Thyroid Function Testing
What Is Thyroid Function Testing?
A number of blood tests may be used to learn if your thyroid gland is working normally. These thyroid function tests reveal if your thyroid is producing the right amount of thyroid hormones. Thyroid blood tests may be ordered:
- To check for thyroid disease before it causes symptoms, especially in newborns
- To diagnose an underactive or overactive thyroid
- To determine if an underlying disorder, such as Hashimoto’s thyroiditis, Graves’ disease, or thyroid inflammation, may be causing an underactive or overactive thyroid
- To evaluate a lump on the thyroid gland, called a thyroid nodule
- To evaluate an enlargement of the thyroid gland, called a goiter
- To monitor treatment for thyroid disorders
Understanding how your thyroid is functioning enables your doctor to treat a thyroid disorder if one is present.
The Role of Thyroid Function Tests
Thyroid function testing can be used in several ways, including:
- Screening: Screening means testing for disease in the absence of symptoms. All newborns in the United States are routinely screened for an underactive thyroid. Some adults may also be screened for thyroid disorders, although not all experts agree that this is beneficial.
- Diagnosis: Diagnostic thyroid function testing aims to find the cause of a person’s symptoms. Thyroid function testing can reveal whether the thyroid gland is functioning normally or abnormally and what specific disorder a person may have.
- Treatment monitoring: Thyroid blood tests provide valuable information about whether treatment for thyroid disorders is working as it should or if it needs adjustment.
Who should get testing?
Thyroid function testing is often ordered when patients have symptoms of a thyroid disorder. Testing can assist with diagnosing or ruling out thyroid problems as a cause of a patient’s symptoms.
Many of the symptoms of common thyroid problems are nonspecific, meaning that there is a wide range of diseases and disorders which may cause them. Thyroid function testing may be included with other tests to evaluate a patient who is having trouble with a nonspecific symptom like fatigue, depression, or difficulty becoming or staying pregnant.
The table below provides examples of symptoms associated with thyroid disorders:
|Thyroid Disorders||Possible Symptoms|
|Underactive Thyroid or Hypothyroidism; Hashiomoto’s Thyroiditis||Fatigue, weight gain, cold intolerance, dry skin and hair, fertility problems, depression, constipation|
|Overactive thyroid or Hyperthyroidism; Graves’ Disease||Weight loss, irritability, anxiety, insomnia, mood swings, heat intolerance, rapid heartbeat, frequent bowel movements|
|Thyroid Nodule||Visible lump in neck, hyperthyroid symptoms, hypothyroid symptoms, hoarseness, pain|
|Goiter||Thyroid gland enlargement, hypothyroid or hyperthroid symptoms, hoarseness, difficulty swallowing, pain|
|Thyroid Cancer||A lump or swollen glands in the neck, hoarseness, pain, difficulty swallowing|
In addition to being used for diagnosis, thyroid function tests may be performed to screen for thyroid disease in patients who have no symptoms. Newborn infants are routinely screened for hypothyroidism shortly after birth.
Screening for thyroid disease in adults is controversial. Some experts recommend screening certain groups who are at higher risk of having an underactive thyroid. These risk factors may include:
- Family history of thyroid disease
- Personal history of type I diabetes
- Personal history of autoimmune disease
- Personal history of radiation to the head and neck
Other experts do not recommend routine screening for thyroid disorders in adults. The United States Preventive Services Task Force, which issues screening recommendations, has concluded that there is currently not enough evidence to assess the benefits and drawbacks of screening for thyroid disorders.
Thyroid function tests are also used for treatment monitoring. Patients with known thyroid disorders will have periodic thyroid function testing to ensure their treatment is effective.
Getting test results
Typically, your doctor will interpret several thyroid function tests results along with your symptoms and health history to determine whether a thyroid disorder is present.
It often takes a few business days before the results of your thyroid function test(s) are available. You may receive the results by mail or through an online health portal, or your doctor may schedule an appointment to review the results with you and discuss next steps.
Types of Thyroid Function Tests
A number of blood tests may be used to screen for and diagnose thyroid disorders.
The table below lists the thyroid function tests that may be used for screening and diagnosis:
|Test Name||What it Measures|
|Thyroid-stimulating hormone (TSH)||A pituitary hormone that stimulates the thyroid gland and reflects thyroid function|
|Free Thyroxine (T4)||A thyroid hormone that is not bound to protein|
|Total T4||A thyroid hormone that is both bound to protein and unbound, or free|
|Free Triiodothyronine (T3)||A thyroid hormone that is not bound to protein|
|Total T3||A thyroid hormone that is both bound to protein and unbound, or free|
|Thyroglobulin (Tg)||A protein made by healthy thyroids and by certain thyroid cancers|
Often, doctors will begin with a TSH test. If it is abnormal, more tests will be ordered to learn more about how the thyroid is functioning. Many labs offer reflexive tests, meaning that if TSH is found to be abnormal, another test such as free thyroxine (T4) will automatically be performed using the same blood sample.
Thyroid antibody tests may also be used to diagnose thyroid disorders. Antibodies are made by the immune system and target specific proteins on cells. The following antibodies may be measured to determine whether an autoimmune disease, such as Hashimoto’s thyroiditis or Graves’ disease, is affecting thyroid function:
- Thyroid peroxidase antibody (TPOAb)
- Thyrotropin receptor antibody test (TRAb)
- Antithyroglobulin antibody test (TgAb)
In many cases, patients will also have imaging tests such as an ultrasound, thyroid scan, or a radioactive iodine uptake in order to establish their diagnosis.
Patients who have been previously diagnosed with a thyroid disorder will typically have thyroid function tests for treatment monitoring. The selection of tests depends on the disorder being treated. Common treatment monitoring tests include:
- TSH testing is used to monitor patients with hypothyroidism and hyperthyroidism
- Free T4 and sometimes total T3 tests are used to monitor patients undergoing active treatment for hyperthyroidism. Measuring TRAb may be used for patients whose hyperthyroidism is caused by Graves’ disease.
- Tg is a test used to monitor patients after treatment for thyroid cancer.
Getting Thyroid Function Testing
Thyroid function tests are typically ordered by a primary care physician, endocrinologist, or other medical professional. Thyroid function tests are most often performed in a doctor’s office, clinic, medical lab, hospital, or other medical setting.
Some thyroid gland tests are available as at-home tests. Commercially available test kits enable testing of the most commonly used tests, such as thyroid-stimulating hormone (TSH) and thyroid panels with TSH, free T3, and T4. Some at-home thyroid panels also include thyroid antibody tests.
Diagnosis of thyroid disorders involves interpreting multiple thyroid function tests along with individual patient factors. It is important to discuss concerns about thyroid function and results of at-home thyroid function tests with a doctor.
Abnormal test results obtained on at-home tests, especially thyroid antibody tests, will likely need to be retested by a doctor for confirmation.
A.D.A.M. Medical Encyclopedia. Fatigue. Updated April 26, 2019. Accessed July 29, 2021. https://medlineplus.gov/ency/article/000317.htm
A.D.A.M. Medical Encyclopedia. Antithyroglobulin antibody test. Updated January, 2021. Accessed August 2, 2021. https://medlineplus.gov/ency/article/003557.htm
A.D.A.M. Medical Encyclopedia. Infertility. Updated January 26, 2020. Accessed July 28, 2021.https://medlineplus.gov/ency/article/001191.htm
A.D.A.M. Medical Encyclopedia. Toxic nodular goiter. Updated January 26, 2020. Accessed July 28, 2021. https://medlineplus.gov/ency/article/000317.htm
A.D.A.M. Medical Encyclopedia. Simple goiter. Updated January 27, 2020. Accessed July 28, 2021. https://medlineplus.gov/ency/article/001178.htm
A.D.A.M. Medical Encyclopedia. Thyroid function tests. Updated July 2, 2021 Accessed July 28, 2021. https://medlineplus.gov/ency/article/003444.htm
A.D.A.M. Medical Encyclopedia. Thyroid nodule. Updated July 2, 2021. Accessed July 28, 2021.
American Society of Clinical Oncology. Guide to thyroid cancer. Updated January 2021. Accessed July 29, 2021. https://www.cancer.net/cancer-types/thyroid-cancer
American Thyroid Association. Thyroid function tests. Date unknown. Accessed July 26, 2021. https://www.thyroid.org/thyroid-function-tests/
American Thyroid Association. Thyroid nodules. Date unknown. Accessed July 28, 2021. https://www.thyroid.org/thyroid-nodules/
ARUP Consult. Initial evaluation of thyroid function.Updated February 2021. Accessed July 26, 2021. https://arupconsult.com/content/initial-evaluation-thyroid-function
Columbia Surgery. At-home thyroid testing kits: What we know…and what we don’t: An interview with Dr. Hyesoo Lowe. Columbia Surgery website. Date unknown. Accessed June 18, 2021. https://columbiasurgery.org/news/home-thyroid-testing-kits-what-we-knowand-what-we-dont
Davies TF. Pathogenesis of Hashimoto’s thyroiditis (chronic autoimmune thyroiditis). In: Ross DS, ed. UpToDate. Updated January 3, 2020. Accessed August 2, 2021. https://www.uptodate.com/contents/laboratory-assessment-of-thyroid-function
LaFranchi S. Clinical features and detection of congenital hypothyroidism. In Geffner ME, ed. UpToDate. Updated April 9, 2021. Accessed July 26, 2021. https://www.uptodate.com/contents/clinical-features-and-detection-of-congenital-hypothyroidism
Lyness JM. Unipolar depression in adults: Assessment and diagnosis. In Roy-Byrne PP, ed. UpToDate. Updated December 28, 2020. Accessed July 29, 2021. https://www.uptodate.com/contents/unipolar-depression-in-adults-assessment-and-diagnosis
National Institute of Diabetes and Digestive and Kidney Diseases. Hyperthyroidism (overactive thyroid). Updated August 2016. Accessed July 27, 2021. https://www.niddk.nih.gov/health-information/endocrine-diseases/hyperthyroidism
National Institute of Diabetes and Digestive and Kidney Diseases. Thyroid tests. Updated May 2017. Accessed July 26, 2021. https://www.niddk.nih.gov/health-information/diagnostic-tests/thyroid
National Institute of Diabetes and Digestive and Kidney Diseases. Hypothyroidism (underactive thyroid). Updated March 2021. Accessed July 27, 2021. https://www.niddk.nih.gov/health-information/endocrine-diseases/hypothyroidism
Ross DS. Laboratory assessment of thyroid function. In: Cooper DS, ed. UpToDate. Updated December 11, 2019. Accessed July 26, 2021. https://www.uptodate.com/contents/laboratory-assessment-of-thyroid-function
Ross DS. Diagnosis of hyperthyroidism. In: Cooper DS, ed. UpToDate. Updated April 19, 2021. Accessed July 28, 2021. https://www.uptodate.com/contents/diagnosis-of-hyperthyroidism
Ross DS. Patient Education: Hypothyroidism (underactive thyroid) (Beyond the basics) In: Cooper DS, ed. UpToDate. Updated April 20, 2021. Accessed July 29, 2021. https://www.uptodate.com/contents/hypothyroidism-underactive-thyroid-beyond-the-basics
U.S. Preventive Services Task Force. Thyroid dysfunction: Screening. Published May 24, 2015. Accessed July 27, 2021. https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/thyroid-dysfunction-screening