Hypothyroidism vs. Hyperthyroidism – What’s the Difference (Part 2)

In this week’s episode of Thyroid Thursday, Dr. Raymond Douglas shares part 2 of his interview with thyroid surgeon Dr. Babak Larian. Last week in Part 1, they taught you about the difference between hypothyroidism vs hyperthyroidism, and this week they will go into greater detail about the differences between Graves’ Disease and Hashimoto’s disease.

Hypothyroidism vs. Hyperthyroidism

As a refresher from last week:

  • Hyperthyroidism – too much thyroid hormone
  • Hypothyroidism – too little thyroid hormone

Hashimoto’s Disease vs. Graves’ Disease

There are two kinds of autoimmune disorders that can affect the thyroid – Hashimoto’s disease and Graves’ disease.

What is Hashimoto’s Disease?

In patients with Hashimoto’s disease, there is an antibody to a specific protein on the thyroid gland, called the thyroid peroxidase. This antibody attaches to those proteins inside the thyroid gland and the immune system then attacks and causes inflammation of the thyroid gland. At the beginning of the attack, a lot of the hormone is released from the thyroid gland. So Hashimoto’s patients may have a hyperthyroid state at the beginning of the attack, but this is short term. It is followed by a period of low free T4 and free T3 with a higher TSH. With each attack the thyroid keeps working a little less. In the long term, the T4 and T3 will just stay at a low state where they cannot produce enough thyroid hormone.

When your thyroid levels are bouncing around like this, it can affect how you feel. However, most people have very subtle Hashimoto’s disease and don’t even know they have it.

What is Graves’ Disease?

Graves’ disease is completely different than Hashimoto’s disease. The antibody in this disease is towards the receptor in the thyroid gland that the TSH attaches to. Normally, when the TSH attaches to this receptor, it stimulates the thyroid gland to produce extra thyroid hormone. Alternatively, in patients with Graves’ disease, when the antibody attaches to the receptor it falsely stimulates the gland to produce extra thyroid hormone – elevation of free T3 and free T4. The brain will try to modulate by lowering the TSH, but it has no real effect.

There are 2 types of receptor antibodies to measure:

  1. Measure the receptor antibodies available
  2. Look at the thyroid stimulating immunoglobulin

Once these different receptor antibodies have been measured and you have the diagnosis of what disease you are dealing with, we can address it appropriately.

What is a Thyroid Nodule?

A nodule within the thyroid is a little lump that most of the time does not cause any symptoms. You can remove the nodule with a minimally-invasive treatment or control it with medicine.

In patients with a hyperthyroid state, we want to know if the whole gland is producing extra hormone or if just the nodule is. If just the nodule is producing extra hormone, then we can address it by just removing the nodule if the nodule. If the entire gland is malfunctioning, then you have to determine the best path of treatment because there are several options.

Thyroid Treatment in Graves’ Disease

There are a few different thyroid treatment options for patients with Graves’ disease. At the International Orbital Institute, we take a very customized approach to thyroid treatment so that it is the healthiest and most successful option for you and your lifestyle.

A thyroidectomy reduces the chance of worsening eye disease in Graves’ disease, while radioactive iodine does aggravate the eye disease. So we may recommend the thyroidectomy to restore your thyroid equilibrium and does not aggravate the eye disease.

Contact the International Orbital Institute

If you have been suffering from Graves’ disease and are looking for the best treatment option for YOU, please contact us today! Also, please do not hesitate to contact us to learn more about hypothyroidism vs. hyperthyeroidism or Graves’ disease vs. Hashimoto’s disease.

Posted in: Thyroid Eye Disease

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