Thyroid hormone tests are blood tests that check how well the thyroid gland is working. The thyroid gland makes hormones that regulate the way the body uses energy.

The thyroid gland is a butterfly-shaped gland that lies in front of your windpipe (trachea), just below your voice box (larynx). The thyroid gland uses iodine from food to make two thyroid hormones: thyroxine (T4) and triiodothyronine (T3). The thyroid gland stores these thyroid hormones and releases them as they are needed.

Thyroid hormones are needed for normal development of the brain, especially during the first 3 years of life. Intellectual disability may occur if a baby's thyroid gland does not produce enough thyroid hormone (congenital hypothyroidism). Older children also need thyroid hormones to grow and develop normally, and adults need the hormones to regulate the way the body uses energy (metabolism). The United States Preventive Services Task Force recommends that all newborns be tested for congenital hypothyroidism.¹

Thyroid hormone blood tests include:

• Total thyroxine (T4). Most of the thyroxine (T4) in the blood is attached to a protein called thyroxine-binding globulin. Less than 1% of the T4 is unattached. A total T4 blood test measures both bound and free thyroxine. Free thyroxine affects tissue function in the body, but bound thyroxine does not.
• Free thyroxine (FTI or FT4). Free thyroxine (T4) can be measured directly (FT4) or calculated as the free thyroxine index (FTI). The FTI tells how much free T4 is present compared to bound T4. The FTI can help tell if abnormal amounts of T4 are present because of abnormal amounts of thyroxine-binding globulin.
• Triiodothyronine (T3). Most of the T3 in the blood is attached to thyroxine-binding globulin. Less than 1% of the T3 is unattached. A T3 blood test measures both bound and free triiodothyronine. T3 has a greater effect on the way the body uses energy than T4, even though T3 is normally present in smaller amounts than T4.

Why It Is Done

Thyroid hormone tests are done to:

• Find out what is causing an abnormal thyroid-stimulating hormone (TSH) test. For more information, see the topic Thyroid-Stimulating Hormone (TSH). This is the most common reason for thyroid hormone tests.
• Check how well treatment of thyroid disease is working. The total thyroxine (T4), free thyroxine (FT4), and free thyroxine index (FTI) values are often used to keep track of treatment for hyperthyroidism.
• Screen newborns to find out if the thyroid gland function is normal. A condition called congenital hypothyroidism can prevent normal growth and development and cause other severe problems, such as intellectual disability, if it is not treated soon after birth.

How To Prepare

Many medicines may change the results of this test. Be sure to tell your doctor about all the nonprescription and prescription medicines you take. If you are taking thyroid medicines, tell your doctor when you took your last dose. Your doctor may instruct you to stop taking thyroid medicines temporarily before having this test.

Talk to your doctor about any concerns you have regarding the need for the test, its risks, how it will be done, or what the results will mean. To help you understand the importance of this test, fill out the medical test information form(What is a PDF document?).