Thyroid Hormone Tests

Test Overview

Thyroid hormone tests are blood tests that check how well the thyroid gland is working. The thyroid gland makes hormones that regulate the way the body uses energy.

The thyroid gland is a butterfly-shaped gland that lies in front of your windpipe (trachea), just below your voice box (larynx). The thyroid gland uses iodine from food to make two thyroid hormones: thyroxine (T4) and triiodothyronine (T3). The thyroid gland stores these thyroid hormones and releases them as they are needed.

Thyroid hormones are needed for normal development of the brain, especially during the first 3 years of life. Intellectual disability may occur if a baby's thyroid gland does not produce enough thyroid hormone (congenital hypothyroidism). Older children also need thyroid hormones to grow and develop normally, and adults need the hormones to regulate the way the body uses energy (metabolism). In BC, all newborns are tested for congenital hypothyroidism using the blood sample collected on the newborn screening card.

Thyroid hormone blood tests include:

Total thyroxine (T4) and free thyroxine (FT4).

Triiodothyronine (T3) and free triiodothyronine (FT3). Most of the T3 in the blood is attached to thyroxine-binding globulin. Less than 1% of the T3 is unattached. Free triiodothyronine (FT3) can be measured directly. T3 has a greater effect on the way the body uses energy than T4, even though T3 is normally present in smaller amounts than T4.

Why It Is Done

Thyroid hormone tests are done to:

Find out what is causing an abnormal thyroid-stimulating hormone (TSH) test. For more information, see the topic Thyroid-Stimulating Hormone (TSH). This is the most common reason for thyroid hormone tests.
Check how well treatment of thyroid disease is working. The free thyroxine (FT4) value is often used to keep track of treatment for hyperthyroidism or hypothyroidism, if TSH is abnormal or if TSH is normal and a patient has pituitary disease.

How To Prepare

Many medicines may change the results of this test. Be sure to tell your doctor about all the non-prescription and prescription medicines you take. If you are taking thyroid medicines, tell your doctor when you took your last dose.

Talk to your doctor about any concerns you have regarding the need for the test, its risks, how it will be done, or what the results will mean. To help you understand the importance of this test, fill out the medical test information form .

How It Is Done

Blood test

The health professional taking a sample of your blood will:

Wrap an elastic band around your upper arm to stop the flow of blood. This makes the veins below the band larger so it is easier to put a needle into the vein.
Clean the needle site with alcohol.
Put the needle into the vein. More than one needle stick may be needed.
Attach a tube to the needle to fill it with blood.
Remove the band from your arm when enough blood is collected.
Put a gauze pad or cotton ball over the needle site as the needle is removed.
Put pressure on the site and then put on a bandage.

Heel stick

A heel stick is used to obtain a blood sample from a newborn. The baby's heel is pricked with a sharp instrument (lancet) and several drops of blood are collected.

How It Feels

Blood test

The blood sample is taken from a vein in your arm. An elastic band is wrapped around your upper arm. It may feel tight. You may feel nothing at all from the needle, or you may feel a quick sting or pinch.

Heel stick

A brief pain, like a sting or a pinch, is usually felt when the lancet punctures the skin. Your baby may feel a little discomfort with the skin puncture.

Risks

Blood test

There is very little chance of a problem from having blood sample taken from a vein.

You may get a small bruise at the site. You can lower the chance of bruising by keeping pressure on the site for several minutes.
In rare cases, the vein may become swollen after the blood sample is taken. This problem is called phlebitis. A warm compress can be used several times a day to treat this.

Heel stick

There is very little chance of a problem from a heel stick. A small bruise may develop at the site.

Results

Thyroid hormone tests are blood tests that check how well the thyroid gland is working.

Normal

The normal values listed here—called a reference range—are just a guide. These ranges vary from lab to lab, and your lab may have a different range for what's normal. Your lab report should contain the range your lab uses. Also, your doctor will evaluate your results based on your health and other factors. This means that a value that falls outside the normal values listed here may still be normal for you or your lab.

Results are usually available within a few days.

Labs generally measure free T4 (FT4) levels, if the TSH is abnormal. Results of these thyroid hormone tests may be compared to your thyroid-stimulating hormone (TSH) results.

Thyroid hormone tests^{footnote 2}
Free thyroxine (FT4):	10–26 picomoles per litre (pmol/L)
Free triiodothyronine (FT3):	4.0–7.4 pmol/L in adults

Many conditions can change thyroid hormone levels. Your doctor will talk with you about any abnormal results that may be related to your symptoms and past health.

High values

High thyroid hormone levels (hyperthyroidism) may be caused by:

Diseases of the thyroid gland, such as Graves' disease, thyroiditis, or a goiter that contains one or more abnormal growths (nodules).
Taking too much thyroid medicine.

Low values

Low thyroid hormone levels (hypothyroidism) may be caused by:

Thyroid disease, such as thyroiditis.
Pituitary gland disease.
Destruction of the thyroid gland by surgery or radiation.

What Affects the Test

Reasons the interpretation of your test may be affected:

Taking certain medicines, such as:
- Corticosteroids, estrogen, progesterone, or birth control pills.
- Antiseizure medicines such as phenytoin or carbamazepine.
- Heart medicines such as amiodarone or propranolol.
- Lithium.
Having recently had an X-ray test that uses contrast material.
Being pregnant.

What To Think About

Thyroid Scan and Radioactive Iodine Uptake Test.
Thyroid Ultrasound and Parathyroid Ultrasound.
Thyroid Biopsy.

Other blood tests are often used to check how well the thyroid gland is working.
- Because false-positive results can occur when testing a newborn for congenital hypothyroidism, the thyroid hormone tests may be repeated a few days after initial testing. If the results are still abnormal and congenital hypothyroidism is suspected, additional testing is done.
- Thyroid-stimulating hormone (TSH) test measures the amount of TSH in the blood and is considered the most reliable way to find a thyroid problem. If the TSH test is abnormal, other thyroid hormone tests such as a FT3 or FT4 may be done. For more information, see the topic Thyroid-Stimulating Hormone.
- Thyroid antibodies test measures the presence of antibodies against thyroid tissue. Antibodies may mean that you have an autoimmune disease such as Hashimoto's thyroiditis or Graves' disease.
Other tests used to investigate problems with the thyroid gland include:

References

Citations

Health Canada (2000). Family-Centred Maternity and Newborn Care: National Guidelines. Minister of public works and government services. Ottawa: Available online: http://www.phac-aspc.gc.ca/dca-dea/publications/fcmc00-eng.php.

Fischbach FT, Dunning MB III, eds. (2009). Manual of Laboratory and Diagnostic Tests, 8th ed. Philadelphia: Lippincott Williams and Wilkins.

Other Works Consulted

Chernecky CC, Berger BJ (2008). Laboratory Tests and Diagnostic Procedures, 5th ed. St. Louis: Saunders.

Fischbach FT, Dunning MB III, eds. (2009). Manual of Laboratory and Diagnostic Tests, 8th ed. Philadelphia: Lippincott Williams and Wilkins.