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Likewise, we have seen patients who appear to have a mixture of Hashimoto's thyroiditis and subacute thyroiditis, with goiter, positive thyroid autoantibodies, normal or low FT 4 , and biopsies which have suggested Hashimoto's on one occasion and included giant cells on another

DOI: 10.1073/pnas.2426564122

No single peptide optimally supports every phase

Guarente said

The presence of a large gland, progressive growth of the goiter, or hypothyroidism indicates the need for replacement thyroid hormone