How do you counsel patients with elevated Thyroglobulin Peroxidase antibody levels, diffuse thyroiditis features on ultrasound, non-specific symptoms of fatigue, but normal biochemical thyroid function labs?  

Assuming this is a female patient and TSH and free T4 are both quite normal, the patient does have asymptomatic Hashimoto’s thyroiditis. The fatigue is unrelated to the thyroiditis. She will need periodic monitoring of TSH and thyroid supplementation only if the TSH is high on two measurements...