Thyroid Tests

Health care professionals use thyroid tests to check how well your thyroid is working and to find the cause of problems such as hyperthyroidism or hypothyroidism. The thyroid is a small, butterfly-shaped gland in the front of your neck that makes two thyroid hormones: thyroxine (T₄) and triiodothyronine (T₃). Thyroid hormones control how the body uses energy, so they affect nearly every organ in your body, even your heart.

Thyroid tests help health care professionals diagnose thyroid diseases such as

• hyperthyroidism—when thyroid hormone levels are too high
• Graves’ disease, the most common cause of hyperthyroidism
• hypothyroidism—when thyroid hormones levels are too low
• Hashimoto’s disease, of the most common cause of hypothyroidism
• thyroid nodules and thyroid cancer

Your doctor will start with blood tests and may also order imaging tests.

What blood tests do doctors use to check thyroid function?

Doctors may order one or more blood tests to check your thyroid function. Tests may include thyroid stimulating hormone (TSH), T₄, T₃, and thyroid antibody tests.

For these tests, a health care professional will draw blood from your arm and send it to a lab for testing. Your doctor will talk to you about your test results.

TSH test

Health care professionals usually check the amount of TSH in your blood first. TSH is a hormone made in the pituitary gland that tells the thyroid how much T₄ and T₃ to make.

A high TSH level most often means you have hypothyroidism, or an underactive thyroid. This means that your thyroid isn’t making enough hormone. As a result, the pituitary keeps making and releasing TSH into your blood.

A low TSH level usually means you have hyperthyroidism, or an overactive thyroid. This means that your thyroid is making too much hormone, so the pituitary stops making and releasing TSH into your blood.

If the TSH test results are not normal, you will need at least one other test to help find the cause of the problem.

T₄ tests

A high blood level of T₄ may mean you have hyperthyroidism. A low level of T₄ may mean you have hypothyroidism.

In some cases, high or low T₄ levels may not mean you have thyroid problems. If you are pregnant or are taking oral contraceptives, your thyroid hormone levels will be higher. Severe illness or using corticosteroids—medicines to treat asthma, arthritis, skin conditions, and other health problems—can lower T₄ levels. These conditions and medicines change the amount of proteins in your blood that “bind,” or attach, to T₄. Bound T₄ is kept in reserve in the blood until it’s needed. “Free” T₄ is not bound to these proteins and is available to enter body tissues. Because changes in binding protein levels don’t affect free T₄ levels, many healthcare professionals prefer to measure free T₄.

T₃ test

If your health care professional thinks you may have hyperthyroidism even though your T₄ level is normal, you may have a T₃ test to confirm the diagnosis. Sometimes T₄ is normal yet T₃ is high, so measuring both T₄ and T₃ levels can be useful in diagnosing hyperthyroidism.

Thyroid antibody tests

Measuring levels of thyroid antibodies may help diagnose an autoimmune thyroid disorder such as Graves’ disease—the most common cause of hyperthyroidism—and Hashimoto’s disease—the most common cause of hypothyroidism. Thyroid antibodies are made when your immune system attacks the thyroid gland by mistake. Your health care professional may order thyroid antibody tests if the results of other blood tests suggest thyroid disease.

What imaging tests do doctors use to diagnose and find the cause of thyroid disease?

Your health care professional may order one or more imaging tests to diagnose and find the cause of thyroid disease. A trained technician usually does these tests in your doctor’s office, outpatient center, or hospital. A radiologist, a doctor who specializes in medical imaging, reviews the images and sends a report for your health care professional to discuss with you.

Ultrasound

Ultrasound of the thyroid is most often used to look for, or more closely at, thyroid nodules. Thyroid nodules are lumps in your neck. Ultrasound can help your doctor tell if the nodules are more likely to be cancerous.

For an ultrasound, you will lie on an exam table and a technician will run a device called a transducer over your neck. The transducer bounces safe, painless sound waves off your neck to make pictures of your thyroid. The ultrasound usually takes around 30 minutes.

Thyroid scan

Health care professionals use a thyroid scan to look at the size, shape, and position of the thyroid gland. This test uses a small amount of radioactive iodine to help find the cause of hyperthyroidism and check for thyroid nodules. Your health care professional may ask you to avoid foods high in iodine, such as kelp, or medicines containing iodine for a week before the test.

For the scan, a technician injects a small amount of radioactive iodine or a similar substance into your vein. You also may swallow the substance in liquid or capsule form. The scan takes place 30 minutes after an injection, or up to 24 hours after you swallow the substance, so your thyroid has enough time to absorb it.

During the scan, you will lie on an exam table while a special camera takes pictures of your thyroid. The scan usually takes 30 minutes or less.

Thyroid nodules that make too much thyroid hormone show up clearly in the pictures. Radioactive iodine that shows up over the whole thyroid could mean you have Graves’ disease.

Even though only a small amount of radiation is needed for a thyroid scan and it is thought to be safe, you should not have this test if you are pregnant or breastfeeding.

Radioactive iodine uptake test

A radioactive iodine uptake test, also called a thyroid uptake test, can help check thyroid function and find the cause of hyperthyroidism. The thyroid “takes up” iodine from the blood to make thyroid hormones, which is why this is called an uptake test. Your health care professional may ask you to avoid foods high in iodine, such as kelp, or medicines containing iodine for a week before the test.

For this test, you will swallow a small amount of radioactive iodine in liquid or capsule form. During the test, you will sit in a chair while a technician places a device called a gamma probe in front of your neck, near your thyroid gland. The probe measures how much radioactive iodine your thyroid takes up from your blood. Measurements are often taken 4 to 6 hours after you swallow the radioactive iodine and again at 24 hours. The test takes only a few minutes.

If your thyroid collects a large amount of radioactive iodine, you may have Graves’ disease, or one or more nodules that make too much thyroid hormone. You may have this test at the same time as a thyroid scan.

Even though the test uses a small amount of radiation and is thought to be safe, you should not have this test if you are pregnant or breastfeeding.

What tests do doctors use if I have a thyroid nodule?

If your health care professional finds a nodule or lump in your neck during a physical exam or on thyroid imaging tests, you may have a fine needle aspiration biopsy to see if the lump is cancerous or noncancerous.

For this test, you will lie on an exam table and slightly bend your neck backward. A technician will clean your neck with an antiseptic and may use medicine to numb the area. An endocrinologist who treats people with endocrine gland problems like thyroid disease, or a specially trained radiologist, will place a needle through the skin and use ultrasound to guide the needle to the nodule. Small samples of tissue from the nodule will be sent to a lab for testing. This procedure usually takes less than 30 minutes. Your health care professional will talk with you about the test result when it is available.