The singer revealed her diagnosis with stiff person syndrome in December 2022 and has stayed out of the public eye since.
She has beaten the previous record of three wins in the category, held by Stevie Wonder, Paul
The legendary musician also closed the show with a performance of his 1980 classic "You May Be Right."
"I feel like today, I'm sprouting finally above ground," she said during her speech.
The award, presented by Céline Dion, moves Swift into sole possession of the most wins in the category's history.
The biggest No. 1 hit of her career also becomes her first Big Four victory.
The icon was joined by Laufey on cello for the performance The post
The track samples Brandy's 1998 Mase-assisted song "Top of the World."
The CEO of the Recording Academy preached about the power of music to unite while a string quartet of Palestinian and Israeli performers played.
After performing "My Eyes" and "I Know," the rapper brought out Playboi Carti for "Fe!n."