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The thyroid is the small, butterfly-shaped gland at the base of your neck that produces hormones to regulate your body's metabolism. A drop in thyroid hormone production is called hypothyroidism. When you're hypothyroid, your body processes slow down and change, affecting essentially all the systems in your body.
You can measure your thyroid function with thyroid blood tests. Many labs only look only at thyroid-stimulating hormone (TSH) to assess thyroid health. Unfortunately, using TSH, a pituitary hormone, offers a limited understanding of how your thyroid is working.
Paloma Health believes it's important to have a comprehensive picture of what's happening with your thyroid health in order to make specific improvements. In addition to tthe TSH test, Paloma measures free triiodothyronine (free T3), free thyroxine (free T4), and thyroid peroxidase (TPO) antibodies to fully understand your thyroid status. Each test offers a crucial piece of information that can help tailor a treatment plan to optimize your thyroid function.
What does a full thyroid panel include?
Thyroid-stimulating hormone (TSH)
The pituitary gland produces thyroid-stimulating hormone (TSH) in the brain. The primary job of TSH is as a messenger hormone that regulates the amount of thyroid hormones—thyroxine (T4) and triiodothyronine (T3)—produced by your thyroid gland. While TSH is the standard test most doctors use to diagnose and manage thyroid conditions, it won't provide detailed information on the actual thyroid hormone levels circulating in your bloodstream.
Free T4
The thyroid produces two hormones: thyroxine (T4) and triiodothyronine (T3). T4 is primarily inactive. Its acts as a "storage hormone," and must be converted into the active T3 hormone before your body can use it to get energy or deliver oxygen to cells. This conversion process happens primarily in the liver. "Free" T4 refers to the portion of T4 that is not bound to proteins, meaning it is available for the body to use. This is different from total T4, which includes both bound and free or available thyroxine.
Free T3
T3 is the active version of the thyroid hormone. T3 circulates in the bloodstream, both bound and not bound to protein. The free (unbound) T3 is what is able to enter cells and help oxygen and energy reach tissues, organs, and glands. Free T3 is different from total T3 because it measures only the unbound, biologically active form of the hormone available for use by cells.
TPO antibodies
Thyroid peroxidase (TPO) antibodies are autoantibodies that target thyroid peroxidase, an enzyme crucial for the production of thyroid hormones. The presence of TPO antibodies indicates that the immune system is mistakenly attacking the thyroid, leading to inflammation and potential dysfunction. If you have high TPO levels, it may indicate Hashimoto's thyroiditis. Hashimoto's is an autoimmune condition in which your immune system attacks your thyroid and eventually causes hypothyroidism. Hashimoto's is actually the most common cause of hypothyroidism in the United States. It's essential to include TPO antibodies in a complete thyroid test because you could have high TPO levels but still have normal TSH levels, and early detection may help slow its progression.
Reverse T3
Reverse T3 is a byproduct of T4 metabolism. It is an inactive form of T3—meaning that reverse T3 cannot carry out the same metabolic activities as T3. Reverse T3 may be an adaptive mechanism to benefit the body in certain situations where you don't want to have as much thyroid hormone activity at the tissue level. For example, if a patient is undergoing extreme stress, trauma, surgery, or malnutrition, reverse T3 may be a valuable marker.
A complete thyroid test panel
The Paloma Health Home Thyroid Test Kit is designed to assess thyroid function by measuring these four key hormone levels. This panel tests for TSH, Free T3, Free T4 and TPO antibodies. You can also add Reverse T3 and Vitamin D tests to the basic 4-test panel. Paloma's test kit offers a convenient, affordable, and accessible way to monitor thyroid health without the need for in-person doctor visits, lab appointments, or venous blood draws. Using a nearly painless finger stick and bloodspot technology, the the Paloma test panel offers accurate certified results. With the option for a telemedicine consultation with a Paloma practitioner, you can better understand your thyroid health and take proactive steps toward managing thyroid-related symptoms like fatigue, weight gain, or brain fog.
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A note from Paloma Health
Should your results indicate that your thyroid is underactive, it is treatable with thyroid hormone replacement medication. When choosing thyroid medication with your doctor, remember that there is no one-size-fits-all treatment. We recommend that you work with an experienced provider who can assess your symptoms, history, and lab results to determine the best treatment plan to optimize your thyroid function.
Frequently asked questions
What is a full thyroid panel?
A full thyroid panel is a group of blood tests that evaluates several aspects of thyroid function rather than relying on a single measurement. It provides a more complete understanding of thyroid hormone production, regulation, and potential autoimmune disease.
Why isn't a TSH test alone always enough?
TSH measures how much stimulation the brain is sending to the thyroid, but it doesn't directly measure thyroid hormone availability or autoimmune activity. Some people continue to experience thyroid symptoms even when their TSH falls within the reference range.
What tests are usually included in a complete thyroid panel?
Most comprehensive thyroid panels include TSH, Free T4, Free T3, and thyroid peroxidase (TPO) antibodies. Depending on your symptoms and medical history, your healthcare provider may also order thyroglobulin antibodies (TgAb) or reverse T3.
What do thyroid antibody tests detect?
Thyroid antibody tests look for evidence that the immune system is attacking the thyroid gland. Elevated antibodies are commonly associated with autoimmune thyroid diseases such as Hashimoto's thyroiditis and Graves' disease.
Can a full thyroid panel detect Hashimoto's disease before thyroid hormone levels become abnormal?
Yes. Many people develop elevated thyroid antibodies months or even years before changes appear in TSH or thyroid hormone levels. Early detection allows for closer monitoring and more proactive management.
How often should thyroid testing be repeated?
The ideal testing schedule depends on your diagnosis, treatment plan, and symptoms. People starting or adjusting thyroid medication often need more frequent testing than those with stable thyroid function.
What is the difference between Free T4 and Free T3?
Free T4 is the primary hormone produced by the thyroid gland, while Free T3 is the active hormone that cells use throughout the body. Measuring both helps determine whether thyroid hormone production and conversion are functioning properly.
Can thyroid test results change over time?
Yes. Thyroid function can fluctuate because of autoimmune disease progression, medication adjustments, pregnancy, aging, illness, and other health conditions. Periodic testing helps ensure treatment remains appropriate.
Who should consider getting a comprehensive thyroid panel?
Anyone experiencing persistent symptoms of thyroid dysfunction, those with a family history of thyroid disease, people with autoimmune conditions, or individuals whose symptoms don't match their previous thyroid test results may benefit from comprehensive testing.
Can a normal thyroid panel rule out every thyroid problem?
Not always. Laboratory results are only one part of the diagnostic process, and thyroid-savvy healthcare providers also consider symptoms, medical history, and repeat testing when appropriate.
Learn more
You can learn more about thyroid blood tests here at the Paloma blog:
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