Hashimoto’s Thyroiditis and Graves Disease are both autoimmune thyroid diseases. Since they are autoimmune diseases, they can cycle from active to inactive phases with the active phases cycling in severity. Over time, Hashimoto’s usually leads to hypothyroidism, while Graves usually leads to hyperthyroidism. Though hypothyroidism and hyperthyroidism can be easy to treat, treatment of autoimmune thyroid diseases as they cycle through phases and severity can be very difficult.
If you have an autoimmune thyroid disease, then you have thyroid antibodies. There are different types of antibodies, with one type usually present in Hashimoto’s and another in Graves. These antibodies attack your thyroid, affecting the way it functions. Hashimoto’s antibodies usually cause your thyroid to be under active, while Graves antibodies usually cause your thyroid to be overactive. Unfortunately, autoimmune diseases tend to have a mind of their own and often do not follow any textbook pattern. Hashimoto’s, for example, can actually swing back and forth between hypothyroid and euthyroid with phases of hyperthyroidism known as Hashitoxicosis.
There are also times that a person will have both Hashimoto’s and Graves antibodies, which can also cause this swinging back and forth. I was originally diagnosed in 2006 with Hashimoto’s and at that time only had the antibodies for Hashimoto’s. I went back and forth between hypothyroid and euthyroid and had a hyperthyroid phase of Hashitoxicosis in 2007 that put me in the hospital for three days. I then went back to the hypothyroid/euthyroid cycle until March of 2010 when I went hyperthyroid again from another phase of Hashitoxicosis. Unlike previous blood tests though, the ones in March now showed that I have the antibodies for Hashimoto’s and Graves Disease, which means I now have both autoimmune thyroid diseases.
When your body is cycling back and forth from hypothyroid and euthyroid to hyperthyroid, it is very difficult to be able to do a consistent treatment. I have gone back and forth several times from being on thyroid medication for hypothyroidism to having to stop taking it because I went euthyroid and started to have hyper symptoms from the medication. I also had to be put on anti-thyroid medication when I was hyperthyroid from Hashitoxicosis and then had to stop the anti-thyroid medication a couple of months later because I became severely hypothyroid. When the anti-thyroid medications was stopped, the plan was to let my body go hyperthyroid again and then get treated with Radioactive Iodine to kill off my thyroid and stop all of the autoimmune cycling. After Radioactive Iodine treatment, I would then go hypothyroid and be able to be put on a consistent dose of thyroid medication. Of course, the autoimmune thyroid diseases didn’t cooperate, and after being off of the anti-thyroid medication for four months, my body is staying slightly hypothyroid. I now need to go back on thyroid medication and hope that I don’t end up hyperthyroid in another phase of Hashitoxicosis.
This vicious cycle of trying to treat the different phases of autoimmune thyroid diseases won’t stop until your thyroid starts to die out on its own or you have a permanent treatment like Radioactive Iodine or a thyroidectomy done. Once your thyroid starts to die out or you have a permanent treatment done, your body will go hypothyroid and stay hypothyroid and you will be able to go on a consistent dose of thyroid medication.
Dealing with the Cycles
Staying on top of the cycles of autoimmune thyroid diseases is not easy, but there are things that can be helpful. First, finding a good doctor that is familiar with the swinging back and forth of autoimmune thyroid diseases and phases of Hashitoxicosis is of most importance. I battled through four years of many doctors, including endocrinologists, not knowing why I was cycling through hypothyroid, euthyroid, and hyperthyroid until I finally found my current endocrinologist, who is a godsend. She was the first doctor that was familiar with the cycling back and forth, with Hashitoxicosis, and with a patient having both Hashimoto’s and Graves antibodies. None of the other doctors had a clue about what was going on. Since having a doctor that is knowledgeable in all of these areas, I am getting much better and more thorough care and the cycles are no longer being allowed to become severe and out of control.
Next, become familiar with the symptoms of hypothyroidism and hyperthyroidism, especially your personal symptoms. I know that my heart rate stays fast, my body feels “spazzy”, and I get pressure headaches when I get hyperthyroid. I also know that I sleep more, am always wore out and dragging through my day with no energy, and get dull, foggy-minded headaches when I’m getting hypothyroid. Your symptoms can help you know that you need to get your thyroid levels checked to find out what treatment you currently need. Make sure you never ignore sudden hyperthyroid symptoms as this can be a sign of Hashitoxicosis and can be dangerous or even fatal if left untreated.
Finally, get blood tests often. A good doctor that understands autoimmune thyroid diseases will know that you need blood tests more often than every six to twelve months. Going that long without blood tests is fine for normal hypo or hyperthyroidism, but not for thyroid diseases that can cycle requiring changes in treatment. I know from experience that you can go from euthyroid with perfect thyroid tests to being in the emergency room with severe hyperthyroidism from Hashitoxicosis in just two months. A good doctor will have blood tests done as often as neccessary. This includes listening to you when you say you are having symptoms and doing blood tests to check your levels. If blood tests are done frequently, changes in cycles can be caught quickly and then be treated accordingly. It is also very important that you get thyroid antibody blood tests done if you’ve never had them done or if a major change in your thyroid function occurs. Many doctors do not run thyroid antibody tests, so it’s important to ask if you are being tested for antibodies and request that you be tested if not.
Having a good doctor, recognizing cycles and symptoms, and getting your thyroid levels tested often will help in the difficulties of treating your autoimmune thyroid disease. I also recommend that you learn as much as you can about the thyroid disease or diseases that you have. Arming yourself with information can help you make good decisions about your thyroid treatment.
For further reading about autoimmune thyroid diseases and related topics, click on the highlighted article titles below.
Hashitoxicosis Signs and Symptoms – Hashimoto’s Thyroiditis with a Twist
Hyperthyroidism: Signs and Symptoms
Methimazole (Tapazole) – Signs and Symptoms of Overmedication and Side Effects
Synthetic Vs. Natural Thyroid Medication: Synthroid Vs. Armour Thyroid Medicine
Side Effects of Synthroid – Signs that Your Thyroid Medicine is Making You Sick
Thyroid Hormone Replacement: Signs and Symptoms of Overmedication (Overdose)
Thyroid Disease: Could You Have It?
Thyroid Tests: Thyroid Ultrasound
Thyroid Uptake and Scan