Graves Disease

In this guide, we cover the blood tests for Graves disease diagnosis, screening, and monitoring. Plus, we describe in detail what each Graves disease test means for you.


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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)


See individual tests

Tests in the Guide to Graves Disease Diagnosis, Screening, and Monitoring

  • CBC (includes Differential and Platelets) [ 6399 ]
  • Comprehensive Metabolic Panel (CMP) [ 10231 ]
  • Hemoglobin A1c (HgbA1C) [ 496 ]
  • Iron and Total Iron Binding Capacity (TIBC) [ 7573 ]
  • Lipid Panel with Ratios [ 19543 ]
  • QuestAssureD™ 25-Hydroxyvitamin D (D2, D3), LC/MS/MS [ 92888 ]
  • T3 Reverse (RT3), LC/MS/MS [ 90963 ]
  • T3 Total [ 859 ]
  • T3, Free [ 34429 ]
  • T4 (Thyroxine), Total [ 867 ]
  • T4, Free [ 866 ]
  • Thyroid Peroxidase and Thyroglobulin Antibodies [ 7260 ]
  • TRAb (TSH Receptor Binding Antibody) [ 5738 ]
  • TSH [ 899 ]
  • TSI (Thyroid Stimulating Immunoglobulin) [ 30551 ]
  • Vitamin B12 (Cobalamin) [ 927 ]
  • Vitamin B6 (Pyridoxal Phosphate ) [ 926 ]
     

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.

  • T3, Free [ 34429 ]
  • T4, Free [ 866 ]
  • TSH [ 899 ]

  • T3, Free [ 34429 ]
  • T4, Free [ 866 ]
  • TSH [ 899 ]

  • CBC (includes Differential and Platelets) [ 6399 ]
  • Comprehensive Metabolic Panel (CMP) [ 10231 ]
  • Hemoglobin A1c (HgbA1C) [ 496 ]
  • Iron and Total Iron Binding Capacity (TIBC) [ 7573 ]
  • Lipid Panel with Ratios [ 19543 ]
  • QuestAssureD™ 25-Hydroxyvitamin D (D2, D3), LC/MS/MS [ 92888 ]
  • T3 Reverse (RT3), LC/MS/MS [ 90963 ]
  • T3 Total [ 859 ]
  • T3, Free [ 34429 ]
  • T4 (Thyroxine), Total [ 867 ]
  • T4, Free [ 866 ]
  • TSH [ 899 ]
  • Vitamin B12 (Cobalamin) [ 927 ]

  • CBC (includes Differential and Platelets) [ 6399 ]
  • Comprehensive Metabolic Panel (CMP) [ 10231 ]
  • Hemoglobin A1c (HgbA1C) [ 496 ]
  • Iron and Total Iron Binding Capacity (TIBC) [ 7573 ]
  • Lipid Panel with Ratios [ 19543 ]
  • QuestAssureD™ 25-Hydroxyvitamin D (D2, D3), LC/MS/MS [ 92888 ]
  • T3 Reverse (RT3), LC/MS/MS [ 90963 ]
  • T3 Total [ 859 ]
  • T3, Free [ 34429 ]
  • T4 (Thyroxine), Total [ 867 ]
  • T4, Free [ 866 ]
  • TSH [ 899 ]
  • Vitamin B12 (Cobalamin) [ 927 ]

  • CBC (includes Differential and Platelets) [ 6399 ]
  • Comprehensive Metabolic Panel (CMP) [ 10231 ]
  • Hemoglobin A1c (HgbA1C) [ 496 ]
  • Iron and Total Iron Binding Capacity (TIBC) [ 7573 ]
  • Lipid Panel with Ratios [ 19543 ]
  • QuestAssureD™ 25-Hydroxyvitamin D (D2, D3), LC/MS/MS [ 92888 ]
  • T3 Reverse (RT3), LC/MS/MS [ 90963 ]
  • T3 Total [ 859 ]
  • T3, Free [ 34429 ]
  • T4 (Thyroxine), Total [ 867 ]
  • T4, Free [ 866 ]
  • Thyroid Peroxidase and Thyroglobulin Antibodies [ 7260 ]
  • TSH [ 899 ]
  • Vitamin B12 (Cobalamin) [ 927 ]
  • Vitamin B6 (Pyridoxal Phosphate ) [ 926 ]
     

  • CBC (includes Differential and Platelets) [ 6399 ]
  • Comprehensive Metabolic Panel (CMP) [ 10231 ]
  • Hemoglobin A1c (HgbA1C) [ 496 ]
  • Iron and Total Iron Binding Capacity (TIBC) [ 7573 ]
  • Lipid Panel with Ratios [ 19543 ]
  • QuestAssureD™ 25-Hydroxyvitamin D (D2, D3), LC/MS/MS [ 92888 ]
  • T3 Reverse (RT3), LC/MS/MS [ 90963 ]
  • T3 Total [ 859 ]
  • T3, Free [ 34429 ]
  • T4 (Thyroxine), Total [ 867 ]
  • T4, Free [ 866 ]
  • Thyroid Peroxidase and Thyroglobulin Antibodies [ 7260 ]
  • TSH [ 899 ]
  • Vitamin B12 (Cobalamin) [ 927 ]
  • Vitamin B6 (Pyridoxal Phosphate ) [ 926 ]
     

  • CBC (includes Differential and Platelets) [ 6399 ]
  • Comprehensive Metabolic Panel (CMP) [ 10231 ]
  • Hemoglobin A1c (HgbA1C) [ 496 ]
  • Iron and Total Iron Binding Capacity (TIBC) [ 7573 ]
  • Lipid Panel with Ratios [ 19543 ]
  • QuestAssureD™ 25-Hydroxyvitamin D (D2, D3), LC/MS/MS [ 92888 ]
  • T3 Reverse (RT3), LC/MS/MS [ 90963 ]
  • T3 Total [ 859 ]
  • T3, Free [ 34429 ]
  • T4 (Thyroxine), Total [ 867 ]
  • T4, Free [ 866 ]
  • Thyroid Peroxidase and Thyroglobulin Antibodies [ 7260 ]
  • TRAb (TSH Receptor Binding Antibody) [ 38683 ]
  • TSH [ 899 ]
  • TSI (Thyroid Stimulating Immunoglobulin) [ 30551 ]
  • Vitamin B12 (Cobalamin) [ 927 ]
  • Vitamin B6 (Pyridoxal Phosphate ) [ 926 ]
     

  • CBC (includes Differential and Platelets) [ 6399 ]
  • Comprehensive Metabolic Panel (CMP) [ 10231 ]
  • Hemoglobin A1c (HgbA1C) [ 496 ]
  • Iron and Total Iron Binding Capacity (TIBC) [ 7573 ]
  • Lipid Panel with Ratios [ 19543 ]
  • QuestAssureD™ 25-Hydroxyvitamin D (D2, D3), LC/MS/MS [ 92888 ]
  • T3 Reverse (RT3), LC/MS/MS [ 90963 ]
  • T3 Total [ 859 ]
  • T3, Free [ 34429 ]
  • T4 (Thyroxine), Total [ 867 ]
  • T4, Free [ 866 ]
  • Thyroid Peroxidase and Thyroglobulin Antibodies [ 7260 ]
  • TRAb (TSH Receptor Binding Antibody) [ 38683 ]
  • TSH [ 899 ]
  • TSI (Thyroid Stimulating Immunoglobulin) [ 30551 ]
  • Vitamin B12 (Cobalamin) [ 927 ]
  • Vitamin B6 (Pyridoxal Phosphate ) [ 926 ]
     

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.


In an individual that has Grave's disease, the immune system develops antibodies that cause the thyroid to produce more hormones than their body actually needs. To be diagnosed with Grave's disease, after your doctor completes a physical examination of your body, they'll order blood tests to see if you have Grave's disease.

Whether you're looking to better understand what blood tests are being ordered to diagnose your Grave's disease or you're interested in learning what tests you should order for yourself to potentially receive a diagnosis, we've come up with a complete guide to understand the key blood tests for diagnosing Grave's disease. Keep reading to learn more! 

Symptoms of Grave's Disease

There's a large variety of symptoms that have been reported in individuals with Grave's disease. Some of these symptoms include:

  • Irritability
  • Anxiety
  • Tremors in your fingers or hands
  • Weight loss, even if you're eating normally
  • Changes in your menstrual cycle
  • Bulging eyes
  • Enlargement of your thyroid
  • Increased perspiration
  • Heat sensitivity
  • Frequent bowel movements
  • Irregular or rapid heartbeat
  • Red, thick shin on the tops of feet or shins
  • Reduced libido
  • Erectile dysfunction
  • Fatigue 

Risk Factors

While anyone can develop Grave's disease, there are a number of factors that can increase your risk of developing the disease. Some of the risk factors include: 

  • Gender - Women are at a higher risk of developing Grave's Disease than men are. 
  • Family history - If you have a family history of Grave's Disease, there's a known risk factor. That means there's like a gene or several genes that can make you more susceptible to developing the disease.
  • Age - Most people are under the age of 40 when they're diagnosed. 
  • Physical or emotional stress - An illness or stressful life events can trigger Grave's disease in individuals that are susceptible to developing the disease. 
  • Smoking -  Smoking cigarettes affects the health of the immune system, which also increases the risk of an individual developing Grave's disease. 
  • Pregnancy - Recent childbirth or pregnancy can increase the risk of women developing the disorder, especially if they're genetically susceptible. 
  • Other autoimmune disorders - People with other disorders of their immune systems, such as type 1 diabetes or rheumatoid arthritis, are at an increased risk of developing the disease.

Key Grave's Disease Blood Tests

Are you interested in learning more about the key blood tests that are needed to diagnosis Grave's disease? Here are key lab tests that are needed: 

1. TSH

TSH, an abbreviation for thyroid stimulating hormone, is a blood test that measures the level of TSH that you have in your body. The TSH hormone is responsible for regulating your body temperature, body weight, the strength of your muscles, and your mood. 

If you have Grave's Disease, the levels of TSH in your blood will be very low. The cause of the low levels of TSH are because of the pituitary gland compensates for excess T3 and T4 hormones. As an end result, this means that your thyroid will stop producing TSH in an attempt to reduce the production of the thyroid hormones. 


2. T3 Reverse, LC/MS/MS

The T3 Reverse LC/MS/MS blood test takes a measurement of the Triiodothyronine (T3), which is an inactive hormone. T3 is one of the two critical hormones that your thyroid creates, while the other hormone is T4 (thyroxine). 

In a body with a healthy thyroid, your thyroid converts the hormone T4 to T3 and RT3. When your body is under stress or you've been injured, the levels of RT3 in your blood rise. Your stress levels influence the amount of RT3 found in your blood, but the level of RT3 isn't necessarily of sign that your thyroid isn't functioning properly. 

By observing your Reverse T3 test along with the Free T3 test results, your medical professional will be able to take a look at the ratio between RT3 and your Free T3 levels, which can help you one step closer to receiving a Grave's Disease diagnosis. 


3. T3 Total

T3 test gives a medical professional an evaluation of the amount of Triiodothyronine in your blood. This hormone is partially produced by your thyroid, while the majority of the T3 that's located in your blood goes through a process to be chemically converted from T4.

The T3 hormone is responsible for body temperature, growth, and heart rate. There are two forms of T3 that are found in your body; Free T3 and Bound T3. The most commonly found type in T3 found in your blood is bound T3, as it's responsible for attaching to the protein that helps to move Free T3 around your body.

The level of T3 total found in your blood takes a measurement of both the Bound T3 and the Free T3 levels in your body. 


4. T3, Free

The Free T3 blood test measures the level of Free T3 that's located in your blood. Different than Bound T3 that attaches itself to proteins, T3 doesn't attach to anything in your body or bloodstream. 


5. T4 (Thyroxine), Total

Thyroxine, also called T4, is the other type of hormone that your thyroid is responsible for producing. T4 is available in two different forms; Bound T4 and Free T4.

Bound T4 attaches to proteins that are located in the bloodstream, which stops the Bound T4 hormone from entering into any tissues in your body. Free T4 enters into the tissues in your body that need the hormone. The Total T4 test takes a measurement of the levels of Bound T4 and the Free T4 in your body. 


6. T4 Free (FT4)

Free T4 enters into tissues throughout your body and creates a variety of effects. If your Free T4 levels aren't normal, it's a sign that there's a disfunction with your thyroid. If your doctor suspects that you have Grave's Disease or they've found that you have a goiter on your thyroid, they'll take a look at your Free T4 levels. 


7. Thyroglobulin Antibodies

Often referred to as TgAb, a blood test of thyroglobulin antibodies takes a measurement of the number of antibodies that your body is making against the thyroglobulin compound. Thyroglucin is the protein that your thyroid produces to create both the T3 and the T4 hormone, which are responsible for controlling your metabolic rate and your growth. 

By testing the level of thyroglobulin antibodies in your bloodstream, doctors will be able to see if there are signs of an autoimmune disorder that involves your thyroid. In a body with a healthy thyroid, the antibodies in the immune system are responsible for protecting the body against bacteria, toxins, and viruses. In individuals with an autoimmune condition, the immune system malfunctions and causes the body to attack healthy organs and tissues. 

If you have an autoimmune condition, such as Grave's Disease, your blood test results will find that you have thyroglobulin antibodies found in your bloodstream. Positive thyroglobulin test results are an indicator that you have Grave's Disease. 


8. Thyroid Peroxidase Antibodies (TPO)

Thyroid Peroxidase Antibodies are a type of enzyme that can be located in the thyroid. The TPO enzyme is responsible for the production of thyroid hormones. By testing the level of thyroid peroxidase in the bloodstream, doctors will be able to identify the number of antibodies that are fighting against TPO.

By identifying TPO antibodies in your bloodstream, your doctor can narrow down the cause of your thyroid condition as a result of an autoimmune disorder, such as Grave's Disease. In individuals with an autoimmune disorder, their immune system develops antibodies that attack healthy tissues, which causes inflammation in the body, resulting in impaired functioning of the thyroid. 


9. TRAb (TSH Receptor Binding Antibody)

A type of antibody that's the cell receptor of the thyroid which, is responsible for the production of thyroid-stimulating hormone (TSH), TSH Receptor Binding Antibody develops when the immune system attacks the thyroid gland and the thyroid proteins. 

As an end result, this causes chronic inflammation in the thyroid, which leads to tissue damage and disruption of hormone production in the thyroid. By testing the levels of TRAb found in your blood, a medical professional can determine the symptoms you're experiencing are a result of an underlying autoimmune disorder. 


10. TSI (Thyroid Stimulating Immunoglobulin)

TSI, known as thyroid-stimulating immunoglobin, binds TSH receptors in the thyroid glands. TSI has the ability to emulate TSH, which forces your thyroid to create extra thyroxine and triiodothyronine. If your blood test results show that you have an elevated level of TSI located in your blood, it's an indication that you have Grave's Disease or hyperthyroidism.  


11. CBC (includes Differential and Platelets)

Complete Blood Count (CBC) with platelets and differential is a routine blood test that takes a measurement of the red blood cells, the white blood cells, and the hemoglobin in your blood. If your thyroid is overactive or if you have Grave's Disease, a CBC can give medical professionals a better understanding of how your autoimmune disorder is affecting other areas of your health. In addition, a CBC also provides better insight into your overall health.


12. Comprehensive Metabolic Panel (CMP)

A CMP is another test that doctors order to get a better understanding of the overall health of your blood proteins, kidneys, liver, metabolism, blood glucose, electrolytes, and acid/base balance. Comprehensive Metabolic Panel blood tests provide medical professionals an idea of how your well your body is functioning in general, as well as insight into your overall health. 


13. Hemoglobin A1c (HgbA1C)

A body with a malfunctioning thyroid can only cause several unique clinical symptoms, but can also affect your metabolic state. In people with an autoimmune disease that effect their thyroid, there's an abnormal glucose metabolism in comparison to individuals with a healthy thyroid. If your Hemoglobin A1c levels are lowered, it's a possible indicator that you have Grave's Disease.

However, if your Hemoglobin A1c levels come back elevated, it could be an indicator that you have another form of an autoimmune disease that affects your thyroid, which is Hashimoto's Disease. 


14. Iron and Total Iron Binding Capacity (TIBC)

TIBC, which is an abbreviation for total iron-binding capacity, is a blood test the measures the level of iron in your blood. As iron moves through the blood, is attached Transferrin, which a type of protein. When your doctor tests for TIHC, they'll get an insight into how much protein in your body is able to carry iron. 

If your TIBC test results are higher, it's a sign that the iron levels in your blood are low. High test results that aren't in a range that are healthy for your body is a sign that your body is fighting against inflammation, which can help contribute to a diagnosis for an autoimmune disorder, such as Grave's Disease. 


15. Lipid Panel with Ratios

This blood test measures the triglycerides, LDL-cholesterol, HDL cholesterol, LDL/HDL cholesterol ratio (calculated), total cholesterol, non-HDL cholesterol (calculated), and cholesterol/HDL ratio (calculated).  

If your thyroid isn't functioning properly, it has a large impact on your lipid profiles, which has an effect on your cardiovascular health. In individuals with hyperthyroidism or Grave's Disease, their LDL-cholesterol values, as well as the cholesterol levels, were reduced in comparison to individuals with a healthy thyroid. Taking a look at your lipid panel with ratios can provide a doctor with better insight into how your autoimmune disorder is affecting your body. 


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

Recent studies have shown that low Vitamin D levels are present in people who have thyroid autoimmune disorders, such as Grave's Disease. Vitamin D is responsible for controlling your bone metabolism and the health of your immune system. A vitamin D deficiency test result can act as an indicator in diagnosing an autoimmune disorder. 


17. Vitamin B12 (Cobalamin)

Checking your body's Vitamin B12 levels can also act as an indicator of an autoimmune disease. Some of the physical symptoms that people experience that are contributed to Grave's Disease, such as anxiety and tremors, are also a sign of a Vitamin B12 deficiency.

If your blood test results that you have a deficiency in Vitamin B12, it can be another indicator that you have an autoimmune disorder that's affecting your thyroid. 


18. Vitamin B6 (Pyridoxal Phosphate) 

If your body doesn't have enough Vitamin B6, it isn't able to use iodine efficiently to control its hormone production. In individuals with Grave's Disease, the thyroid is overactive, which causes the body to produce too much for the thyroid hormone. Discovering if your body has too little Vitamin B6 help can your medical professional determine if you have Grave's Disease. 

Getting a Grave's Disease Diagnosis 

Receiving a Grave's disease diagnosis can be difficult, especially if you aren't presenting all of the symptoms that are needed for a physician to diagnosis you. If you're looking to take your health into your own hands, ordering Grave's Disease blood tests can help to speed up the process of your diagnosis.

Making your health a priority is essential. 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 receiving a Grave's Disease diagnosis.