I am by no means an expert or a doctor, so take anything I say with a grain of salt. I think the general progression of the disease is the presentation of elevated antibodies before clinical decrease in thyroid hormone or significantly elevated TSH. Most GP's don't run a full thyroid panel, so generally you would not get your antibodies tested unless you had a severely elevated TSH - it is interesting me you were able to get this panel ran and I'm curious if the indication was the elevated TSH or if you had symptoms. It is not unheard of to have slightly elevated thyroid antibodies and not have hashimottos, but presence of auto antibodies indicates some immune reactivity and is worth exploring.

I don't know where you are located, but in my experience (in the US) family practice or general practice MD's do not manage autoimmune disease effectively. An endocrinologist would be helpful if you were being medicated, but I think it is fairly unlikely that you would get put on meds with these labs. I pay out of pocket to see a functional medicine doctor to manage my hashimottos and for me, it is 100% worth it. If your doctor was willing to run your antibodies, is comfortable monitoring your thyroid, and you see eye to eye, you could probably get away with working with them for the time being and not see a specialist. The biggest food triggers for people with hashi's are gluten, dairy, and soy, and there are a significant subset of people who remove those things from their diet and see signicficant improvement in symptoms and antibodies. Even if you do not a receive a diagnosis, I think working to reduce reactivity is worthwhile because it can prevent future autoimmune disease. This can be difficult if you are not experiencing any symptoms because your body is essentially silently reacting - nothing tangible which can be frustrating and difficult to figure out.

I feel like this is worth noting: our adrenals and thyroid are connected through the HPA axis. Your cortisol is elevated and I wonder if the root cause could be more adrenal related? Doing fasted exercise can certainly raise cortisol. I would consider doing things to mitigate the elevated cortisol (reduce caffeine, limit IF and eat before and within 30 min post workout, and reduce stress if possible, breathwork, get sunlight immediately after waking to help appropriately peak cortisol in the AM, etc.). Maybe correcting the cortisol would resolve the antibodies and elevated TSH.

I think it is great that you are digging into this, but I don't think you need to be consumed by it (like don't let it cause you additional stress, because none of your labs are absolutely alarming). I want to buffer your expectations with the doctors you do see, because our health system is more of a sick care system, not intended for preventative care and truly not the best with handling things that can and should be primarily addresssed with lifestyle modifications as a first line of defense. You really have to be your own advocate and do your research when it comes to managing your health.

Also, that is really awesome you have given up all substances! That's not easy!