Yes. When I got the diagnosis, I did a ton of research and waited 7 months to get in with the best endocrinologist in my area. My antibodies are high, but my TSH ranges from 2-4. She made it very clear at my first appointment that she had no problem treating symptoms over labs. Right now, I am focusing on diet and exercise, and we are ruling out other autoimmune disorders. Even though medication is my personal last resort, it's a great feeling to know I have that option. Answer from AggravatingPlum4301 on reddit.com
Paloma Health
palomahealth.com › learn › treatment-hashimotos-normal-tsh
Treatment For Hashimotoʼs With Normal TSH Levels | Paloma Health
August 27, 2024 - As mentioned, the presence of TPO antibodies in your blood may indicate the presence of Hashimoto’s. So, a Hashimoto diagnosis typically only requires the presence of thyroid antibodies, like TPO. For a diagnosis of Hashimoto’s hypothyroidism, you must also have abnormal thyroid biomarkers. In this case, you must have an elevated TSH level with a low free T4 level and TPO antibodies above the reference range cutoff.
Reddit
reddit.com › r/hashimotos › does anybody on here have normal thyroid function but high antibodies?
r/Hashimotos on Reddit: Does anybody on here have normal thyroid function but high antibodies?
May 29, 2024 -
Do you feel good or do you have symptoms?
What explains that we can have symptoms with normal levels?
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Yes. When I got the diagnosis, I did a ton of research and waited 7 months to get in with the best endocrinologist in my area. My antibodies are high, but my TSH ranges from 2-4. She made it very clear at my first appointment that she had no problem treating symptoms over labs. Right now, I am focusing on diet and exercise, and we are ruling out other autoimmune disorders. Even though medication is my personal last resort, it's a great feeling to know I have that option.
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The problem is "normal" is relative... Normal used to be TSH at or under 10 is normal. Then the current at most places 4.5-5 Meanwhile thyroid. Org says most should aim for like 2.5 particularly those on meds or antibodies positive. This is even further complicated by the fact that Biotin (aka vitamin b7) skews results
Verywell Health
verywellhealth.com › how-to-test-for-hashimotos-disease-4159884
Discover if You Have Hashimoto's With These Tests
October 23, 2025 - Some people have defects in their T3 receptors, causing what's known as a generalized thyroid hormone resistance. Like TSH resistance, this condition is rare. It can cause an elevated TSH level, though some people are within the normal range; ...
Reddit
reddit.com › r/hashimotos › anyone have normal thyroid levels but high antibodies?
r/Hashimotos on Reddit: Anyone have normal thyroid levels but high antibodies?
December 14, 2024 -
I’ve previously been in a state of hypothyroidism but stopped taking medicine like 10 years ago because I didn’t like the way I feel. Recently got my thyroid levels tested and TSH is completely normal but antibodies are still very high.
Is that normal? Anyone else go through this? Doctor said I don’t need to do anything/take medicine since my thyroid is functioning normally.
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Yes, it’s like I only have hashi on paper because I have zero symptoms and no thyroid damage. It’s literally just the antibodies that show up, and they’re decreasing every test.
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I thought that was the normal situation with Hashimoto’s - they only care about keeping thyroid hormone levels in check (whether that requires medication or not yet), but your body continues to attack your thyroid until it’s done someday. Symptoms aren’t even a big concern to doctors usually, as long as TSH is ok. That’s why many here resort to alternative attempts of treating this condition - diet/LDN/supplements etc.
University of North Carolina
med.unc.edu › home › podcasts › autoimmune thyroid disease – with deepa kirk, md
Autoimmune Thyroid Disease - with Deepa Kirk, MD | Department of Medicine
June 6, 2023 - Now the difficulty lies—if the patient is having symptoms, and everything is normal, the TSH is fine, T4 and T3 are fine–some practitioners are drawing another test called antibody tests—TPO antibodies.
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
In case of clinical suspicion of hypothyroidism, thyroid function assessment consists of TSH and FT4 measurement [6]. HD is diagnosed by the presence of TPO- or Tg-abs, plus or minus characteristic thyroid ultrasound abnormalities, such as reduced echogenicity [3,6,7]. Common, but also quite unspecific complaints in (primary) hypothyroidism are fatigue, weight gain with poor appetite, constipation, concentration problems and depression [[8], [9], [10]]. Treatment of hypothyroidism consists of daily administration of levothyroxine (LT4) [6,8,11]. LT4 is preferable to triiodothyronine (T3) becau
Reddit
reddit.com › r/hashimotos › high tpo but normal tsh
r/Hashimotos on Reddit: High TPO but normal TSH
May 19, 2022 -
So I’ve had Hashimoto’s for awhile now, my TSH is 2.04, so I’m not on Synthroid. But my TPO is 229, last year it was 104. My WBC is also elevated at 12….
Here’s my question (and I have an appointment to discuss these results with my endocrinologist next week) but let’s say my TSH always stays normal, are there symptoms I might experience eventually if it’s just my TPO that keeps increasing?
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Autoimmunity means inflammation which by itself causes a host of problems. Autoimmune thyroid means your immune system is attacking and destroying the thyroid gland. However, TPO on its own doesn't tell you the extent of the autoimmune activity - T cell activity is involved as well. If TPO is ridiculously high, it doesn't always mean thyroid damage is high because you could have low T cell activity and vice versa. The assumption, without knowing T cell activity and without biopsying thyroid tissue to see evidence of damage, would be that as the autoimmunity and inflammation progress, it will damage the thyroid enough to cause dysfunction to where you will become hypothyroid. This pattern accounts for ~90% of hypothyroid cases in the US. Perhaps your T cell activity is really low or perhaps they have caught the antibodies early such that your TSH still shows as normal. Conventional doctors as far as I know will not treat the antibodies beyond wait and see. Meanwhile, inflammation will be left to rage in your body unchecked. Eventually you'll need thyroid hormone replacement and they'll give you a prescription to fill that gap while still ignoring that your immune system is destroying your thyroid. Recommend you dig into ways of identifying and reducing inflammation triggers - diet, supplements, stress reduction, etc.
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There are doctors who don't even think that a TPO of only 229 even means Hashimotos, in spite of reference ranges. My rheumatologist explained to me that active Hashimotos for him starts at TPO > 900 and that most his patients once had high TPOs but they have come down and then stay below 400 for the rest of their lives, often even going away and sometimes coming back at 200-400 for a couple of months during stress . He doesn't consider these patientes in need of hormone treatment if their TSH and hormone levels are normal and they have no symptoms. He says that the most important indicator whether you need T4 is your symptoms. Obviously this opinion is controversial, but he is a very experienced and kind physician, having seen a lot of patients in and out of hospitals over his 30 years experience. So I trust him with it. I have since also found Dr. Berndt Rieger, a doctor in Germany who specialised on Thyroid issues, with a Youtube Channel who is more on the naturopathic side of medicine, who also says that a TPO with 250 doesn't mean it's even Hashimotos and in his experience (having seen thousands of patients over the course of 25 years) in most people this resolves without needing to go on Levothyroxine ever. He also says that stress and stressful situations is the main trigger for active Hashimotos and Hashimotos crises, but once you overcome the stress in many of his patients the thyroid even recovers. He knows that he is being laughed at by convential doctors who treat thyroid patients but he says he doesn't care, because he has got so many of his patients to confirm his experience of thyroids actually recovering and never needing Levothyroxine. Others might need it for a while only and he always encourages people to try come off it after a while. Just wanted to share this with you, that there are thyroid doctors who absolutely believe it's possible.
Quora
quora.com › If-my-Anti-TPO-is-high-500-and-my-T3-T4-TSH-levels-are-normal-does-that-mean-I-have-Hashimotos-disease
If my Anti TPO is high (>500) and my T3, T4, TSH levels are normal, does that mean I have Hashimoto's disease? - Quora
Answer (1 of 4): Hashimoto disease is an auto immune disease that attaches the thyroid and results in inflammation and damage the the thyroid cells. This process take time and it is only when a significant number of cells are damaged that the ...
Clarity Chiropractic
claritychirotrt.com › blog › hashimotos-with-normal-tsh
Unraveling Hashimoto's: Navigating Normal TSH Levels Holistically — Chiropractic Care in Johnston Iowa
For the sake of this article we are going to assume TSH is normal, but if we see an elevated TSH level (over 1) that is a separate conversation. Almost always this condition is diagnosed based on lab or serum levels. Specifically lab results associated with anti-thyroid peroxidase or anti-thyroglobulin antibodies. Those are a mouthful, so we will refer to them as TPO antibodies and TgAb.
Published April 12, 2024
American Thyroid Association
thyroid.org › home › hashimoto’s thyroiditis
Hashimoto’s Thyroiditis | American Thyroid Association
August 25, 2023 - If you have high thyroid antibody levels but normal thyroid function tests (TSH and Free T4), you do not require treatment with thyroid hormone.
Mitchellholistichealth
mitchellholistichealth.com › high-thyroid-antibodies-but-normal-tsh-functional-medicine-healing
High Thyroid Antibodies But Normal TSH? Functional Medicine Healing - Mitchell Holistic Health
October 22, 2025 - Thyroid antibodies are proteins your immune system makes when it mistakenly attacks your thyroid. The most common ones are thyroid peroxidase (TPO) and thyroglobulin (Tg) antibodies. When these antibodies are high, they signal Hashimoto’s disease or another autoimmune process, even if your TSH looks “normal.”
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Drooracle
droracle.ai › articles › 249954 › tpoab-540-normal-tsh-t3-t4
What is the management for elevated TPOAb with normal TSH, T3, and T4 levels?
August 7, 2025 - Patients with elevated TPOAb (>500 IU/ml) and normal thyroid function tests should be monitored annually for development of hypothyroidism, but do not requir...
Eureka Health
eurekahealth.com › home › resources › high tpo antibodies but normal tsh—do i still have hashimoto’s disease?
High TPO Antibodies but Normal TSH—Do I Still Have Hashimoto’s Disease?
June 19, 2025 - A high thyroid-peroxidase (TPO) antibody level means your immune system is attacking thyroid tissue—even if your thyroid-stimulating hormone (TSH) is still in the normal range. About 20-30 % of people with positive TPO antibodies but normal ...
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 - Most people with Hashimoto's disease will have TPO antibodies in their blood. Lab tests for other antibodies associated with Hashimoto's disease may need to be done. ... Most people with Hashimoto's disease take medication to treat hypothyroidism.
HealthMatch
healthmatch.io › hashimotos-disease › can-you-have-hashimotos-with-normal-tsh
Can You Have Hashimoto’s Disease With Normal Thyroid Levels?
June 6, 2022 - If the thyroid hormone levels are normal, but TSH is elevated, it could signify that the body is compensating for a poorly functioning thyroid.
PubMed Central
pmc.ncbi.nlm.nih.gov › articles › PMC5922674
How to interpret thyroid function tests - PMC
For example, both fractionated and unfractionated heparin activate endothelial lipoprotein lipase with hydrolysis of triglycerides and an increase in circulating free fatty acid levels that, in some individuals, leads to displacement of T4 and T3 from TBG, thus raising free (but not total) TH levels. Interestingly, such changes are not generally associated with clinical thyrotoxicosis, and TSH is usually normal.
Verywell Health
verywellhealth.com › hashimotos-disease-treatment-3233013
How Hashimoto's Disease Is Treated
October 9, 2025 - Hashimoto's disease doesn't always cause hypothyroidism. The majority of people with this condition have thyroid peroxidase (TPO) antibodies, which attack the thyroid, present in their blood.
Reddit
reddit.com › r/thyroidhealth › what causes high tsh but normal t4?
r/thyroidhealth on Reddit: What causes high TSH but normal T4?
August 26, 2022 -
My TSH is 10.15 (range .5-4.3) and my Free T4 is 1.1 range (.8-1.4) However, I am having many symptoms. I have been in contact with many doctors and they don’t really know what is going on. Does anyone have any suggestions or have been through this situation before? I started 25mcg levothyroxine 5 days ago but since my Free T4 is normal I am doubtful that will help.
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Your pituitary can manage to keep your T4 levels up by constantly poking and prodding your thyroid while it is exhausted. Imagine a factory that has to make 1,000 thing-a-ma-bobs a day. Now say that factory is running smoothly with 50 thing-a-ma-bob assemblers working a normal shifts of 8 hours 5 days a week. Then a few of them quit, or pass away, or retire, or whatever. The manager, Mr Pituitary, gives a speech to the remaining 45 or so worker about putting in a little extra time and working harder to make up the slack. The factory still makes it’s 1,000 thing-a-ma-bobs and everyone manages though they’re a little extra tired. But then, another guy retires, and it’s getting a bit tough, so some guy starts putting in an extra shift each week. Then the assembler putting in the extra shift falls asleep behind the wheel, and now the thing-a-ma-bob factory is down another worker, but they still need to get out that 1,000 thing-a-ma-bobs every day. Then another few assemblers quit because they are becoming unhappy. So the manager, Mr Pituitary, just starts yelling at all the remaining assemblers constantly and insisting they put in 10 hour shifts 6 days a week. The factory is still pumping out those 1,000 thing-a-ma-bobs a day for now, but it can’t keep it up. Soon more employees are going to quit or hurt themselves. It isn’t sustainable. A little levothyroxine will let it relax and work at a more manageable pace.
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This is common with Hashimoto’s which is an organ specific autoimmune disease that affects the thyroid and causes secondary hypothyroidism, which means that the hypothyroidism is caused by the Hashimoto’s. You need a doctor that will treat your symptoms and TSH lab, while also testing your T3 and reverse T3. Some people with Hashimoto’s do well on just T4, some need that and T3.
Medscape
emedicine.medscape.com › tools & reference › endocrinology
Hashimoto Thyroiditis Workup: Approach Considerations, Serum TSH Test and Other Studies, Ultrasonography
Up to 15% of patients aged 65 years ... any symptoms suggestive of hypothyroidism. These patients have a decreased thyroid reserve. The best marker of progression to overt hypothyroidism is an elevated TSH level combined with the presence of thyroid autoantibodies, namely anti-TPO ...