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The lab. diagnosis of hypothyroidism depending on low levels of T4 and high levels of TSH has both high sensitivity and specificity.

However, at earlier stages of autoimmune thyroid impairment, serum TSH is elevated but the free T4 estimate is in the low-normal range and TPO ( Anti-Thyroid Peroxidase) antibodies are present , in this case, the term Subclinical Hypothyroidism is applied.