Difference Between Hashimoto and Hypothyroidism

Hashimoto's thyroiditis and hypothyroidism are two different conditions that affect the thyroid gland. While they share some similarities, they have distinct differences that make it important to differentiate between the two.

The thyroid gland is a small, butterfly-shaped gland located in the neck, responsible for producing hormones that regulate metabolism and energy levels in the body.

Hashimoto's thyroiditis is an autoimmune disorder in which the immune system attacks the thyroid gland, leading to inflammation and damage. Hypothyroidism, on the other hand, is a condition in which the thyroid gland is not producing enough hormones, often due to damage or disease.

What is Hashimoto?

Hashimoto is a disease in which a person’s thyroid gland is attacked by their own immune system resulting in problems in how many hormones are then secreted by the gland.

Symptoms − The main symptom is an increase in the size of the thyroid, and hence a feeling of fullness in a persons’ neck. This swelling is called a goiter and may be externally visible. The thyroid, although enlarged, is not painful though. Other symptoms include a patient showing signs of too little or too many thyroid hormones. Hypothyroidism symptoms such as weight gain, feeling sluggish, and signs and symptoms associated with a slow metabolic rate often occur in Hashimoto disease.

Diagnosis − Tests can be done to determine the levels of thyroid stimulating hormone (TSH) and thyroxine hormone (T4). The presence of high levels of antibodies in the blood, such as antithyroglobulin and thyroid peroxidase antibodies are an indication of the condition. Levels of TSH and T4 may change later in the disease but may be normal if the disorder is in the early stages. Ultrasonography can be used for diagnosis particularly if bumps can be felt in the neck. This test would then show these nodules as dark masses in the thyroid.

Treatment − Most patients with Hashimoto disease need to have thyroid hormone replacement treatment for the remainder of their lives. This is usually in the form of L-thyroxine hormone that is given each day.

Causes and risk factors − Women who have a family history of Grave’s disease or Hashimoto’s are at increased risk of developing Hashimoto’s as they grow older. Scientists have also found a common genetic link between both these autoimmune diseases.

What is Hypothyroidism?

Hypothyroidism is the condition that a person has when the levels of thyroid hormones in their bloodstream are too low. The disease can also be divided into a primary type which is related to the thyroid, and a secondary type that is related to the pituitary gland and hypothalamus.

Symptoms − There are many signs and symptoms that can point to the condition of hypothyroidism. Patients often gain weight because of a drop in metabolic rate, and they feel cold more often than normal. They may also suffer from constipation and have a decreased heart rate. The face may seem puffy and hair becomes coarse. Patients may also become depressed and more forgetful than usual.

Diagnosis − Blood tests to examine levels of TSH and T4 are done. The TSH levels are often noticed to be higher than normal if a person has hypothyroidism. Levels of T4 hormone are usually lower than usual.

Treatment − The usual treatment is for patients to be given L-thyroxine to compensate for the low hormone levels unless the cause is secondary hypothyroidism in which case the levels of cortisol have to first be verified or supplemented in patients.

Causes and risk factors − Hypothyroidism can sometimes be caused by autoimmune conditions such as Hashimoto disease or it can be a result of thyroid surgery or radiation treatment. Certain medications such as lithium can also cause hypothyroidism. In addition, some women develop the disorder during pregnancy and some babies are born with congenital hypothyroidism. A lack of iodine in the diet can also cause the problem but in most countries, this is rare today since iodine is added to table salt.

Differences: Hashimoto and Hypothyroidism

Causes − One of the key differences between Hashimoto's thyroiditis and hypothyroidism is the cause. Hashimoto's thyroiditis is an autoimmune disorder, meaning the body's own immune system mistakenly attacks healthy tissue.

In the case of Hashimoto's, the immune system attacks the thyroid gland, leading to inflammation and damage over time. Hypothyroidism, on the other hand, can have a range of causes, including damage to the thyroid gland, radiation treatment, and certain medications. It can also be a result of Hashimoto's thyroiditis, as the inflammation and damage to the gland can eventually lead to hypothyroidism.

Symptoms − Hashimoto's thyroiditis often presents with a range of symptoms that are not necessarily related to the thyroid gland. These can include fatigue, weight gain, muscle weakness, joint pain, and depression. As the condition progresses, symptoms specific to the thyroid gland may develop, such as a goiter (enlarged thyroid gland), sensitivity to cold, and dry skin.

Hypothyroidism, on the other hand, primarily presents with symptoms related to a low level of thyroid hormones, including fatigue, weight gain, cold intolerance, constipation, and dry skin.

Both conditions can also cause changes in mood and mental function, such as depression, anxiety, and difficulty concentrating.

Diagnosis − Diagnosis of Hashimoto's thyroiditis and hypothyroidism is also different. Hashimoto's thyroiditis is typically diagnosed through a combination of blood tests and imaging studies. Blood tests can reveal high levels of antibodies that indicate an autoimmune response, as well as low levels of thyroid hormones. Imaging studies, such as ultrasound or a thyroid scan, can show the size and shape of the gland, as well as any abnormalities.

Hypothyroidism, on the other hand, is usually diagnosed through blood tests that show low levels of thyroid hormones. Imaging studies may also be used to evaluate the size and shape of the thyroid gland.

Treatment − Treatment for Hashimoto's thyroiditis and hypothyroidism also differs. Hashimoto's thyroiditis is typically treated with medication that reduces inflammation and slows the progression of the disease. Hormone replacement therapy may also be necessary if hypothyroidism develops.

Hypothyroidism, on the other hand, is primarily treated with hormone replacement therapy, which involves taking synthetic thyroid hormones to replace the hormones that the thyroid gland is not producing.

The following table highlights the major differences between Hashimoto and Hypothyroidism −





Hashimoto disorder is the condition where the immune system attacks the thyroid gland.

Hypothyroidism is the condition where too few thyroid hormones occur in the blood.

Primary and secondary type

Hashimoto disease does not have a primary and secondary type since it always concerns a problem with the thyroid gland.

Hypothyroidism has a primary and secondary type since it can also concern problems with the hypothalamus and pituitary.


In Hashimoto disease, a goiter is present in the neck region.

In hypothyroidism, a goiter is not always present.


Hashimoto is only caused by one problem, which is an issue with the immune system.

Hypothyroidism has many causes besides the immune system and can be caused by certain types of medication, a lack of iodine in the diet, and radiation therapy.

Immune system

Hashimoto disease is always caused by a problem with the immune system.

Hypothyroidism is not always caused by an immune system problem.


Antithyroglobulin and thyroid peroxidase antibodies are always elevated in the case of Hashimoto disease.

The antithyroglobulin and thyroid peroxidase antibodies are not always elevated in the case of hypothyroidism.


Thyroiditis, in which the thyroid gland is actually inflamed, is typically evident in Hashimoto.

Such inflammation is not always evident in patients who have hypothyroidism.


In conclusion, while Hashimoto's thyroiditis and hypothyroidism share some similarities, they are two distinct conditions with different causes, symptoms, and treatments.

Understanding the differences between the two can help individuals and healthcare professionals make an accurate diagnosis and develop an appropriate treatment plan.

Updated on: 10-Apr-2023


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