone levels can increase blood pressure through interactions with the blood vessels and circulatory system.

Heart attack risk: Hypothyroidism may increase cholesterol levels and narrow arteries. This could contribute to an increased risk of heart attack.

Slow metabolism: Too little thyroid hormone slows the body's metabolism, which can lead to weight gain.

Gallstones: Hypothyroidism may increase your risk of gallstones, hard pieces made up of substances like cholesterol or bile that form in your gallbladder.

Stomach bloating: A lack of thyroid hormones slows the movement of food through your digestive tract, which can leave your belly bloated.

Constipations: Slowed movement of food through your intestines can back up stool, making you constipated.

Heartburn: Hypothyroidism slows digestion which can lead to heartburn and other gastrointestinal issues.

Menstrual changes: Women with hypothyroidism may have irregular periods and changes in menstrual flow. Fertility may also be affected, making it harder to get pregnant.

Dry skin: Low thyroid hormone levels directly affect the skin causing a variety of changes, including dryness, thickening, and scaling.

Weakness: Low thyroid hormone production can leave your muscles weak, achy or stiff


Studies point to family history, nutritional deficiencies, damage to the pituitary gland, certain medications, pregnancy or other large hormonal events as the cause of hypothyroidism, but it's hard to say for sure what causes this condition.


What we do know is that an estimated 90% of all hypothyroidism is caused by Hashimoto's Disease, an autoimmune disease caused by your immune system attacking your thyroid gland.


No matter the cause of the slowed thyroid, the signs and symptoms will be similar. Working closely with your doctor to understand your symptoms and history is critical to identifying which treatment is ideal and what dosage is optimal. 


Hyperthyroidism


Hyperthyroidism is when the thyroid is overactive, producing more thyroid hormone than the body requires. Similarly to hypothyroidism, this affects almost every tissue and cell in the body by speeding up the body’s processes.


Common symptoms include: 


  • Nervousness or irritability
  • Fatigue or muscle weakness
  • Heat intolerance
  • Difficulty sleeping
  • Rapid and irregular heartbeat
  • Hand tremors
  • Frequent bowel movements or diarrhea
  • Weight loss
  • Mood swings
  • An enlarged thyroid, called a goiter

The most common cause of hyperthyroidism is Grave’s disease, another autoimmune disorder. In this disease, the body produces antibodies that connect to the thyroid and chemically turn it on, causing the thyroid to produce too many hormones, speeding up the body’s metabolism. As with hypothyroidism, there are several other possible causes of hyperthyroidism but again, most causes present with similar signs and symptoms.


What happens after I present with my symptoms?


Laboratory blood tests are needed to confirm a diagnosis. 


Traditionally, labs look primarily at Thyroid Stimulating Hormone (TSH) to assess thyroid health, and sometimes free thyroxine (fT4). 


TSH is a hormone produced in the pituitary gland in the brain. This hormone regulates the amount of thyroxine (T4) and triiodothyronine (T3) produced by the thyroid gland. T4 is the storage hormone and must be converted by the body into T3 to be used by cells. 


These two hormones are counterregulatory, meaning that if the thyroid is overactive (such is the case in hyperthyroidism), the thyroid produces too much T4 which in turn tells the pituitary gland in the brain to decrease the production of TSH.


On the other hand, if the thyroid produces too little T4 (such is the cae in hypothyroidism), the pituitary gland will produce more TSH than normal to try to stimulate the thyroid gland. 


Paloma Health believes it is critical to also measure free triiodothyronine (fT3) and TPO antibodies. 


Triiodothyronine (T3) is the active thyroid hormone that works at the cellular level to help with the delivery of oxygen and energy to cells, tissues, and glands throughout the body. Testing for fT3 can be beneficial when the above two tests are inconclusive. 


Testing for thyroid peroxidase (TPO) measures the levels of TPO antibodies in your blood. If your have high levels of TPO, it may indicate that your immune system is attacking your thyroid hormone as if it’s a foreign invader. This could be caused by an autoimmune disorder like Hashimoto’s or Graves’. It’s important to include TPO antibodies in a complete thyroid test because you could have high levels of TPO but still show as a normal TSH score. 


How is hypothyroidism treated?


Thyroid drugs, or synthetic forms of thyroid hormones, are often used to boost or regulate low thyroid levels in people with hypothyroidism.

 

Pure synthetic thyroxine (T4), taken once daily by mouth, fully replaces the thyroid gland and successfully treats the symptoms of hypothyroidism in most patients. Because the potency of generic thyroxine has varied considerably in the past, your physician may specify a brand name to treat your thyroid problem. The current branded forms of synthetic T4 are Synthroid®, Levoxyl®, Levothroid®, Tirosint® and Unithroid® For the few patients who do not feel completely normal taking a synthetic preparation of T4 alone, the addition of T3 (Cytomel®) may be of benefit.

 

If only there was one medication that worked for all of us — but the reality is that we each react differently to the different treatment options. Paloma Health works closely with our patients to investigate which treatment is ideal and what dosage is optimal.

 

It’s important to note that these medications are not a cure for hypothyroidism. They do not go after the condition itself, but rather the symptoms.


How is hyperthyroidism treated?


Same as above, there is no one-size-fits-all for treatment. We think it’s essential to find the right specialist to investigate with treatment option is right for you.


Treatment for hyperthyroidism often involves medication, radioiodine therapy, and/or thyroid surgery to bring your thyroid hormone to normal levels. Radioiodine therapy destroys part of the thyroid gland so that the remaining part of the thyroid functions normally, and surgery (should it come to that) removes part or most of the thyroid gland to normalize hormone levels. If the entire thyroid gland needs to be removed, patients will take levothyroxine to replace the lost hormones. As always, careful medical supervision is advised.

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