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Although TSH shows a logarithmic amplification in response to minor changes in FT4 and free triiodothyronine (FT3), it reflects pituitary thyroid hormone sensitivity but may not accurately represent peripheral thyroid hormone activity ( Third, the autoimmune nature of Hashimotos thyroiditis may itself contribute significantly to persistent symptoms, even when thyroid hormone levels are within the reference ranges ( In light of these mechanisms, the prevailing assumption that biochemical euthyroidism equates to clinical remission in HT should be challenged, highlighting the need to broaden the clinical framework beyond hormone levels to include markers of immune activity, inflammation, and patient-reported outcomes

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Stained slides were analyzed using Qu-Path digital imagining analysis to measure staining intensity as optical density on positively stained tissue as previously described [30]