Hashimoto's thyroiditis and Graves' disease are both autoimmune disorders affecting the thyroid gland, but they result in opposite thyroid hormone conditions. Hashimoto's leads to hypothyroidism (underactive thyroid), while Graves' disease leads to hyperthyroidism (overactive thyroid).

🔹 Hashimoto's Thyroiditis (Chronic Lymphocytic Thyroiditis)

Overview:

• Cause: Autoimmune destruction of the thyroid gland.

• Effect: Hypothyroidism (underactive thyroid).

• Prevalence: Most common cause of hypothyroidism in iodine-sufficient regions.

• Gender: More common in women (especially middle-aged).

Pathophysiology:

• The immune system mistakenly attacks the thyroid gland.

• Autoantibodies involved:

  • Anti-thyroid peroxidase (anti-TPO)

  • Anti-thyroglobulin antibodies

• Lymphocytes infiltrate the thyroid, causing inflammation and gradual gland destruction.

Symptoms:

• Fatigue

• Weight gain

• Cold intolerance

• Depression

• Constipation

• Dry skin

• Menstrual irregularities

• Goiter (enlarged thyroid)

• Puffy face and slow heart rate

Diagnosis:

• TSH: High

• Free T4: Low

• Anti-TPO: Positive

• Ultrasound: May show a heterogeneous and hypoechoic thyroid

Treatment:

• Levothyroxine (synthetic T4): lifelong replacement therapy

• Monitoring TSH levels regularly

🔹 Graves’ Disease

Overview:

• Cause: Autoimmune stimulation of the thyroid gland.

• Effect: Hyperthyroidism (overactive thyroid).

• Prevalence: Most common cause of hyperthyroidism.

• Gender: More common in women, often in ages 20–40.

Pathophysiology:

• The immune system produces thyroid-stimulating immunoglobulin (TSI).

• TSI mimics TSH and overstimulates the thyroid gland.

• Leads to overproduction of thyroid hormones.

Symptoms:

• Weight loss

• Heat intolerance

• Anxiety, irritability

• Palpitations

• Tremors

• Frequent bowel movements

• Increased appetite

• Menstrual disturbances

• Exophthalmos (bulging eyes, specific to Graves’)

• Goiter

Diagnosis:

• TSH: Low

• Free T3 and T4: High

• TSI or TRAb: Positive

• Radioactive iodine uptake (RAIU): High uptake

• Ultrasound: Increased vascularity

Treatment:

• Anti-thyroid drugs (e.g., methimazole, propylthiouracil)

• Radioactive iodine ablation

• Surgery (thyroidectomy) in selected cases

• Beta-blockers to control symptoms (e.g., propranolol)

🔄 Comparison Table:

Feature	Hashimoto's Thyroiditis	Graves’ Disease
Thyroid Function	Decreased (Hypothyroidism)	Increased (Hyperthyroidism)
Autoantibodies	Anti-TPO, Anti-thyroglobulin	TSI (Thyroid-stimulating Ig)
Common Age/Gender	Women, 30–50 years	Women, 20–40 years
Goiter	Common	Common
Eye Involvement	Rare	Common (exophthalmos)
Treatment	Levothyroxine	Antithyroid meds, RAI, surgery
Risk of Thyroid Cancer	Slightly increased	Slightly increased

⚠️ Complications

• Hashimoto’s: Myxedema (severe hypothyroidism), infertility, miscarriage risk, heart issues.

• Graves’: Thyroid storm (life-threatening), heart arrhythmias, osteoporosis, eye damage (Graves' orbitopathy).

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