A truly hypothyroid patient will not have a TSH slightly outside the ULN, rather, it may be 2-10x the ULN. Different labs have different normal ranges which is why, if you get your TSH drawn at e.g., the VA and then transfer care to a physician which uses e.g., Quest they should draw another level if they're concerned since the assay may be different and therefore the nml levels may be different.
There is subclinical hypothyroidism, in which patients have TSH levels that are at or near the ULN and may still be exhibiting signs/symptoms of hypothyroidism, particularly low energy. In these cases, at least in my primary care experience, a trial of low-dose LT4 (I start @ 50mcg in <70 or folks w/ HTN needing >2 meds for control and 25mcg in the others) and re-check a TSH and clinical status in 6-8 wks. YMMV of course but it's worked for me.
