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How To Tell The Difference Between Lupus and Hashimoto's

Learn how to distinguish the symptoms of lupus from Hashimoto's in this article.
How To Tell The Difference Between Lupus and Hashimoto's
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In this article:

  • Overview of polyautoimmunity
  • What is lupus?
  • What is Hashimoto's?
  • How are lupus and Hashimoto's diagnosed?

Overview of polyautoimmunity 

Polyautoimmunity is when a person has more than one autoimmune disease. Sometimes, people can have three or more autoimmune disease—called multiple autoimmune syndrome (MAS). An estimated 25% of people with an autoimmune thyroid disorder like Hashimoto's or Graves' disease also had at least one other autoimmune condition. Indeed, once a person has one autoimmune disorder, their risk for developing another autoimmune condition is much higher.  

People with Hashimoto's thyroiditis are at greater risk for also having the following autoimmune conditions:

  • Type 1 diabetes
  • Addison's disease (adrenal insufficiency)
  • Alopecia
  • Rheumatoid arthritis
  • Chronic autoimmune gastritis
  • Celiac disease
  • Polymyalgia rheumatic
  • Sjogren's syndrome
  • Multiple sclerosis
  • Systemic lupus erythematosus
  • Myasthenia gravis

Autoimmune disorders tend to share similar symptoms, making it hard to identify your condition. For example, most autoimmune diseases manifest as symptoms like unexplained fatigue, weight changes, changes in skin texture or appearance, and muscle and joint pain. Ahead, a look at two prevalent autoimmune conditions—lupus and Hashimoto' s—and how to tell the difference between the two.

What is lupus?

Systemic lupus erythematosus (SLE) is an autoimmune condition characterized by pain and inflammation that moves throughout the body. Like other autoimmune conditions, your immune system attacks your healthy tissues when you have lupus. Some commonly affected areas include the skin, joints, and internal organs (like your kidneys, muscles, and heart). 

People can develop lupus at any point in their life, although some populations are at higher risk, including:

  • Women between ages 15-44
  • People of African American, Asian American, Hispanic/Latino, Native American, and Pacific Islander descent
  • People with a family history of lupus or other autoimmune disorders

According to the Lupus Foundation of America, nine in ten people with lupus are female. This staggering statistic suggests that estrogen may play a role in the development of this condition. Other causes of lupus include your genetics and environmental triggers, such as UV light, infections, and exposure to agricultural and industrial toxins. Likely, a combination of all these factors causes lupus.

Symptoms of lupus

Like many autoimmune conditions, lupus is characterized by:

  • Joint pain and swelling
  • Extreme fatigue
  • Headaches
  • Swelling of the extremities like the hands and feet
  • Low fevers
  • Light sensitivity
  • Hair thinning

One of the defining characteristics of lupus is a distinct butterfly-shaped red rash on the cheeks and nose. Mouth sores and chest pain with breathing are also symptoms of lupus. 

What is Hashimoto's?

Hashimoto's thyroiditis is an autoimmune condition where your immune system attacks healthy cells in the thyroid gland. Over time, the thyroid gland becomes chronically inflamed, which leads to a decline in thyroid function. 

The thyroid is responsible for producing thyroid hormones that regulate your metabolism, growth, development, and energy storage and utilization. Hashimoto's eventually leads to hypothyroidism, where your thyroid is unable to produce a sufficient amount of thyroid hormone to support its metabolic needs.

Symptoms of Hashimoto's

People with Hashimoto's can be asymptomatic for many years. However, when chronic inflammation eventually leads to a decline in thyroid hormone production, people develop hypothyroidism.

These symptoms generally suggest a slowing of your metabolism, including:

  • Fatigue and malaise
  • Dry skin and brittle nails
  • Puffy skin, especially on the face
  • Constipation
  • Weight gain
  • Depression
  • Brain fog and trouble remembering things

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How are lupus and Hashimoto's diagnosed?

Because the symptoms are so similar, it can be hard to distinguish between the two conditions unless you have an apparent family history or a characteristic sign like a butterfly rash. People with symptoms of autoimmune diseases, such as unexplained fatigue and joint pain, usually require blood tests to get a clearer picture of what is happening at a cellular level. Your family medical provider may be able to order some of these tests. However, if you do have an autoimmune disease, you will likely need to see a specialist like a rheumatologist or an endocrinologist.

Diagnosis of lupus

Regrettably, there is no individual diagnostic test that fully identifies lupus. To test for lupus, your doctor will look for obvious inflammation signs, such as swelling, redness, heat, and loss of function. Blood tests can also reveal inflammation inside your body. Your doctor may order the following blood tests:

  • Complete blood count  (CBC) - tests red and white blood cells, platelets, and clotting factors)
  • Antinuclear Antibodies (ANA) - the immune system produces antibodies to attack foreign cells. However, antibodies can also be high in autoimmune disease.
  • Erythrocyte sedimentation rate (ESR) - A high ESR may indicate a systemic disease like lupus.
  • Kidney and liver function panel - Lupus can reduce both of these organs' function, which is reflective in these blood tests.

Your doctor may also order a urinalysis to see if kidney function is compromised. In this test, your doctor is looking for proteins and red blood cells, which should not be present if your kidneys are functioning appropriately.

Diagnosis of Hashimoto's

Testing for Hashimoto's is a little more straightforward, comparatively. While you can experience symptoms all over your body, Hashimoto's primarily attacks the thyroid gland, which means testing thyroid function is an excellent place to start. You'll want to order these tests:

  • A TSH test to measures the amount of thyroid stimulating hormone (TSH) in your blood
  • A thyroid hormone test to measures the two primary thyroid hormones: T4 (thyroxine) and T3 (triiodothyronine)
  • A TPO (thyroperoxidase) antibody test to detect autoimmune thyroid disease

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A note from Paloma Health

Of course, nothing in this article is a medical diagnosis. Getting a correct diagnosis is crucial for your health and well-being. We recommend that you work with a doctor who takes a whole-body approach to explore your symptoms and identify if the cause is related to autoimmunity. Each condition has a different prognosis and requires unique treatment. 

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Julia Walker, RN, BSN

Clinical Nurse

Julia Walker, RN, BSN, is a clinical nurse specializing in helping patients with thyroid disorders. She holds a Bachelor of Science in Nursing from Regis University in Denver and a Bachelor of Arts in the History of Medicine from the University of Colorado-Boulder. She believes managing chronic illnesses requires a balance of medical interventions and lifestyle adjustments. Her background includes caring for patients in women’s health, critical care, pediatrics, allergy, and immunology.

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