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So high TSH alone will confirm a suspected diagnosis of primary hypothyroidism but if you suspect secondary hypothyroidism, then you should check T4 as well if they are both low, then this will confirm a suspected diagnosis of hypothyroidism

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doi: 10.1111/j.20427158.1970.tb08465.x 237 HolmgrenSAxelssonMJensenJAldmanGSundellKJonssonAC

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