Chronic spontaneous urticaria affects 0.5–1% of the population and approximately 40% of patients do not respond to standard treatment. The study examined 350 euthyroid patients with this diagnosis in the period 2020–2023 and found that the presence of thyroid autoantibodies (TPOAb/TgAb) significantly worsens treatment outcomes. Antibody-positive patients showed lower response rates at week 24 (47.6% vs. 69.4%). The treatment started to work more slowly for them - the median time to response was delayed by 4 weeks (14 weeks versus 10 weeks). Among responders, relapse rates were higher in those with positive antibodies (27.1% versus 14.0%). Patients with positive antibodies also required more frequent escalation of treatment – omalizumab was required by 38.7% of them compared to 21.0% without antibodies. Researchers recommend routine thyroid autoantibody screening at diagnosis of chronic spontaneous urticaria to personalize treatment and improve outcomes.