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This is a 67-year old male who was referred for autoimmune myxedema after prior presentation in different departments. This real life case introduces the discussion related to relationship TSH and specific thyroid antibodies against thyroid. Despite relative high frequency, autoimmune thyroiditis may be under diagnosed until myxedema is recognised, challenging various differential diagnoses, as in our case. Male are rarer affected than women. Overall, the levels of thyroid antibodies are not correlated with TSH; neither they predict the pattern of response to levothyroxine substitution.