If you’ve ever felt like you’re stuck in a constant battle between feeling hyperactive and sluggish, you’re not alone. The unpredictable nature of thyroid conditions, particularly Hashimoto’s, can leave you swinging between extremes – sometimes feeling wired, other times completely drained. It’s frustrating, confusing, and can make it hard to know what’s going on with your body. Let’s dive into what’s happening beneath the surface and explore how these fluctuations occur and how you can manage them with greater confidence.
First, can you swing between hyperthyroidism and hypothyroidism?
Yes, you can experience swings between hypothyroidism and hyperthyroidism. This back-and-forth between overactivity and underactivity can happen in the early stages of Hashimoto’s, or during autoimmune flare-ups. However, over time, the condition typically settles into an underactive (hypothyroid Hashimoto’s) state.
Understanding the transition: Hashimoto’s disease
Hashimoto’s disease is an autoimmune condition where the immune system attacks the thyroid gland, leading to inflammation and damage. The elevated levels of thyroid peroxidase antibodies (TPO Ab) play a significant role in this process. These antibodies are linked to the buildup of certain cells (lymphocytes, which are white blood cells) and tissue damage in the thyroid, which affects its function.
If autoimmune inflammation remains unmanaged, the damage to thyroid tissue becomes progressive and often irreversible. This leads to a decline in thyroid hormone production, resulting in hypothyroidism. This is why a functional medicine approach emphasises reducing inflammation and managing autoimmunity to preserve thyroid function wherever possible.
Can hypothyroidism transition to Graves’ hyperthyroidism?
While it is rare, some individuals may experience a transition from hypothyroidism to Graves’ hyperthyroidism. This phenomenon is linked to changes in the types and activity of thyroid autoantibodies:
- Thyroid-stimulating antibodies (TS Ab): These stimulate the thyroid gland, causing hyperthyroidism
- Thyroid-stimulating blocking antibodies (TSB Ab): Also known as TSH-R-blocking immunoglobulins (TBII), these inhibit thyroid function, leading to hypothyroidism
In certain cases, shifts in the balance of these antibodies can result in a clinical presentation that swings between hypothyroidism and hyperthyroidism. Graves’ hyperthyroidism occurs due to the action of thyroid-stimulating antibodies, while hypothyroidism can result from thyroid-stimulating blocking antibodies. The switch between these antibodies is more commonly observed in women.
Factors that contribute to these swings
Four key factors are thought to influence these conversions:
- Autoantibody dynamics: The presence and activity of thyroid-stimulating antibodies (TS Ab) and/or thyroid-stimulating blocking antibodies (TSB Ab) in the blood (also known as TSH-R-blocking immunoglobulins (TBII)
- The thyroid gland’s response to these antibodies
- Medication effects: Treatments such as levothyroxine or antithyroid drugs (e.g., carbimazole) can sometimes influence antibody activity
- Physiological changes: Events like pregnancy may alter the concentrations of these antibodies, leading to shifts in thyroid function
Interestingly, some studies have reported that patients with hypothyroidism caused by TSB Ab, who were treated with levothyroxine, later developed TS Ab, leading to hyperthyroidism.
Similar conversions have also been observed in cases involving the use of antithyroid drugs (Carbemazole), or during physiological changes such as pregnancy. As the concentrations of TS Ab and TSB Ab shift, so can the clinical presentation of the patient.
Why doesn’t this happen to everyone with Hashimoto’s?
Not everyone with Hashimoto’s experiences swings between hyperthyroidism and hypothyroidism. It depends on factors like:
- Disease stage: Fluctuations are more common in the early stages of Hashimoto’s, before significant destruction of thyroid tissue
- Immune system activity: Flare-ups in autoimmunity, often triggered by stress, infections, or environmental factors, can drive these shifts
- Other conditions: If you also have Graves’ disease (another autoimmune thyroid condition), swings are more likely because it primarily causes hyperthyroidism
- Autoantibodies: The type and activity of autoantibodies present in the body determine the thyroid gland’s response
Discover how to heal hypothyroidism
While Hashimoto’s may lead to unpredictable thyroid fluctuations, understanding the science behind these swings is the first step toward taking control of your health. By addressing the root causes of inflammation and managing autoimmunity with a functional medicine approach, it’s possible to stabilise your thyroid function and regain balance.
If you’re looking for guidance and support, our Healing Hypothyroidism masterclass provides the tools, insights, and strategies you need to navigate this journey with confidence.
Click to watch the thyroid masterclass today.
You don’t have to navigate the ups and downs of Hashimoto’s alone. With the right approach, you can manage your thyroid health, reduce inflammation, and find the stability you need to live your best life.
