Last Chance - Mother's Day Sale

Last chance - Mother's Day Sale

For moms, thyroid health matters. Save $25 on our thyroid test kit or self-pay membership using code MOMDAY.

Treatment For Hashimotoʼs With Normal TSH Levels

Find out when treatment is necessary for Hashimoto's, and how else to manage symptoms.
Treatment For Hashimotoʼs With Normal TSH Levels
Last updated:
Medically Reviewed by:

In this article

You may have heard that Hashimoto’s thyroiditis is the number one cause of hypothyroidism in the United States. Now imagine being diagnosed with having Hashimoto’s thyroiditis, but your thyroid hormone levels are all “within the normal range.” Are you hypothyroid or not? Confusing, right?

Ahead, we’ll look at the complexities behind treating Hashimoto’s thyroiditis when thyroid function is otherwise normal.

What is Hashimoto’s thyroiditis?

Hashimoto’s thyroiditis is an autoimmune disease where your immune system goes into overdrive. For reasons not entirely clear to experts, your immune system creates antibodies against your healthy thyroid cells. Over time, the ongoing antibody attack and autoimmune process can destroy your thyroid gland.

Hashimoto’s is progressive, so as more thyroid damage occurs, thyroid hormone levels will continue to drop, resulting in overt hypothyroidism. Hypothyroidism is a medical condition in which the thyroid can’t produce enough thyroid hormone to meet the body’s demands.

Because thyroid hormones regulate metabolism, growth, and development, people with hypothyroidism experience a general slowing of their body systems. Symptoms of hypothyroidism include:

While Hashimoto’s is one of the leading causes of hypothyroidism, Hashimoto’s is an autoimmune disease, while hypothyroidism is a condition, and they are different. So, you can have Hashimoto’s without having hypothyroidism and vice versa.

How is Hashimoto’s thyroiditis diagnosed?

Suppose you or your healthcare provider suspects you have a thyroid dysfunction like hypothyroidism. In that case, your provider will likely order a complete thyroid panel to determine how well your thyroid functions. A typical thyroid panel usually includes three thyroid function tests:

  • Thyroid-stimulating hormone: a hormone secreted by the pituitary gland that tells the thyroid gland to make and release thyroid hormone
  • Free T4 (thyroxine): the inactive form of thyroid hormone that circulates in your body and is converted by your cells to T3
  • Free T3 (triiodothyronine): the active form of thyroid hormone that cells need to function

Besides monitoring these thyroid biomarkers, your healthcare provider may also check for thyroid peroxidase (TPO) antibodies. By measuring TPO antibody levels, your healthcare provider can determine if an autoimmune thyroid disease like Hashimoto’s is the cause of your thyroid dysfunction.

TPO antibodies

Thyroid peroxidase (TPO) is an enzyme in the thyroid that plays a vital role in producing thyroid hormones. Without the thyroid peroxidase enzyme, the thyroid can’t make thyroid hormones.

TPO antibodies block the activity of the thyroid peroxidase enzyme, negatively affecting thyroid hormone production. 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.

But remember, not everyone with TPO antibodies has a thyroid disorder. The presence of TPO antibodies means there is an ongoing attack against the thyroid, and likely some inflammatory response to the antibodies. But elevated antibodies do mean that you’re at a greater risk of developing a thyroid disorder like hypothyroidism in the future.

What does it mean if TSH is normal?

Sometimes, people test positive for TPO antibodies, but their TSH and T4 levels are still normal. What this means is you likely have Hashimoto’s but not hypothyroidism.

In some instances, a person with a normal T4 level but a slightly elevated TSH level may receive a diagnosis of subclinical hypothyroidism. Subclinical hypothyroidism is a mild form of hypothyroidism and is frequently part of the natural progression to full-fledged Hashimoto’s.

Before diagnosing subclinical hypothyroidism, your healthcare provider may want to recheck your TSH level. Different factors, such as a lab error or recovering from an illness, can alter your TSH level.

Is medication necessary for normal TSH levels?

Those with a normal TSH typically don’t need treatment with thyroid hormone replacement medication, even if their lab results show positive TPO antibodies.

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.

Hashimoto’s often progresses into overt hypothyroidism, and those hypothyroid patients do require treatment with thyroid hormone replacement medication. This is in comparison to subclinical hypothyroidism and autoimmune thyroiditis, where evidence for starting a thyroid medication is conflicting. Thus, treatment for subclinical hypothyroidism is on a case-by-case basis. 

In either case, your provider will work with you to determine the type and dose of medication you need, depending on your lab values. 

Can I prevent the progression of Hashimoto’s to hypothyroidism?

At the root of every autoimmune condition is chronic inflammation. In the case of Hashimoto’s, this inflammation can lead to eventual slowdown and failure of the thyroid and overt hypothyroidism. Keeping the damage from Hashimoto’s under control may help prevent or delay the future development of hypothyroidism.

One of the main ways to manage your Hashimoto’s is to reduce inflammation. Paloma Health’s expert thyroid practitioners recommend optimizing the four pillars of health to reduce inflammation: diet, exercise, sleep, and stress management.

Once you have these four pillars in balance, you might consider adding vitamin, mineral, and herbal supplements to help further reduce inflammation and support thyroid function. Specifically, maintaining healthy vitamin D levels and taking selenium to boost your thyroid function is frequently recommended for hypothyroid patients.

Keep in mind that even with optimization of your thyroid health, you may still develop hypothyroidism.

A note from Paloma Health

If you suspect you have a thyroid disorder or something feels off, your first step is to talk with your healthcare provider. More than likely, they will recommend a complete thyroid panel to rule in or rule out a thyroid disorder.

Paloma’s at-home testing kit provides an accurate evaluation of thyroid function, measuring your levels of TSH, free T3, free T4, and TPO antibodies. You even have the option to add on a reverse T3 and vitamin D level. Your provider will use the results of these thyroid function tests to determine if you have a thyroid disorder and/or if an autoimmune disease is at play.

Do you already live with hypothyroidism or Hashimoto’s but want to learn more about our four pillars for thyroid health? Schedule a virtual appointment with one of our thyroid experts today.

Limited offer

20% off your first Thyroid Test

Test your thyroid levels from home and know your levels in days
Use code GETBETTER at checkout
Use code
Oops! Something went wrong while submitting the form.


Fröhlich E, Wahl R. Thyroid Autoimmunity: Role of Anti-thyroid Antibodies in Thyroid and Extra-Thyroidal Diseases. Front Immunol. 2017;8:521. doi:

American Thyroid Association. Thyroid Function Tests | American Thyroid Association. American Thyroid Association. Published 2016. Accessed November 9, 2023.

Klubo-Gwiezdzinska J, Wartofsky L. Hashimoto thyroiditis: an evidence-based guide to etiology, diagnosis and treatment. Pol Arch Intern Med. 2022;132(3):16222. doi:

Share article:

Emilie White, PharmD

Clinical Pharmacist and Medical Blogger

Emilie White, PharmD is a clinical pharmacist with over a decade of providing direct patient care to those hospitalized. She received her Doctor of Pharmacy degree from Massachusetts College of Pharmacy and Health Sciences. After graduation, Emilie completed a postgraduate pharmacy residency at Bon Secours Memorial Regional Medical Center in Virginia. Her background includes caring for critical care, internal medicine, and surgical patients.

Read more

Is Paloma Right For Me?

Hypothyroidism is a long-term commitment and we’re committed to you. Schedule a free, no-obligation phone consultation with one of our intake specialists to find out more.

Schedule a call
thyroid hormone for hypothyroidism

Find out if Paloma is right for you. Schedule a free call with one of our health care advisors.

Schedule a Call