Does high TPOab and elevated TSH always mean Hashimotos?

Hi all! Quick background to my question: I was diagnosed with hypo at the end of June and just last week went in for my first follow up appointment. I was told at my follow up appointment that they would be testing my TSH, Free T3, Free T4, and my TPOab. I told the Doctor that despite having a few days of improved symptoms shortly after starting medication that I had soon returned to feeling subpar. She said it was likely that I needed an increase in my dosage. Lab results came back, and I got a phone call saying that everything was within normal ranges and my dose would stay the same. I just got back the reports from both appointments and these are the lab results:


June- 4.26 (0.27-4.2)

Sept- 3.14 (0.27-4.2)


June- 13.4 (0.0-5.5)

They NEVER ran the Free T3 and T4 tests they said they would, which has me rather upset. I fully intend on going back to request additional testing and a referral to an endocrinologist as soon as my usual provider is back in the office. I wasn't able to see her for my last appointment as she is on convalescent leave. She herself is a thyroid patient so I'm inclined to think she'd be more likely to understand the ins and outs of my condition.

My question today is, does an elevated TSH and a high TPOab always mean a Hashimotos diagnosis, or do I need to ask for more tests to get a definite diagnosis? Also, what is considered the optimal TSH level?

I appreciate any information you can share with me, and welcome any advice you have as well. Thanks!

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  • There is actually no need for TSH to be elevated!

    Thyroid hormone levels often vary in the course of Hashimoto's - with a rise in T3 seemingly often noted before the final fall, even if T4 is already a bit low.

    TPOab can often be found after any trauma to the thyroid such as external force (e.g. seatbelt in an accident) or surgery. The difference is that the peak levels is often not as high as in Hashimoto's and the level often normalises over time.

    Ultrasound scans can sometimes identify damage which is due to Hashimoto's.


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