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American Thyroid Association
thyroid.org › home › hashimoto’s thyroiditis
Hashimoto’s Thyroiditis | American Thyroid Association
August 25, 2023 - Over time, you may develop low thyroid hormone levels. If you have high thyroid antibody levels but normal thyroid function tests (TSH and Free T4), you do not require treatment with thyroid hormone.
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Mayo Clinic
mayoclinic.org › diseases-conditions › hashimotos-disease › diagnosis-treatment › drc-20351860
Hashimoto's disease-Hashimoto's disease - Diagnosis & treatment - Mayo Clinic
April 30, 2025 - High TSH levels in the blood indicates hypothyroidism. T-4 tests. The main thyroid hormone is thyroxine (T-4). A low blood level of T-4 confirms the findings of a TSH test and indicates the problem is within the thyroid itself.
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Paloma Health
palomahealth.com › learn › treatment-hashimotos-normal-tsh
Treatment For Hashimotoʼs With Normal TSH Levels | Paloma Health
August 27, 2024 - A normal TSH and T4 level means your thyroid still functions well, and the body is not suffering from a lack of thyroid hormone. Thus, there is no need to add extra thyroid hormone to the body.
Discussions

High T4/normal TSH

If you feel fine, then ignore the slight increase. Hormones also fluctuate throughout the day and you may simply have a slight elevation when tested. Remember: the norm is an intersection of young and old people who need different levels and maybe this is just your personal perfect level.

Watch your levels over the next few months and see if anything changes and if the time of day or your cycle (if you are female) affects it in any way.

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September 11, 2021
Normal TSH, high T4

Why do labs place such different values levels ? My t4 was 13.9 (lab upper limit was 10.9) dr said it was mildly elevated .. tsh was normal

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🌐 r/Hashimotos
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2
March 30, 2023
High T4 but Normal Tsh
Yah I have been having similar experiences my free t4 came back as 3.3 my tsh is 1.12 t4 total 10.6 and t3 uptake 31. Unsure of what all this means, still waiting to hear back from my pcp. More on reddit.com
🌐 r/thyroidhealth
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January 14, 2024
High T4, normal TSH. Could there be something wrong with my Thyroid?

High T4 can be associated with heart palpitations. Definitely have this checked out and discuss with your doctor. Seeing an endocrinologist would be best.

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September 21, 2023
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PubMed Central
pmc.ncbi.nlm.nih.gov › articles › PMC8122172
Persisting symptoms in patients with Hashimoto’s disease despite normal thyroid hormone levels: Does thyroid autoimmunity play a role? A systematic review - PMC
Despite normalized TSH and FT4 levels by LT4 treatment, approximately five to ten percent of HD patients experience persisting symptoms [[12], [13], [14]]. With respect to these persisting symptoms, several hypotheses have been postulated and discussed: 1) TSH is not a perfect marker; consequently, there standard LT4 treatment may not result in a truly biochemically euthyroid state [4]; therefore, some experts suggest to treat with a supraphysiological LT4 dose, which would result in a suppressed TSH, but fewer complaints; however, not all studies show the same results, and higher LT4 doses ma
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Drtsoukalas
drtsoukalas.com › why_many_patients_with_hashimoto_s_thyroiditis_do_not_feel_well_despite_their_thyroid_function_tests_appearing_normal-lp-7.html
Why many Patients with Hashimoto`s Thyroiditis do not Feel Well Despite their Thyroid Function tests Appearing Normal - Dr Tsoukalas
Acting for long periods, they alter the composition and morphology of thyroid cells and deregulate the functioning of the immune system. It's noteworthy that symptoms can remain, to a lesser or greater extent, even after the regulation of hypothyroidism with medication[1,2]. An individual can have normal levels of thyroid hormones and TSH yet still exhibit most of the above symptoms.
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Clarity Chiropractic
claritychirotrt.com › blog › hashimotos-with-normal-tsh
Unraveling Hashimoto's: Navigating Normal TSH Levels Holistically — Chiropractic Care in Johnston Iowa
This is a loaded question. We can treat for high TSH or a high antibody count. To fully answer the question I would need to know if we are seeing high TSH or high TPO antibodies. Yes and no. Hashimoto's thyroiditis is hypothyroidism, but hypothyroidism is not always hashimoto's thyroiditis.
Published   April 12, 2024
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Boston Children's Hospital
childrenshospital.org › conditions-treatments › hashimoto-thyroiditis
Hashimoto Thyroiditis | Boston Children's Hospital
If your child’s TSH and free T4 are normal, their thyroid is still working normally and no treatment is needed.
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UCLA Health
uclahealth.org › medical-services › surgery › endocrine-surgery › conditions-treated › thyroid › normal-thyroid-hormone-levels
Normal Thyroid Hormone Levels - Endocrine Surgery | UCLA Health
A normal Total T4 level in adults ranges from 5.0 to 12.0μg/dL. A normal Total T3 level in adults ranges from 80-220 ng/dL. Free T3 assays are often unreliable and not routinely used to assess thyroid function. Primary Hypothyroidism A high TSH and low thyroid hormone level (e.g.
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American Academy of Family Physicians
aafp.org › pubs › afp › issues › 1998 › 0215 › p776.html
Subclinical Hypothyroidism: Deciding When to Treat | AAFP
February 15, 1998 - Its very sensitivity, however, may create a dilemma, since some patients are found to have elevated serum TSH levels, suggesting hypothyroidism, but have normal levels of thyroid hormone, whether measured as free thyroxine (T4) or free T4 index.
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Verywell Health
verywellhealth.com › how-to-test-for-hashimotos-disease-4159884
Discover if You Have Hashimoto's With These Tests
October 23, 2025 - More than 90% of people with Hashimoto’s disease have elevated TPO antibody levels. However, this test alone doesn’t confirm the condition. Other forms of thyroiditis, such as silent thyroiditis or postpartum thyroiditis, may be responsible. Or you may be one of the more than one in 10 people who have the antibodies but normal TSH and free T4 levels.
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Endocrine Society
endocrine.org › patient-engagement › endocrine-library › hashimoto-disease
Hashimoto Disease | Endocrine Society
March 31, 2022 - TSH test: TSH is hormone released from your pituitary gland when there is not enough thyroid hormone in the system. TSH will be high if there is not enough thyroid hormone in the system. Normal ...
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NHS
nhs.uk › conditions › underactive-thyroid-hypothyroidism
Underactive thyroid (hypothyroidism) - NHS
You may have blood tests to check how much thyroid-stimulating hormone (TSH) and thyroxine (T4) is in your blood. The GP may also refer you to a specialist for more tests. ... An underactive thyroid is usually treated with medicine to replace the thyroid hormone that your body cannot produce. This medicine is usually levothyroxine tablets. You'll usually need to take them for the rest of your life to prevent your symptoms returning. You should be able to live a normal life.
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Johns Hopkins Medicine
hopkinsmedicine.org › health › conditions-and-diseases › hashimotos-thyroiditis
Hashimoto's Thyroiditis | Johns Hopkins Medicine
August 8, 2024 - You will not need treatment if your thyroid hormone levels are normal. But Hashimoto thyroiditis can cause an underactive thyroid gland. If so, it can be treated with medicine. The medicine replaces lost thyroid hormone. That should stop your symptoms. Some people with Hashimoto's develop an enlarged thyroid gland called a goiter.
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NCBI
ncbi.nlm.nih.gov › books › NBK459262
Hashimoto Thyroiditis - StatPearls - NCBI Bookshelf
November 30, 2025 - Up to 6% of individuals with Hashimoto thyroiditis can be affected by thyroid eye disease.[54] About 15% of individuals with Hashimoto thyroiditis have TSHR Ab. Most of these are the blocking type. A small proportion of individuals may have TSHR-stimulating antibodies, leading to eye involvement.[54][89][90] ... The following laboratory studies may be used for diagnostic evaluation of thyroid function and identification of comorbid conditions: Thyroid function tests: TSH, T4, and T3 levels should be tested to assess thyroid function.
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RACGP
racgp.org.au › afp › 2012 › august › hypothyroidism
RACGP - Hypothyroidism - Investigation and management
April 9, 2012 - AetiologyIodine deficiency remains the most common cause of hypothyroidism worldwide.4 However, in Australia and other iodine replete countries, autoimmune chronic&#x2026
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Medscape
emedicine.medscape.com › tools & reference › endocrinology
Hashimoto Thyroiditis Workup: Approach Considerations, Serum TSH Test and Other Studies, Ultrasonography
June 19, 2024 - The diagnosis of Hashimoto thyroiditis ... certain histologic features. Up to 15% of patients aged 65 years or older may have subclinical hypothyroidism (mild thyroid failure, as evidenced by an elevated TSH of over 4.0 mIU/mL and normal free T4 levels), with few if any symptoms suggestive ...
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Mount Sinai
mountsinai.org › health-library › report › hypothyroidism
Hypothyroidism Information | Mount Sinai - New York
If your test results show high levels of antithyroid antibodies, but your TSH and T4 levels are within normal limits, your provider will probably delay treatment until your thyroid function levels indicate an underactive thyroid. Many people with positive thyroid antibodies never develop overt ...
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Medical News Today
medicalnewstoday.com › articles › hypothyroidism-with-normal-tsh
Hypothyroidism with normal TSH: Causes and treatment
December 18, 2023 - Sometimes, a person has a TSH level that, technically, does not fall outside the healthy range but is higher than usual for that person. This can indicate that their thyroid is beginning to work less efficiently. People with subclinical hypothyroidism can also have elevated thyroid antibodies, but typically, they do not have low levels of the thyroid hormones T3 or T4.