Hypothyroidism and Hyperthyroidism (+ 5 Natural Steps to a Healthier Thyroid Gland)

July 12, 2019

Thyroid disease is one area that I am very passionate about because I see so many patients who are frustrated that they are not getting better using conventional treatment protocols.

Hypothyroidism and hyperthyroidism affect many people. In fact, it’s estimated that about 20 million Americans have thyroid disease. [1]

Many people struggle with thyroid disease that results from environmental factors, such as chronic stress and resulting adrenal fatigue, exposure to radioactivity, other autoimmune diseases, and nutritional deficiency.

One of the top prescribed drugs in the U.S. is levothyroxine (also known by the brand name Synthroid), a primary conventional treatment for low thyroid function. Yet despite this therapy, many people are still not feeling better. [2]

On top of that, many people fly “under the radar” because they have what’s known as subclinical hypothyroidism or low-functioning thyroid. This condition is commonly missed by standard screening tests. Because of this, many people are told that their thyroid is in the “normal” range and they walk away feeling frustrated, meanwhile struggling with symptoms of a hypoactive thyroid.

And, although not as common, some patients present with an overactive thyroid gland, usually in the form of Graves’ disease.

Learn more below as I explain what the thyroid does, symptoms of thyroid disease, and the difference between hypothyroidism and hyperthyroidism. I have also provided a hyperthyroid vs. hypothyroid symptoms chart to help make it easier to understand these conditions.


The Thyroid Gland and Thyroid Disease

Your thyroid gland is located at the base of your neck and it’s shaped like a butterfly. The thyroid plays an important role in helping the body to maintain the skin, bones, nails, metabolism, and more.

I consider the thyroid to be a “compensation organ” because it steps in to help when other hormones in your body aren’t working to their full capacity. It adapts to the situation surrounding it.

Thyroid disease occurs when there is an imbalance in thyroid hormones. This imbalance may happen due to several factors, including autoimmune disease, genetic causes, viruses, toxins, or nutritional deficiencies such as low iodine or selenium.

Depending on how the thyroid imbalance manifests, it will either become underactive or overactive. When the thyroid is underactive, hypothyroidism may result and when it is overactive, hyperthyroidism may result.

Keep in mind that this process is gradual; you don’t become hypo- or hyperthyroid overnight. In conventional medicine, the thyroid is considered either normal or abnormal. My specialty lies in treating the thyroid while it’s in the in-between or subclinical state and preventing it from turning into full-blown thyroid disease.

The thyroid gland - Dr. Pingel

Thyroid Hormones

You may be wondering, “What hormone does the thyroid gland produce?”

The thyroid produces thyroxine (T4), which then converts to either T3 thyroid hormone or reverse T3.

The thyroid also works closely with the pituitary gland, which produces a key hormone called TSH (thyroid stimulating hormone).

Here is a breakdown of each thyroid hormone and its function:

TSH: The pituitary gland in your brain releases TSH in response to the levels of thyroid hormone in your blood. If you have too much thyroid hormone in your blood, TSH will be low. If not enough, it will be high.

It doesn’t actually produce thyroid hormone; it just lets the thyroid know it needs to produce thyroxine, or T4. It’s a signal, per se.

A study published in the Journal of Endocrinology in 2013 noted that the standard range for thyroid screening may not be appropriate for evaluating symptoms. The researchers found that even the slightest variation in TSH levels can be associated with negative symptoms, even when those levels fall within what has been determined to be an acceptable range. [3]

For example, the “normal” range for TSH is rather broad, from approximately 0.5 to 4.5 uIU/L, but I have found that once the TSH moves above 2.5, the thyroid is usually not working optimally. Although everyone presents differently, typically, I find that this indicates subclinical hypothyroidism, which means that T4 is not being converted appropriately to T3.

Research has shown similar results and conclusions. Scientists reported in a 2012 study that any TSH level above 2 should be considered abnormal.

But, I caution you to not simply rely on the TSH value. Make sure to evaluate the entire thyroid picture before making a treatment decision. There is more to the picture—T4, T3, reverse T3 (RT3), and antibodies. [4]

T4 (thyroxine): After the thyroid gland receives the signal from the TSH hormone, it then uses iodine and the amino acid tyrosine to produce the hormone T4, also known as thyroxine.

T4 is then converted into one of two other hormones: T3 or reverse T3.

An important note: Only a small portion of the Total T4 and Total T3 is released for use in the body, the remainder (and majority) is bound to proteins rendering it unusable. When screening for lab levels, it is important to look at FREE levels, as TOTAL levels will not distinguish bound versus free and could provide an inaccurate picture of metabolic activity! It is essential to request screening Free T4 and Free T3, rather than simply T4 and T3. Far too many times I have seen a Total T4 that is completely normal paired with a very low Free T4. Trust me, that person did not feel normal!

The importance of the usage and storage of T4 is often overlooked by doctors due to too much focus on simply numbers and not function. T4 is produced by the thyroid but is not the most metabolically active in your body. The conversion into T3 is essential for our bodies to function.

This is why, many times, a patient may have normal TSH and Free T4 levels, but still experience weight gain, fatigue, hair loss, and other hormone irregularities. You have to look at all the aspects of thyroid function to get the full picture!

T3: Once T4 is released into your bloodstream, your tissues will decide whether to use it as Free T3 or to store it as reverse T3.

Converting T4 to T3 requires vitamin A, selenium, zinc, and iodine. Free T3 will be used by your body to maintain your nails, bones, skin, and metabolism.

If you are in adrenal fatigue, your body will often convert T4 into the inactive form, reverse T3, and store it rather than use it. This situation will give the symptoms of hypothyroidism but with “normal” TSH and Free T4 levels.

Reverse T3 (RT3): Reverse T3 (RT3) is the inactive form of thyroid hormone that the body stores. High levels of RT3 will produce the same symptoms as low levels of T4, yet Free T4 and TSH levels will appear normal on a standard thyroid blood test. Basically, the levels of Free T4 and TSH are normal, but the use of the hormone is reduced.

When a patient comes to me with thyroid disease, many times I find that the thyroid is actually producing T4 just fine, but the problem is in how the body is using it—they often have high levels of RT3 or low levels of Free T3 or both!

Often the T4 is being converted to RT3 and stored as a result of high cortisol levels. The thyroid “thinks” it needs to store excess T4 for future energy use. Higher cortisol levels are often related to the early stages of adrenal fatigue.


The Difference Between Hypothyroidism and Hyperthyroidism

When your thyroid is out of balance it will either be underactive or overactive. If it’s underactive, you may have hypothyroidism. If your thyroid is overactive, you may have hyperthyroidism.

So, what are the signs and symptoms of hyperthyroidism and hypothyroidism? Keep reading below for more information on the difference between hypothyroidism and hyperthyroidism. Plus, see the hyperthyroid vs. hypothyroid symptoms chart for a quick breakdown.

Some patients have asked me, “Can you have hypothyroidism and hyperthyroidism at the same time?” While you can’t have both conditions at the same time, you may experience both conditions depending on what is causing your thyroid disease. Keep reading to learn more.


Hypothyroidism is more common than hyperthyroidism. In the U.S. about 4.6 percent of the population of those aged 12 years and older, or 5 people out of 100, have hypothyroidism. [5]

Women and individuals over 60 years old are more likely to develop hypothyroidism.

What level of TSH indicates hypothyroidism? An abnormally high level of TSH will usually indicate hypothyroidism, but the symptoms of hypothyroidism can be present when TSH is also in range due to the hormone conversion issues I explained under “Thyroid Hormones.”

Hypothyroidism Causes and Risk Factors

  • Previous thyroid issues such as a goiter or nodules
  • Stress
  • Thyroid surgery
  • Radiation treatment to the thyroid, neck, or chest (including radioactive iodine)
  • Family history of thyroid disease
  • Pregnancy within the past six months
  • Turner syndrome
  • Autoimmune conditions such as Hashimoto's, Sjögren’s syndrome, Rheumatoid arthritis, lupus, and celiac disease
  • Pernicious anemia
  • Type 1 diabetes
  • Perimenopause
  • Estrogen hormone therapy (bio-identical, fertility, birth control pills)
  • Estrogen dominant conditions, such as polycystic ovarian syndrome (PCOS)
  • Magnesium deficiency [6]
  • Thyroiditis (inflammation of thyroid gland due to virus or immune disorder)
  • Congenital hypothyroidism (the condition is present at birth)
  • Some medications, such as antidepressants and anti-anxiolytics
  • Too little iodine
  • Disease of the pituitary gland
  • Poor gut flora
  • Poor mineral nutrition
  • Diets containing gluten

Common Hypothyroidism Symptoms

  • Fatigue
  • Forgetfulness
  • Dry skin and hair
  • Puffy face
  • Hoarse voice
  • Cold intolerance
  • Decreased sweating
  • Frequent, heavy menstrual periods
  • Fertility problems
  • Constipation
  • Depression
  • Slowed heart rate
  • Pain in the joints and bones
  • Weight gain
  • Low levels of magnesium and vitamin D [7]

Complications of hypothyroidism may contribute to high cholesterol. It can also lead to myxedema coma, which is an extreme form of hypothyroidism that causes bodily functions to slow down so much that it becomes life-threatening. This condition, though rare, requires emergency medical treatment.

Hashimoto’s Thyroiditis

Hashimoto’s thyroiditis is an autoimmune disease that causes the immune system to attack the thyroid gland. It is the most common cause of hypothyroidism in iodine-sufficient areas such as the U.S. [8]

When Hashimoto’s, antibodies (TPO and thyroglobulin) form against the thyroid, they cause decreased thyroid production. It was previously believed that Hashimoto’s was genetic, although more recently, it has been recognized that environmental factors can cause it to develop as well.

In my clinic, I find that it to be primarily environmental in origin, and highly related to stress adaptation.

Your thyroid is involved in the control of every system in your body and must be properly evaluated whenever you develop a chronic symptom or disease. In my experience, there are two types of Hashimoto’s patients.

One type of Hashimoto’s patients has the genetic form of Hashimoto’s where their antibodies fall well above normal levels. You must have 35 IU/ml TPO antibodies in order to be officially diagnosed with Hashimoto’s thyroiditis. The genetic patients will typically have hundreds to thousands that commonly will have been present for quite some time, often since puberty or pregnancy in women.

Note that this diagnosis is independent of your T4 levels. Having Hashimoto’s thyroiditis does not always mean that you are hypothyroid, it simply means you have the antibodies developing to become hypothyroid in the future. This is why I always recommend evaluating for antibodies even when TSH and T4 are within range.

Many Hashimoto’s patients have normal levels of T4 and normal to slightly elevated TSH. I find that only a small percentage of patients have ridiculously high levels of antibodies.

The majority of patients I see have much lower levels of antibodies—that have not always been present or vary in number, frequently less than 500, with the majority of cases below 100.

And here is a little tip I learned early in my practice: when adrenal fatigue is treated, the number of antibodies decrease, T3 levels increase, and symptoms resolve many times without the use of thyroid medications. If the disease were genetic, this would not always happen, although, they definitely saw symptom improvement.

Complications of Hashimoto’s may include increased cholesterol, irregular heartbeat leading to heart failure, significant depression, decreased sex drive, and slowed metabolism. It will also impact other hormones, often resulting in menopausal-like symptoms and insulin resistance.

Hypothyroidism and hyperthyroidism - Dr. Pingel


Hyperthyroidism is the term used to describe an overactive thyroid gland. Roughly 1 person out of 100 in the U.S.—or 1.2 percent of the people— has hyperthyroidism. Hyperthyroidism symptoms in women are more common as women are 2 to 10 times more likely to develop hyperthyroidism than men. [9]

In hyperthyroidism, TSH levels are low, so a diagnosis of hyperthyroidism is usually related to low TSH levels, along with increased T4 and T3 levels.

Conventional treatment for hyperthyroid conditions includes beta blockers, which don’t stop thyroid hormone production but rather treat the symptoms by blocking cardiovascular output, and antithyroid medications, which cause the thyroid to produce less hormone. The most common antithyroid medication is methimazole. These medications may cause significant side effects.

Radioactive iodine is another common conventional treatment for hyperthyroidism. This treatment slowly destroys the thyroid gland and eventually leads to hypothyroidism, requiring ongoing treatment for hypothyroid symptoms.

The least common conventional hyperthyroidism treatment method is surgical removal of part or all of the thyroid gland, which also results in hypothyroidism, especially if the entire gland is removed.

Hyperthyroidism Risk Factors

  • Family history of thyroid disease
  • Pernicious anemia
  • Type 1 diabetes
  • Adrenal insufficiency
  • Consuming a lot of food that contains iodine or taking medications that contain iodine (unlike hypothyroidism where a lack of iodine can be a risk factor, the opposite is true of hyperthyroidism)
  • Pregnant within the last six months

Untreated hyperthyroidism can lead to serious health complications including:

  • Irregular heartbeat that may lead to blood clots, stroke, and heart failure
  • Bone thinning and osteoporosis
  • Graves’ ophthalmopathy, an eye disease that can cause sensitivity to light, double vision, eye pain, bulging eyes, and vision loss (rare)
  • Menstrual cycle and fertility problems

 Hyperthyroidism Symptoms

  • Trouble sleeping
  • Irregular heartbeat
  • Enlarged thyroid gland (goiter)
  • Irritability and nervousness
  • Mood swings
  • Muscle weakness
  • Tremor (shaky hands)
  • Vision problems
  • Eye irritation
  • Sensitivity to heat
  • Infrequent, light periods
  • Frequent bowel movements
  • Weight loss
  • Magnesium deficiency [10]

Hyperthyroidism Causes

Graves’ Disease

The most common cause of hyperthyroidism is Graves’ disease, an autoimmune condition that attacks the thyroid gland.

However, something that I commonly see among patients that is often overlooked by conventional practitioners is that it is common for the thyroid to surge before it fails. Just as adrenal gland function rises and falls after prolonged stress, so does thyroid function.

If you experience heart palpitations, hair loss, weight loss, skin changes, and lack of menstruation, you may have your thyroid checked and be told that you have hyperthyroidism.

The doctor may recommend an antithyroid medication to block thyroid function. These medications can permanently damage your thyroid, so this is not a decision to take lightly. It’s very common for a low-functioning thyroid gland to have a final surge of thyroid hormone before its function slows.

These symptoms can resemble the symptoms of adrenal fatigue. If you have not been diagnosed with hyperthyroidism or Graves’ disease, then do some further investigation before treating your condition with medications. If the cause is adrenal fatigue, many people will regain normal thyroid function within a few weeks.

Other causes of hyperthyroidism may include thyroid nodules, thyroiditis, and, rarely, a noncancerous tumor of the pituitary gland. Ingesting too much iodine or taking too much thyroid hormone medication may also cause hyperthyroid symptoms.

Thyroid Nodules

Thyroid nodules are lumps on the thyroid that occur when parts of the thyroid become overactive, rather than the entire thyroid gland. Note that this can also occur in hypothyroidism as well, in response to a poorly functioning gland.


There are several kinds of thyroiditis, but basically, it is an inflammation of the thyroid gland that causes excess thyroid hormone to release from the thyroid. This may last for several months and then the thyroid may switch to an underactive state, or hypothyroidism.

Thyroiditis may be a sign of other conditions, such as adrenal fatigue, Hashimoto’s or Graves’ disease, but it may also be temporary in response to a virus or infection. Many cases of thyroiditis will spontaneously resolve after a few weeks. Keep an eye on your thyroid levels, and if steadily improving, consider waiting on treatment, particularly if you have recently been exposed to a possible virus.

Too much iodine

While this is not a common cause of hyperthyroidism and although the thyroid uses iodine to make thyroid hormone, eating too much iodine can sometimes result in the thyroid producing too much thyroid hormone. Foods that contain a lot of iodine include seaweed or kelp and seaweed-based supplements.

Some cough syrups and medications such as the heart medicine amiodarone also contain high levels of iodine.

Too much thyroid hormone medicine and medication interactions

If you take medicine for hypothyroidism be sure to get hypothyroidism labs to check your thyroid hormone levels at least once a year as taking too much thyroid hormone medication can sometimes lead to hyperthyroidism. It’s also possible that some other medications, such as birth control pills and other estrogen-based therapies, may interact with thyroid hormone medicine to alter thyroid hormone levels

Stress and Thyroid Function

Chronic stress can lead to adrenal fatigue, which can, in turn, lead to thyroid disease. It’s important to find healthy, fun ways to manage stress. If you do find yourself experiencing symptoms that appear to be thyroid-related, it’s very possible that what you are experiencing is adrenal fatigue. If treated correctly, these symptoms will likely disappear.


5 Natural Steps to a Healthier Thyroid

  1. Find fun ways to manage stress.
  2. Get plenty of rest.
  3. Eat a balanced diet that includes appropriate amounts of iodine, selenium, and zinc.
  4. Consider going gluten-free to help manage Hashimoto’s.
  5. If you have subclinical hypothyroidism, try ashwaghandha, an herbal remedy, to help relieve symptoms. (Note: If you have a nightshade sensitivity, don’t take ashwaghandha.) [11]


Key Takeaways

  • Hypothyroidism and hyperthyroidism are thyroid conditions caused by an imbalance in the production and body’s usage of thyroid hormone.
  • Adrenal fatigue can often lead to thyroid disease.
  • Conventional thyroid screening standards often miss subclinical hypothyroidism.
  • A variety of risk factors can lead to thyroid disease, including genetics, environmental factors, other diseases, viruses, medication interactions, mineral deficiencies, and toxins.
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