Can I Have Hashimoto's With Normal TSH?
- Dr. Jessica
- 6 days ago
- 4 min read
Most women with early Hashimoto’s look “normal” on paper.
Their TSH sits comfortably in range.
Their doctor reassures them nothing serious is happening.
But underneath that normal number, a pattern is forming.
The immune system is shifting.
Inflammation is building.
Thyroid antibodies are rising.
And symptoms begin long before traditional testing catches it.
This is why so many women feel dismissed.
They sense the pattern before the system does.
80% of women that I see in my practice have never been tested for Hashimoto's.
Hashimoto’s Starts in the Immune System, Not the Thyroid Hormone Levels
Hashimoto’s is one of the most common autoimmune conditions in women. It affects almost one in five women, and many live with symptoms long before they receive a diagnosis.
The earliest changes happen in the immune system, not in your TSH. Here is what happens inside the thyroid in simple terms:
Certain immune cells become more active
The calming immune cells become weaker
The attacking cells begin damaging thyroid tissue
Inflammation builds inside the gland
Thyroid proteins (TPO and TG) leak out
Your body makes antibodies against them
This whole process can happen while your TSH remains completely normal.
Why You Can Feel Hypothyroid Even When TSH Looks Fine
Many women feel symptoms early because inflammation affects the body before hormone levels fall.
Common early symptoms include:
Low energy
Brain fog
Trouble losing weight
Feeling cold
Mood changes
Heavy or irregular periods
Hair thinning
Constipation
Swelling or puffiness
Research shows that women with high antibody levels often have more symptoms, even when TSH is normal.
This is one of the biggest reasons so many women feel ignored or “dismissed” when they are told their labs are normal.
Understanding TPO and TG Antibodies
Most thyroid tests stop at TSH. That is not enough.
Antibody testing helps detect Hashimoto’s years earlier.
TPO Antibodies
Very common in Hashimoto’s
High levels often match higher inflammation
Found in up to 95 percent of Hashimoto’s cases
TG Antibodies
Less specific
Some women only have TG elevated
If TG is high and TSH is high, an ultrasound may be needed
Antibodies do not match your TSH level
A normal TSH with high antibodies does not mean your symptoms are mild. It means you are in the early autoimmune stage, and the thyroid is still compensating.
Antibodies change slowly, so testing them once or twice a year is enough.
The Stages of Hashimoto’s (Most Doctors Miss Stage 1 and 2)
Hashimoto’s progresses through clear stages. Most women are diagnosed late, after years of symptoms.
Stage 1: Low antibodies, Normal TSH, T3, T4
Stage 2: High antibodies, Normal TSH, T3, T4
Stage 3: TSH rises, Free T4 begins to fall
Stage 4: High TSH, Low thyroid hormones
Traditional testing only catches stage 3 and 4. But the best time to support the thyroid is stage 1 and 2.
Who Is Most at Risk for Early Hashimoto’s?
Hashimoto’s is more likely if you have:
A family history of thyroid disease
Postpartum thyroid symptoms
PCOS
Type 1 diabetes
Celiac disease
Any other autoimmune condition
Miscarriages
Fluctuating TSH over months or years
If you recognize yourself in this list, do not rely on TSH alone.
How I Support Early Hashimoto’s in Practice
Catching Hashimoto’s early means we can support the thyroid before long term damage happens. The first step is always proper testing, because every woman’s pattern looks a little different. I do not use a one size fits all plan. Your protocol depends on your symptoms, your lab work, your risk factors, and how your thyroid is functioning right now.
Testing helps us see three things clearly:
How active the autoimmune process is
Whether the thyroid is still producing enough hormone
Which nutrients or systems need support
From there, we build a plan that matches your pattern, not a generic thyroid protocol.
Research on Selenium
Many women ask whether supplements can help lower thyroid antibodies in Hashimoto’s. The short answer is yes, but not all supplements work the same way. A recent review looked at the best available research to see which nutrients actually help lower TPO and TG antibodies in people with Hashimoto’s who still have normal thyroid hormone levels.
Across the studies, selenium was the only supplement that consistently lowered thyroid antibodies. People taking selenium had a meaningful drop in both:
TPO antibodies
TG antibodies
Compared to placebo, selenium lowered these antibodies enough that the change showed up clearly in the research. Selenium also helped support more stable TSH levels.
You Are Not “Fine.” You Are Early.
If your TSH is normal but your body feels off, it is not “all in your head”. It is not stress. It is not aging.
This is often the early stage of Hashimoto’s. And this is the exact stage where support makes the biggest difference.
You are not waiting for things to get worse. You are catching it early and changing the direction of your health.
Patients in my practice tell me that their medical doctor won't test their antibodies because it won't change the treatment offered to them. Please know that naturopathic medicine has lots of options to treat autoimmune conditions.
If this feels like you
I help women across Ontario get clear answers about testing and treatment for Hashimoto's. Especially when they feel dismissed or unheard.
If you want a warm, knowledgeable approach, you can book a free ten minute discovery call.
This is the first step to becoming a patient. I look forward to speaking with you!
Comments