Thyroid Function Tests: What To Do
Blood tests measuring TSH and thyroid hormones to assess thyroid activity.
Last revised
TSH moves in the opposite direction to the hormone it regulates, which is the single most confusing thing about the result.
Key takeaways
- TSH: rises when the thyroid is underactive, falls when overactive
- Subclinical hypothyroidism: high TSH with normal T4
- Most useful single change: Ask for the actual numbers rather than "normal" or "abnormal".
- Commonest mistake: Reading TSH as if it moved in the same direction as thyroid hormone.
- See a doctor if any of the signs under "When to get help" below apply to you.
Do
- Ask for the actual numbers rather than "normal" or "abnormal"
- Tell your doctor if you take biotin, and ask whether to stop it before testing
- Retest after an acute illness rather than acting on a result taken during it
- Ask whether antibodies were tested if the picture is borderline
Do not
- Reading TSH as if it moved in the same direction as thyroid hormone
- Acting on a single borderline result
- Buying direct-to-consumer thyroid panels and self-treating
The figures behind the list
Each item above follows from these, published in the guidance named at the foot of the page.
| Measure | Figure |
|---|---|
| TSH | rises when the thyroid is underactive, falls when overactive |
| Subclinical hypothyroidism | high TSH with normal T4 |
| Acute illness | can distort results; retest once recovered |
| Biotin supplements | can interfere with some lab tests, including thyroid tests |
| Antibody testing | helps identify autoimmune thyroid disease |
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- Having a Blood Test: Sorting the Evidence From the Noise (Using Health Services)
Where to go next
- Thyroid Function Tests: Separating Myth From Guidance
- Starting Out With Thyroid Function Tests
- Thyroid Function Tests — the reference entry
- Thyroid and Hormones: The Complete Guide
- Thyroid Lumps: What Published Guidance Supports
- The Evidence on Polycystic Ovary Syndrome, Without the Hype
When to get help
See your doctor promptly if you are pregnant or planning pregnancy and have any thyroid abnormality, as targets differ and treatment often needs adjusting quickly. Call 911 for extreme drowsiness and confusion, or for fever with a very rapid heart rate and agitation.
Where this comes from
- American Thyroid Association — Thyroid Function Tests
- FDA — The FDA Warns that Biotin May Interfere with Lab Tests
How this page was put together
Every figure, recommendation and warning above is taken from the guidance named in Where this comes from. Nothing on this page is inferred, summarized or generalized beyond what those bodies publish: where they give a number, it is their number, and where they are silent, so are we. Pages are rebuilt whenever the underlying record changes. Sign-off by a named clinician, where it has happened, is shown at the top of the page along with the date.
Medical disclaimer
This article is general information, not medical advice. It cannot account for your own history, medication or circumstances. Always speak to your doctor, pharmacist or another qualified health professional before making changes that affect your treatment, and never delay seeking medical advice because of something you have read here. In an emergency, call 911.