Originally published on 11th March 2016 Last updated on 24th November 2023
As a thyroid patient, the below blood tests are recommended to get the full picture of what’s going on. If you still have symptoms, despite being on thyroid medication, explore these. If you feel well on your thyroid medication, monitor these regularly.
Really, everyone should monitor their thyroid levels.
You may have to repeatedly ask doctor or try a few different types of medical professionals before you find one who will do all of them. Alternatively, you could order them yourself if this is an option. I have linked to some places below, next to each test.
The results you should be aiming for are also listed where possible.
The Essentials: A Full Thyroid Panel, to include as many of these as possible:
Thyroid Stimulating hormone. It gives an indication of thyroid hormone levels but doesn’t actually measure them as it is a pituitary hormone and not a thyroid hormone. Read more here. It serves as an average read out over the previous four to six weeks of your thyroid levels.
A measure of the active thyroid hormone, T3.
There are binding proteins that attach to thyroid hormones to transport through the blood vessels, to cells all over our body. When they reach the cells, only the unbound ‘free’ hormones can actually be used by the cells. Therefore Free T3 levels (and Free T4) are important to monitor. It’s important to be aware that Free T3 and Free T4 are different to Total T3 and Total T4. Make sure you check ‘free’ levels.
A measure of the less active thyroid hormone, T4. The body should convert T4 to T3 but doesn’t for a lot of thyroid patients.
(see here why testing Reverse T3 is often controversial and why I’m dubious about whether it’s truly useful. I lean more towards ‘no’, however, you will see other thyroid resources suggesting we must have it checked.)
Thyroid Peroxidase Antibody/ies (TPOAB)
This measures the amount of thyroid attacking antibodies in your blood and is used to identify an autoimmune disease like Hashimoto’s Thyroiditis.
Thyroglobulin Antibody/ies (TGAB)
Also used to identify Hashimoto’s.
Related Article: Why It’s Important to Know if You Have Hashimoto’s
Why You Need These
At the very least, you must have TSH, Free T3 and Free T4 tested to get an idea of how you are doing, but also testing the two antibody tests can be very beneficial.
Optimal Thyroid Test Results
TSH – Below 2.5. May be close to 0 on T3 containing thyroid medication. More information found here
Free T3 – Upper quarter of the range. More information found here
Free T4 – Midrange or a bit higher. More information found here
TpoAB and TgAB – In range indicates Hashimoto’s is not present or that it is in remission. Over range means you have Hashimoto’s that is not controlled. (UK lab test including thyroid antibodies here and a worldwide lab here.)
Always work with a doctor in evaluating and reevaluating your thyroid hormone levels, keeping in mind your symptoms and overall health as well. We’re all individuals and there is no ‘one size fits all‘, but there are obviously health risks if your thyroid hormone levels, vitamin levels or any others are either too low or too high for an extended period of time. Your doctor should know where they sit best for your health. The given numbers are a guide only.
Other tests to explore and results most thyroid information sources state to aim for:
Vitamins and Minerals:
B12 – Close to top of range. (Worldwide test option here.)
Folate/Folic acid – In the top quarter of the range. (Worldwide test option here.)
Ferritin – 70-90 ng/ml, being slightly higher for men. (Worldwide test option here.)
Selenium – Worldwide test option here.
24-Hour, 4-point Saliva Cortisol Test
8am – Top of the range.
Midday – Upper quarter of the range.
4-5pm – Midrange.
11pm – Midnight – At the very bottom of the range.
DHEA – Above mid-range.
If your doctor won’t check your adrenals, you can very simply order testing yourself in the UK here. I am yet to find a 4-point saliva test for the US. Please Leave any suggestions in the comments!
Gut Health Testing
Candida (yeast overgrowth) – A UK test for Candida can be found here.
Coeliac Disease – A UK test can be seen here.
Other Endocrine Testing
Other Testing – these often seem to come hand in hand with thyroid issues
Liver Function (ALP, ALT, CK, Gamma GT, Bilirubin) – UK test option.
Lyme Disease – Find a worldwide test for Lyme Disease here.
You can click on the hyperlinks in the above post to learn more and see references to information given.