Hashimoto Thyroiditis

When it comes to Hashimoto's disease, there are blood tests used to screen, diagnose, and monitor. In this guide, we cover Hashimoto's thyroiditis tests.

Are you looking to learn more about the key lab tests needed to diagnose Hashimoto's Disease? Here are the 18 key lab tests that are needed for Diagnosing Hashimoto's Disease 

SEE BELOW THE LIST OF TESTS FOR MORE INFORMATION ABOUT  The 18 Key Lab Tests for Diagnosing Hashimoto's Disease ???????

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A Complete Blood Count (CBC) Panel is used as a screening test for various disease states including anemia, leukemia and inflammatory processes.

A CBC blood test includes the following biomarkers: WBC, RBC, Hemoglobin, Hematocrit, MCV, MCH, MCHC, RDW, Platelet count, Neutrophils, Lymphs, Monocytes, Eos, Basos, Neutrophils (Absolute), Lymphs (Absolute), Monocytes(Absolute), Eos (Absolute), Basos (Absolute), Immature Granulocytes, Immature Grans (Abs)

NOTE: Only measurable biomarkers will be reported.

See individual tests

Hashimoto’s is an autoimmune disease and a thyroid disorder, therefor one must evaluate many things not just the thyroid. This panel contains tests for Hashimoto’s.

Thyroid tests

  • T3 Reverse (RT3), LC/MS/MS
  • T3, Free
  • T4, Free
  • TSH

Blood Sugar and Cholesterol Analysis

  • Hemoglobin A1c (HgbA1C)
  • Lipid Panel with Ratios


  • Iron and Total Iron Binding Capacity (TIBC)

Vitamin D2, D3

  • Vitamin D-  25-Hydroxyvitamin D (D2, D3), LC/MS/MS

Vitamin B12 and B6

  • Vitamin B12 (Cobalamin)
  • Vitamin B6 (Pyridoxal Phosphate)

Red and White Blood Cell Count

  • CBC (includes Differential and Platelets)

Adrenal Gland Health and Electrolytes

  • Comprehensive Metabolic Panel (CMP)


  • Thyroid Peroxidase and Thyroglobulin Antibodies


A Hemoglobin (Hb) A1c Blood Test evaluates the average amount of glucose in the blood. The A1c test will help determine whether you are at a higher risk of developing diabetes; to help diagnose diabetes and prediabetes; to monitor diabetes and to aid in treatment decisions.

To assist with control of blood glucose levels, the American Diabetes Association (ADA) has recommended glycated hemoglobin testing (HbA1c) twice a year for patients with stable glycemia, and quarterly for patients with poor glucose control. Interpretative ranges are based on ADA guidelines.

Serum iron quantification is useful in confirming the diagnosis of iron-deficiency anemia or hemochromatosis. The measurement of total iron binding in the same specimen may facilitate the clinician''s ability to distinguish between low serum iron levels caused by iron deficiency from those related to inflammatory neoplastic disorders. The assay for iron measures the amount of iron which is bound to transferrin. The total iron binding capacity (TIBC) measures the amount of iron that would appear in blood if all the transferrin were saturated with iron. It is an indirect measurement of transferri

A lipid panel includes:Total cholesterol —this test measures all of the cholesterol in all the lipoprotein particles.High-density lipoprotein cholesterol (HDL-C) — measures the cholesterol in HDL particles; often called "good cholesterol" because it removes excess cholesterol and carries it to the liver for removal.Low-density lipoprotein cholesterol (LDL-C) — calculates the cholesterol in LDL particles; often called "bad cholesterol" because it deposits excess cholesterol in walls of blood vessels, which can contribute to atherosclerosis. Usually, the amount of LDL cholesterol (LDL-C) is calculated using the results of total cholesterol, HDL-C, and triglycerides.Triglycerides — measures all the triglycerides in all the lipoprotein particles; most is in the very low-density lipoproteins (VLDL).Very low-density lipoprotein cholesterol (VLDL-C) — calculated from triglycerides/5; this formula is based on the typical composition of VLDL particles.Non-HDL-C — calculated from total cholesterol minus HDL-C.Cholesterol/HDL ratio — calculated ratio of total cholesterol to HDL-C.

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The assay may be useful in the diagnosis of nonthyroidal illness (NTI). Patients with NTI have low T3 concentrations and increased concentrations of rT3. RT3 may be useful in neonates to distinguish euthyroid sick syndrome from central hypothyroidism.

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Total T3 measurements are used to diagnose and monitor treatment of hyperthyroidism and are essential for recognizing T3 toxicosis

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This test is used to diagnose hyperthyroidism and to clarify thyroid status in the presence of a possible protein binding abnormality.

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For diagnosis of hypothyroidism and hyperthyroidism.

Note: Free T4 Index (T7) will only be calculated and reported if test code code 861 (T3 Uptake) is ordered as well.

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The free T4 are tests thelps evaluate thyroid function. The free T4 test is used to help diagnose hyperthyroidism and hypothyroidism. Free T4 is the active form of thyroxine and is usually ordered along with or following a TSH test. This helps the doctor to determine whether the thyroid hormone feedback system is functioning as it should, and the results of the tests help to distinguish between different causes of hyperthyroidism and hypothyroidism.

Thyroid Peroxidase Antibodies (TPO) and Thyroglobulin Antibodies

Measurement of thyroglobulin antibodies and thyroid peroxidase antibodies (TPO) is useful in the diagnosis and management of a variety of thyroid disorders including autoimmune thyroiditis, Hashimoto's Disease, Graves Disease and certain types of goiter.

 "IMPORTANT - Please note that Quest returns values up to 900 for the Thyroid Peroxidase Antibodies test.  If tracking requires values above 900 for the Thyroid Peroxidase Antibodies, then order test TPO Antibody Endpoint (Test Code # 15116).

TRAb (TSH Receptor Binding Antibody) 

TBII (Thyrotropin Binding Inhibit Immunoglobulin)

Clinical Significance

Measurement of TBII is used to diagnose and manage Graves' Disease, Neonatal Hypothyroidism, and Postpartum Thyroid Dysfunction.

Alternative Name(s) 

Thyroid Stimulating Hormone (TSH) Receptor Antibody,Thyrotropin Receptor Antibody,TSH Receptor Blocking Antibody,Thyrotropin-Binding Inhibitory Immunoglobulin



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The Thyroid-stimulating Hormone (TSH) Blood Test is for differential diagnosis of primary, secondary, and tertiary hypothyroidism. The TSH test is also useful in screening for hyperthyroidism. This assay allows adjustment of exogenous thyroxine dosage in hypothyroid patients and in patients on suppressive thyroxine therapy for thyroid neoplasia.

TSI stands for thyroid stimulating immunoglobulin. TSI tells the thyroid gland to swell and release excess amounts of thyroid hormone into the blood.

Vitamin B12 is decreased in pernicious anemia, total or partial gastrectomy, malabsorption and certain congenital and biochemical disorders

Vitamin B6 is a cofactor in many metabolic pathways including heme synthesis. Vitamin B6 deficiency may be observed in patients with metabolic disorders, secondary to therapeutic drug use, or alcoholism. Deficiency affects the function of the immune system.

Measurement of serum 25-OH vitamin D concentrations provide a good index of circulating vitamin D activity in patients not suffering from renal disease. Lower than normal 25-OH vitamin D levels can result from a dietary deficiency, poor absorption of the vitamin or impaired metabolism of the sterol in the liver. A 25-OH vitamin D deficiency can lead to bone diseases such as rickets and osteomalacia. Above normal levels can lead hypercalcemia. This assay employs liquid chromatography tandem mass spectrometry to independently measure and report the two common forms of 25-hydroxy vitamin D: 25OH D3 - the endogenous form of the vitamin and 25OH D2 - the analog form used to treat 25OH Vitamin D3 deficiency.

Hashimoto's Disease is a condition of the thyroid, where your immune system attacks your thyroid. Your thyroid is a gland that's located at the base of your neck, right below your Adam's apple. A functioning part of the endocrine system, the thyroid is responsible for producing hormones that interact and control several vital functions in your body.

This disease is the most common cause of hypothyroidism, primarily affecting middle-aged women. However, this condition affects men and women, and people of all ages. In order to be diagnosed with Hashimoto's, your doctor will conduct a physical examination of your thyroid and order blood tests to take a look at your thyroid function.

If you're looking to take back control of your health by ordering your own Hashimoto's Disease blood tests or you're looking to understand better the tests your doctor has ordered for you, we've created a guide to help guide you through each blood test that's used for a diagnosis. Keep reading to learn more!

Signs and Symptoms of Hypothyroidism 

Some of the most commonly reported symptoms of hypothyroidism include: 

  • Fatigue
  • Sluggishness
  • Feeling tired for no reason
  • Constipation
  • Dry, pale skin
  • Hair loss
  • Brittle nails
  • Puffy face
  • Increased sensitivity to the cold
  • Depression
  • Muscle weakness
  • Unexplained weight gain
  • Muscle aches, stiffness, and tenderness
  • Joint stiffness and pain
  • Prolonged or excessive menstrual bleeding
  • Lapses in memory 

Risk Factors for Hashimoto's Disease

The following factors may contribute to the risk of developing Hashimoto's Disease: 

  • Gender- Women are at an increased risk of developing Hashimoto's disease.
  • Heredity- If someone in your family has a thyroid disease or another type of autoimmune, you're at increased risk of developing Hashimoto's. 
  • Age- While you can develop Hashimoto's Disease at any age, it's most commonly diagnosed during middle age.
  • Radiation exposure- If you've been exposed to an excessive level of environmental radiation, you're an increased risk of developing Hashimoto's Disease.
  • Other types of autoimmune diseases- Having other types of autoimmune diseases such as type 1 diabetes, lupus, or rheumatoid arthritis can increase your risk for developing Hashimoto's Disease.  

18 Key Lab Tests for Diagnosing Hashimoto's Disease 

Are you looking to learn more about the key lab tests that are needed to diagnose Hashimoto's Disease? Here are the key lab tests that are needed: 

1. TSH

An abbreviation for thyroid stimulating hormone, a TSH test that measures the level of TSH in your body. This hormone regulates your body weight, body temperature, your mood, and even the strength of your muscles. When the TSH levels in your body are too low, it's an indication that your thyroid isn't functioning properly and a possible determining factor in diagnosing Hashimoto's Disease. 

2. T3 Reverse, LC/MS/MS

The T3 reverse LC/MS/MS blood test measures the inactive hormone, Triiodothyronine (T3). This hormone is one of the two vital hormones that your thyroid produces (the other hormone is thyroxine (T4). 

When your thyroid is functioning normally, your body converts the T4 hormone to T3 and RT3. In specific situations, such as when your body is under stress, sick, or you've been injured, the levels of RT3 rise in your blood. Since stress levels influence the level of RT3 found in blood, the level of RT3 found isn't indicative of a problem with your thyroid.

However, by assessing the Reverse T3 test combined with the Free T3 test will allow a medical professional to access the ratio between Free T3 and RT3, which can help you get one step closer to being diagnosed.

3. T3 Total

T3 total provides an evaluation of the functioning of the thyroid. This blood test measures the level of triiodothyronine in your blood, which is partially produced by your thyroid. However, the majority of the T3 found in your blood is chemically converted from T4.

T3 is responsible for controlling your heart rate, growth, and body temperature. There are two forms of T3 found in your blood, which are Bound T3 and Free T3. Bound T3 is the most commonly found form in your blood, as it attaches to the protein that helps to transport Free T3 throughout your body. 

The T3 total test measures both the Free T3 and the Bound T3 levels in your blood. 

4. T3, Free

Free T3 blood tests measure the amount of free T3 that's found in the blood. Unlike Bound T3 that attaches to proteins, Free T3 doesn't attach to anything in the body. 

5. T4 (Thyroxine), Total

Thyroxine, which is also often referred to as T4, is another type of hormone that your thyroid produces. There are two different forms that the T4 hormone comes in; Free T4 and Bound T4.

Bound T4 attaches to proteins found in the blood, which prevents the hormone from penetrating the tissues in your body. Free T4 enters into the tissues of your body whenever the tissues need it. The Total T4 test measures both the bound and free T4 levels in your body. 

6. T4 Free (FT4)

Free T4 enters into various tissues to provide your body with a variety of effects. While this blood test plays a roll in figuring out how the thyroid is functioning and provides a measurement of how much of the hormone is found in your blood. Low levels of FT4 found in your tests is an indicating sign of hypothyroidism. 

7. Thyroglobulin Antibodies

Also referred to as TgAb, a thyroglobulin antibodies blood test measures the level of antibodies that your body is making against the compound thyroglobulin. 

Thyroglobulin is a protein that your thyroid produces to create T3 and T4, which both help to control the growth and your metabolism rate. Testing thyroglobulin antibodies in your blood can help to diagnose any autoimmune conditions that involve your thyroid. 

In a healthy body, antibodies in the immune system fight against toxins, viruses, and bacteria. In people with autoimmune diseases, there's a malfunction in the immune system that causes the body to attack healthy tissues and organs. For people with autoimmune conditions that involve their thyroglobulin antibodies found in the blood. 

A positive test of TgAb may result in a diagnosis for Hashimoto's. 

8. Thyroid Peroxidase Antibodies (TPO)

Thyroid Peroxidase is an enzyme that can typically be found in the thyroid. This enzyme plays an important role in the production of thyroid hormones. Testing the TPO levels identifies antibodies against TPO that are in the blood. 

Finding TPO antibodies in your blood can help your doctor to discover if the cause of your thyroid disease is because of an autoimmune disorder, such as Grave's disease or Hashimoto's. When you have an autoimmune disorder, your immune system creates antibodies that attack the healthy tissue in your body, which can cause inflammation and affect the functioning of your thyroid. 

9. TRAb (TSH Receptor Binding Antibody)

Thyrotropin-receptor binding antibodies is a type of autoantibody to the cell receptor of the thyroid that's responsible for developing the thyroid-stimulating hormone. Thyroid autoantibodies develop when the immune system attacks parts of the thyroid proteins and the thyroid gland, which results in chronic inflammation in the thyroid. 

This inflammation in the thyroid can lead to a disruption of hormone production and tissue damage. By testing the level of TSH receptor binding antibodies in the blood, doctors can determine if the thyroid problems you're having are a result of an autoimmune disease. 

10. TSI (Thyroid Stimulating Immunoglobulin)

Thyroid-stimulating immunoglobin is a form of immunoglobin that has the ability to bind to TSH receptors in the thyroid gland. TSI has the ability to mimic TSH, which causes your thyroid to develop extra triiodothyronine and thyroxine. If there's an elevated level of TSI found in a person's blood, it's an indication that you have hyperthyroidism or Grave's Disease, which is another form of an autoimmune thyroid disorder.

11. CBC (includes Differential and Platelets)

complete blood count with platelets and differential is a routine part of blood work, as it measures the level of white blood cells, hemoglobin, hemoglobin, and red blood cells in the blood. 

When the thyroid is malfunctioning, there's an effect on blood cells, which can create other effects such as anemia. By evaluating the results from a CBC test, a medical professional can evaluate the effect that the thyroid malfunctioning is having on your blood cells. 

12. Comprehensive Metabolic Panel (CMP)

comprehensive metabolic panel will provide your doctor with more information on the status of the health of your liver, kidneys, metabolism, acid/base balance, electrolytes, blood proteins, and blood glucose. If your medical professional is suspecting that your thyroid is malfunctioning, a CMP can give them a better insight into how your body is functioning and a general idea of your overall health. 

13. Hemoglobin A1c (HgbA1C)

A body that has hypothyroidism can not only cause several clinical symptoms, but it can cause abnormalities in your metabolic state. In people with Hashimoto's, the blood sugar levels may be elevated in comparison to a healthy individual. Getting a look at the Hemoglobin A1C levels can help your doctor to get an idea if your blood sugar levels are in control and if you're considered to be pre-diabetic. 

14. Iron and Total Iron Binding Capacity (TIBC)

TIBC (total iron binding capacity) is a test the measures the level of iron in your blood. When iron moves in your blood, it attaches to a protein that's called Transferrin. Testing the TIBC, your doctor will get a better understanding of how much protein your blood has the ability to carry iron. 

When the irons of level are low, the TIBC test results are higher. If your levels aren't in a healthy range, it's a sign that your body is fighting against inflammation, which is commonly contributed as a sign of an autoimmune disease. 

15. Lipid Panel with Ratios

lipid panel with ratios tests the total cholesterol, triglycerides, HDL cholesterol, LDL-cholesterol, cholesterol/HDL ratio (calculated), LDL/HDL ratio (calculated), and the non-HDL cholesterol (calculated). 

A dysfunction in the thyroid has a large impact on your body's lipid profiles, which affects your cardiovascular health. In people with hypothyroidism, there's an unfavorable effect on their lipid profiles, which can increase the lipoprotein metabolism and increase your body's total cholesterol, increasing your chances of developing cardiovascular disease. 

16. Vitamin D 25-Hydroxyvitamin D (D2, D3)

A deficiency in this vitamin has been present in patients that have been diagnosed with Hashimoto's disease.  Playing a vital role in overall immune health, a vitamin D deficiency can act as an indicator in diagnosing an autoimmune disease. In people with hypothyroidism, studies have shown that there's an increased risk of vitamin D deficiency. 

17. Vitamin B12 (Cobalamin)

Some of the symptoms that are contributed to Hashimoto's include generalized weakness, depression, numbness, and impaired memory. These physical symptoms are both a sign of a Vitamin B12 deficiency and an impaired thyroid. Studies have shown that individuals who have hypothyroidism are at an increased risk of having a vitamin B12 deficiency. 

If your test results show that you have a B12 deficiency, it may play a key role in getting a diagnosis.  

18. Vitamin B6 (Pyridoxal Phosphate)

Without enough B6 in your body, your thyroid can't properly utilize the iodine that it needs to produce hormones. In people with Hashimoto's disease, the thyroid depends heavily on adequate levels of Vitamin B6 in order to regulate enough thyroid hormones. If there's too low of a level in the blood, people may experience muscle weakness that's commonly reported with Hashimoto's Disease. 

Taking Back Control of Your Health  

If you've struggled to get a diagnosis for Hashimoto's Disease and are looking to take matters into your own hands, ordering Hashimoto's Disease blood tests can help to speed up the process of your diagnosis.

Focusing on your health is important. That's why we've made it easy for you to order your own lab tests online. Click here to learn more about our available blood tests that'll help you to get one step closer to being diagnosed with Hashimoto's Disease.