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Originally published on 11th March 2016 Last updated on 18th April 2021
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.
This counteracts the T3 your body is producing, so it is important to test this wherever possible because the three above could potentially be OK, whereas a hidden overproduction of RT3 can cause ongoing symptoms because your body is attacking the T3 that is produced.
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 Reverse T3 and the two antibody tests can be very beneficial.
It’s worth knowing that you can order full thyroid panels yourself from online laboratories too. Find a UK lab here and a worldwide lab here. Many panels do not include Reverse T3, so I have listed this separately below.
If you only want to check TSH, Free T3 and Free T4, then you can find a UK option for this from Monitor My Health.
Optimal Thyroid Test Results
TSH – Below 2 or 2.5 on T4 medication, but often close to 0 (suppressed) 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
Reverse T3 – Low in range
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.)
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.
Gut Health Testing
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
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.
Rachel Hill is the highly ranked and multi-award winning thyroid patient advocate, writer, speaker and author behind The Invisible Hypothyroidism. Her thyroid advocacy work includes writing articles, authoring books, producing her Thyroid Family email newsletters and speaking on podcasts, as well as being a founding board member for the American College of Thyroidology. She is well-recognised as a crucial contributor to the thyroid community and has a large social media presence. Her books include “Be Your Own Thyroid Advocate” and “You, Me and Hypothyroidism”.