diff --git a/packages/react-table/src/components/Table/Th.tsx b/packages/react-table/src/components/Table/Th.tsx
index 8bbfb788117..adf013579c5 100644
--- a/packages/react-table/src/components/Table/Th.tsx
+++ b/packages/react-table/src/components/Table/Th.tsx
@@ -1,4 +1,4 @@
-import { createRef, forwardRef, useEffect, useState, useContext } from 'react';
+import { forwardRef, useEffect, useState, useContext, useRef, useImperativeHandle } from 'react';
 import { css } from '@patternfly/react-styles';
 import styles from '@patternfly/react-styles/css/components/Table/table';
 import scrollStyles from '@patternfly/react-styles/css/components/Table/table-scrollable';
@@ -8,6 +8,7 @@ import { ThInfoType, ThSelectType, ThExpandType, ThSortType, formatterValueType
 import { mergeProps } from './base/merge-props';
 import { IVisibility } from './utils/decorators/classNames';
 import { Tooltip, TooltipProps } from '@patternfly/react-core/dist/esm/components/Tooltip';
+import { getResizeObserver } from '@patternfly/react-core/dist/esm/helpers/resizeObserver';
 import { BaseCellProps, TableContext } from './Table';
 import { IFormatterValueType, IColumn } from './TableTypes';
 import cssStickyCellMinWidth from '@patternfly/react-tokens/dist/esm/c_table__sticky_cell_MinWidth';
@@ -109,7 +110,7 @@ const ThBase: React.FunctionComponent<ThProps> = ({
 
   const [showTooltip, setShowTooltip] = useState(false);
   const [truncated, setTruncated] = useState(false);
-  const cellRef = innerRef ? innerRef : createRef();
+  const cellRef = useRef<HTMLElement>(null);
   const onMouseEnter = (event: any) => {
     if (event.target.offsetWidth < event.target.scrollWidth) {
       !showTooltip && setShowTooltip(true);
@@ -202,12 +203,33 @@ const ThBase: React.FunctionComponent<ThProps> = ({
     ...mergedProps
   } = merged;
 
+  // Reconnect the forwarded ref only when React replaces the header element.
+  // eslint-disable-next-line react-hooks/exhaustive-deps
+  useImperativeHandle(innerRef, () => cellRef.current, [MergedComponent]);
+
   useEffect(() => {
-    setTruncated(
-      (cellRef as React.RefObject<HTMLElement | null>).current.offsetWidth <
-        (cellRef as React.RefObject<HTMLElement | null>).current.scrollWidth
-    );
-  }, [cellRef]);
+    const cell = cellRef.current;
+    if (!cell) {
+      return;
+    }
+
+    const updateTruncated = () => setTruncated(cell.offsetWidth < cell.scrollWidth);
+    updateTruncated();
+    const unobserveResize = getResizeObserver(cell, updateTruncated, true);
+    // Content can overflow a fixed-width cell without changing its observed size.
+    const contentObserver = new MutationObserver(updateTruncated);
+    contentObserver.observe(cell, {
+      childList: true,
+      characterData: true,
+      subtree: true,
+      attributes: true,
+      attributeFilter: ['class', 'style']
+    });
+    return () => {
+      unobserveResize();
+      contentObserver.disconnect();
+    };
+  }, [MergedComponent]);
 
   const cell = (
     <MergedComponent
diff --git a/packages/react-table/src/components/Table/__tests__/Th.test.tsx b/packages/react-table/src/components/Table/__tests__/Th.test.tsx
index 01276ce909d..c759eef461c 100644
--- a/packages/react-table/src/components/Table/__tests__/Th.test.tsx
+++ b/packages/react-table/src/components/Table/__tests__/Th.test.tsx
@@ -1,4 +1,5 @@
-import { render, screen } from '@testing-library/react';
+import { createRef, useState } from 'react';
+import { act, fireEvent, render, screen, waitFor } from '@testing-library/react';
 import { Th } from '../Th';
 
 test('Does not render with aria-label by default', () => {
@@ -77,3 +78,154 @@ test('Renders checked checkbox when isSelected is true and isIndeterminate is fa
   expect(checkbox).toBeChecked();
   expect(checkbox.indeterminate).toBe(false);
 });
+
+describe('truncated headers', () => {
+  let offsetWidth: jest.SpyInstance;
+  let scrollWidth: jest.SpyInstance;
+
+  beforeEach(() => {
+    offsetWidth = jest.spyOn(HTMLElement.prototype, 'offsetWidth', 'get').mockReturnValue(100);
+    scrollWidth = jest.spyOn(HTMLElement.prototype, 'scrollWidth', 'get').mockReturnValue(200);
+  });
+
+  afterEach(() => {
+    jest.restoreAllMocks();
+  });
+
+  test('does not remeasure unchanged JSX when unrelated props change', () => {
+    const { rerender } = render(
+      <Th data-testid="header">
+        <span>Heading</span>
+      </Th>
+    );
+    expect(screen.getByRole('columnheader')).toHaveAttribute('tabindex', '0');
+    offsetWidth.mockClear();
+    scrollWidth.mockClear();
+
+    rerender(
+      <Th data-testid="updated-header">
+        <span>Heading</span>
+      </Th>
+    );
+
+    expect(offsetWidth).not.toHaveBeenCalled();
+    expect(scrollWidth).not.toHaveBeenCalled();
+  });
+
+  test('updates keyboard focusability when the label changes', async () => {
+    const { rerender } = render(<Th>Long heading</Th>);
+    expect(screen.getByRole('columnheader')).toHaveAttribute('tabindex', '0');
+
+    scrollWidth.mockReturnValue(100);
+    rerender(<Th>Short</Th>);
+    await waitFor(() => expect(screen.getByRole('columnheader')).toHaveAttribute('tabindex', '-1'));
+  });
+
+  test('updates keyboard focusability when a child changes its own content', async () => {
+    const Heading = () => {
+      const [label, setLabel] = useState('Long heading');
+      return <button onClick={() => setLabel('Short')}>{label}</button>;
+    };
+    render(
+      <Th>
+        <Heading />
+      </Th>
+    );
+    expect(screen.getByRole('columnheader')).toHaveAttribute('tabindex', '0');
+
+    scrollWidth.mockReturnValue(100);
+    fireEvent.click(screen.getByRole('button'));
+
+    await waitFor(() => expect(screen.getByRole('columnheader')).toHaveAttribute('tabindex', '-1'));
+  });
+
+  test('updates keyboard focusability when an info control is added', async () => {
+    scrollWidth.mockReturnValue(100);
+    const { rerender } = render(<Th>Heading</Th>);
+    expect(screen.getByRole('columnheader')).toHaveAttribute('tabindex', '-1');
+
+    scrollWidth.mockReturnValue(200);
+    rerender(<Th info={{ tooltip: 'More information' }}>Heading</Th>);
+
+    await waitFor(() => expect(screen.getByRole('columnheader')).toHaveAttribute('tabindex', '0'));
+  });
+
+  test('updates keyboard focusability when the rendered layout changes', async () => {
+    const { rerender } = render(<Th modifier="nowrap">Heading</Th>);
+    expect(screen.getByRole('columnheader')).toHaveAttribute('tabindex', '0');
+
+    scrollWidth.mockReturnValue(100);
+    rerender(<Th modifier="wrap">Heading</Th>);
+
+    await waitFor(() => expect(screen.getByRole('columnheader')).toHaveAttribute('tabindex', '-1'));
+  });
+
+  test('keeps the same callback ref attached until the header element changes', () => {
+    const callbackRef = jest.fn();
+    const { rerender, unmount } = render(<Th ref={callbackRef}>Heading</Th>);
+    const header = screen.getByRole('columnheader');
+    expect(callbackRef).toHaveBeenCalledTimes(1);
+    expect(callbackRef).toHaveBeenLastCalledWith(header);
+    callbackRef.mockClear();
+
+    rerender(
+      <Th ref={callbackRef} data-testid="updated-header">
+        Heading
+      </Th>
+    );
+    expect(callbackRef).not.toHaveBeenCalled();
+
+    rerender(
+      <Th ref={callbackRef} component="td">
+        Heading
+      </Th>
+    );
+    expect(callbackRef).toHaveBeenNthCalledWith(1, null);
+    expect(callbackRef).toHaveBeenNthCalledWith(2, screen.getByRole('cell'));
+    unmount();
+    expect(callbackRef).toHaveBeenLastCalledWith(null);
+  });
+
+  test('updates keyboard focusability when the cell is resized and cleans up the observer', () => {
+    const disconnectContent = jest.spyOn(MutationObserver.prototype, 'disconnect');
+    let onResize: ResizeObserverCallback;
+    const observe = jest.fn();
+    const unobserve = jest.fn();
+    const previousObserver = window.ResizeObserver;
+    window.ResizeObserver = jest.fn().mockImplementation((callback) => {
+      onResize = callback;
+      return { observe, unobserve };
+    });
+    jest.spyOn(window, 'requestAnimationFrame').mockImplementation((callback) => {
+      callback(0);
+      return 0;
+    });
+
+    try {
+      const { unmount } = render(<Th>Heading</Th>);
+      const header = screen.getByRole('columnheader');
+      expect(observe).toHaveBeenCalledWith(header);
+      expect(header).toHaveAttribute('tabindex', '0');
+      offsetWidth.mockReturnValue(300);
+      act(() => onResize([{ target: header } as ResizeObserverEntry], {} as ResizeObserver));
+      expect(header).toHaveAttribute('tabindex', '-1');
+      unmount();
+      expect(unobserve).toHaveBeenCalledWith(header);
+      expect(disconnectContent).toHaveBeenCalled();
+    } finally {
+      window.ResizeObserver = previousObserver;
+    }
+  });
+
+  test('forwards object and callback refs to the header', () => {
+    const objectRef = createRef<HTMLTableHeaderCellElement>();
+    const callbackRef = jest.fn();
+    const { rerender, unmount } = render(<Th ref={objectRef}>Heading</Th>);
+    expect(objectRef.current).toBe(screen.getByRole('columnheader'));
+    rerender(<Th ref={callbackRef}>Heading</Th>);
+    expect(objectRef.current).toBeNull();
+    expect(callbackRef).toHaveBeenCalledWith(screen.getByRole('columnheader'));
+    unmount();
+    expect(callbackRef).toHaveBeenLastCalledWith(null);
+  });
+});