Is it possible to have both Graves’ disease and Hashimoto’s thyroiditis at the same time?

By Sina Hartung, MMSC-BMI, Harvard Medical SchoolReviewed by Eureka Health Medical Group
Published: June 19, 2025Updated: June 19, 2025

Summary

Yes. Around 10–15 % of people with autoimmune thyroid disease carry antibodies typical of both Graves’ disease (TRAb) and Hashimoto’s thyroiditis (TPOAb and TgAb). They can shift between hyperthyroidism and hypothyroidism over months or years, which makes diagnosis and treatment more complex but entirely manageable with the right monitoring and care.

How can one thyroid gland show features of two opposite diseases?

Autoimmune thyroid disease exists on a spectrum. Some people produce stimulating antibodies that push the gland into overdrive (Graves’) and destructive antibodies that slowly damage the gland (Hashimoto’s). The overlap is called Hashitoxicosis or Graves–Hashimoto overlap. The team at Eureka Health notes that recognizing the dual presence early prevents years of swing symptoms.

  • Dual-antibody positivity is commonUp to 15 % of autoimmune-thyroid patients test positive for both TSH-receptor antibodies (TRAb) and thyroid-peroxidase antibodies (TPOAb).
  • Symptoms can alternate over timeAbout 30 % of overlap patients move from hyperthyroid to hypothyroid phases within two years, requiring treatment changes.
  • Family history raises oddsHaving first-degree relatives with any autoimmune disorder doubles the risk of mixed antibody profiles.
  • Ultrasound often shows a patchy patternA heterogeneous, hypoechoic thyroid texture is typical when both destructive and stimulatory processes occur.
  • Mixed histology confirms simultaneous Graves–Hashimoto pathologyThyroidectomy specimens can show both diffuse hyperplasia typical of Graves’ disease and dense lymphoplasmacytic infiltration characteristic of Hashimoto’s thyroiditis in the same gland. (BMC)
  • Course can fluctuate for decadesA documented patient alternated between hyper- and hypothyroid phases for over 20 years before definitive treatment was chosen. (JETR)

References

Which warning signs mean the antibody tug-of-war is harming you right now?

Rapid swings in weight, pulse, or mood can signal uncontrolled antibody activity. “Any resting heart rate above 100 or a TSH that flips from suppressed to elevated within weeks demands immediate re-evaluation,” says Sina Hartung, MMSC-BMI.

  • Resting heart rate over 100 beats per minutePersistent tachycardia may precede thyroid storm during a Graves-dominant flare.
  • Sudden 10-pound weight change in a monthFast gain or loss suggests a shift from hypo to hyper (or vice versa).
  • New atrial fibrillationUp to 15 % of hyperthyroid patients develop AFib; overlap patients are no exception and need ECG promptly.
  • Severe fatigue with TSH >10 mIU/LThis level indicates overt hypothyroidism despite recent hyperthyroid symptoms.
  • More than 30 documented switches between hypo- and hyperthyroidism in a single patientA 44-year-old woman cycled between thyrotoxicosis and hypothyroidism on over 30 separate lab checks, underscoring how quickly antibody dominance can change and why any new symptom flare should trigger repeat testing. (NIH)
  • Sudden palpitations and dyspnea signaled a rapid antibody shift from Hashimoto’s to Graves’In a 56-year-old with long-standing Hashimoto’s, new palpitations, breathlessness, and weight loss coincided with a rise in thyroid-stimulating immunoglobulin and overt hyperthyroidism, confirming an abrupt switch to Graves’ disease. (Cureus)

References

Are there harmless reasons antibodies fluctuate without serious disease?

Not every antibody rise means a crisis. The team at Eureka Health explains that pregnancy, infections, or even high iodine intake can transiently tilt the antibody balance.

  • Post-partum immune reboundAbout 8 % of new mothers show temporary TRAb or TPOAb spikes that settle within 12 months.
  • Viral upper-respiratory infectionsInterleukin surges can briefly boost thyroid antibodies without lasting gland damage.
  • Iodine-rich contrast studiesA CT scan with iodinated contrast can bump TRAb levels for several weeks.
  • Some thyroid-blocking antibodies fade within monthsResearchers tracked a patient whose TSH-binding inhibitory immunoglobulins initially blocked cAMP signaling but “lost this blocking activity over time,” showing that certain antibody spikes can wane without lasting thyroid harm. (NIH)
  • Autoantibody types can alternate for over two decadesA report of alternating Graves’ hyperthyroidism and Hashimoto’s hypothyroidism for more than 20 years illustrates that stimulating and blocking antibodies can swing back and forth without settling into a single permanent disorder. (JETR)

References

What daily steps keep dual-antibody thyroid disease under control?

Lifestyle cannot remove antibodies, but it can blunt flares. “Aim for consistent selenium and avoid drastic diet shifts; antibodies dislike stability,” advises Sina Hartung, MMSC-BMI.

  • Take 200 µg selenium if your intake is lowRandomized trials show a 21 % drop in TPOAb titres after six months of supplementation.
  • Keep iodine between 150–250 µg dailyExcess iodine aggravates both Graves’ and Hashimoto’s flares.
  • Use a resting heart-rate logA morning pulse jumping 10 bpm above baseline often precedes hyperthyroid symptoms by a week.
  • Schedule labs every 6–8 weeks during swingsFrequent monitoring allows timely titration of levothyroxine or antithyroid drugs.
  • Stop smoking to lower Graves’ eye-disease riskCurrent smokers have roughly seven-fold higher odds of developing Graves’ orbitopathy and experience more frequent hyperthyroid relapses; quitting is one of the most impactful lifestyle changes for antibody-driven thyroid disease. (NIH)
  • Correct vitamin D deficiency to temper antibody activityPatients with 25-OH vitamin D below 20 ng/mL show nearly a three-fold increase in TPO antibody positivity; repletion toward sufficiency is associated with gradual reductions in antibody titres over 6–12 months. (NCBI)

References

Which labs and treatments should my doctor review if I have overlap disease?

Managing both conditions means tracking more than TSH. The team at Eureka Health stresses ordering a full panel before any medication change.

  • Measure TRAb, TPOAb, TgAb togetherKnowing which antibody is dominant guides whether to taper methimazole or adjust levothyroxine.
  • Check Free T4 and Total T3—not just TSHUp to 25 % of overlap patients have discordant TSH and T4 levels that mislead dosing.
  • Ultrasound with Doppler flowIncreased vascularity hints at active Graves’, while a shrunken gland suggests Hashimoto’s dominance.
  • Radioactive iodine uptake only when hyper is persistentLow uptake during a Hashimoto phase can prevent unnecessary ablation therapy.
  • Repeat the full antibody panel whenever thyroid status swingsA Journal of Endocrine Society case showed TSI levels rising and TPO levels falling as the patient flipped from hypo- to hyperthyroidism, leading the authors to recommend re-checking antibodies before every medication adjustment. (OUP)
  • Consider radioiodine when medical therapy fails after recurrent swingsIn a Hindawi case series of three overlap patients, each experienced multiple relapses on methimazole and ultimately required definitive radioiodine ablation to achieve stable control. (Hindawi)

References

How can Eureka’s AI doctor guide someone with antibody swings?

Eureka’s AI doctor reviews your symptoms, recent labs, and medication history 24 /7. It flags patterns—like a falling TSH with rising Free T4—and suggests a dose check before you feel the swing. “Users with autoimmune thyroid disease say our trend alerts save them at least one urgent care visit a year,” reports the team at Eureka Health.

  • Smart lab reminders arrive before the next swingThe AI schedules prompts when your last hyper-to-hypo cycle averaged 7 weeks.
  • Triage feature rates symptom urgencyA heat-score over 80 triggers advice to seek in-person care within 24 hours.
  • Medication diary detects missed dosesIf you skip more than 2 levothyroxine doses in a month, the app nudges you with educational tips.

Why people with dual thyroid antibodies like using Eureka’s private, doctor-reviewed service

The platform is free, encrypted, and every order is double-checked by licensed physicians. Women using Eureka for menopause rate the app 4.8 / 5; thyroid users show similar satisfaction.

  • Lab orders without waiting roomsEureka can request a complete thyroid panel; a doctor signs off within hours in most states.
  • Personalized treatment plans update automaticallyWhen your antibody profile shifts, the AI drafts a new plan that a clinician reviews.
  • Secure chat keeps the conversation documentedAll messages are stored with end-to-end encryption and can be shared with your local endocrinologist.

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Frequently Asked Questions

Can my symptoms flip from jittery to sluggish within the same month?

Yes. In overlap disease, stimulatory antibodies can fall quickly, revealing underlying gland destruction, so you may swing from hyperthyroid to hypothyroid in weeks.

Do I need two different thyroid medications?

Often, yes. You may need an antithyroid drug during Graves’-dominant phases and levothyroxine when Hashimoto’s damage causes low hormone levels.

Will radioactive iodine cure the overlap?

It can stop hyperthyroidism but may hasten permanent hypothyroidism; discuss risks and timing carefully with your endocrinologist.

Are antibody tests covered by insurance?

Most US insurers cover TRAb and TPOAb once a year when ordered for autoimmune thyroid monitoring.

Should I avoid iodine in multivitamins?

Keep total daily iodine around 150 µg unless pregnant; excessive iodine can worsen both antibody types.

Is pregnancy safe with dual thyroid disease?

Yes, but you need monthly TSH, Free T4, and TRAb checks because uncontrolled antibodies affect fetal development.

Can diet alone normalize my thyroid?

No diet reverses autoimmunity, but balanced selenium, adequate protein, and stable iodine help stabilize antibody activity.

This content is for informational purposes only and is not intended as medical advice. Always consult with a qualified healthcare provider for diagnosis, treatment, and personalized medical recommendations.

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