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Thyroid Blood Tests: Free T4 & TSH Levels

Pedro Pinheiro, MD

Updated January 22, 2024

comment 2 Comments

Thyroid Blood Tests: Free T4 & TSH Levels

Summary of the Article : TL;DR

What is the thyroid? : A butterfly-shaped gland located in the neck, it produces thyroid hormones (T3 and T4).
What is hypothyroidism? : A condition in which there is insufficient production of thyroid hormones.
What is hyperthyroidism? : A condition in which there is an excess production of thyroid hormones.
Diagnosis : Made through the measurement of thyroid hormones in the blood, mainly TSH and free T4.
What are Free T4 and Free T3? : Active fractions of the T3 and T4 hormones, which effectively modulate metabolism.
What is TSH? : A pituitary hormone, it regulates the production of T3 and T4 by the thyroid.
Normal TSH values : 0.4 to 4.5 mU/L.
Normal Free T4 values : 0.7 to 1.8 ng/dl.
What elevated TSH indicates : Usually hypothyroidism, but can also be a pituitary issue.
What very low TSH indicates : Usually hyperthyroidism, but can also be a pituitary issue.

Hypothyroidism and Hyperthyroidism

Hypothyroidism is a condition caused by an underactive thyroid gland, resulting in insufficient production of thyroid hormones. Hyperthyroidism, on the other hand, is a condition caused by an overactive thyroid gland, resulting in an excess production of thyroid hormones.

Although hypothyroidism and hyperthyroidism are different diseases and have different symptoms, both are diagnosed by measuring thyroid hormone levels in the blood, specifically TSH and free T4.

In this article, we’ll explain the thyroid hormones and how to interpret their levels in blood tests.

How Does the Thyroid Gland Work?

The thyroid is a butterfly-shaped gland located at the base of the neck. It captures iodine consumed in food and combines it with an amino acid called tyrosine to synthesize two hormones known as triiodothyronine (T3) and thyroxine (T4).

The T3 and T4 synthesized by the thyroid are released into the bloodstream, where they act on all the cells of our body, regulating their metabolism, dictating how cells transform oxygen, glucose, and calories into energy.

When the thyroid produces too much T3 and T4, our metabolism speeds up.
When the thyroid produces too little T3 and T4, our metabolism slows down.

Generally, of the total hormones produced by the thyroid, 80% are T4 and 20% are T3. Although produced in smaller quantities, T3 is a much more potent hormone than T4, with its blood concentration directly dictating the body’s metabolic rate.

T4 is actually a prohormone, meaning it is a precursor to T3. 80% of the T4 released into the bloodstream, when reaching organs or tissues such as the liver, kidneys, spleen, muscles, or fat, is converted into T3 to be utilized by the cells.

Therefore, T3 is the thyroid hormone that effectively acts in our body, originating predominantly from circulating T4. Only a tiny portion of the active T3 is directly produced by the thyroid.

What is Free T4?

Over 99% of circulating T4 and T3 are bound to a protein called thyroxine-binding globulin (TBG).

These TBG-bound hormones are inert and cannot be used by organs and tissues. Therefore, only a tiny fraction, called free T4 and free T3, are chemically active and can modulate the body’s metabolism. Only free T4 can be transformed into T3 in organs and tissues.

In summary:

The T3 hormone is the one that effectively acts on body cells, modulating metabolism.
Most of the active T3 is derived from the conversion of T4 in peripheral tissues.
Since more than 99% of T4 is bound to TBG, only a tiny fraction of free T4, less than 1%, provides T3 for the body’s organs and tissues to use in their cells.

In conclusion, measuring free T4 in the blood is the test that really gives us an idea of how much potentially viable thyroid hormone is in the circulation. If there is too much circulating free T4, there will be too much T3 production in the organs, leading to hyperthyroidism. If there is too little circulating free T4, there will be a lack of T3 in the tissues, resulting in hypothyroidism.

In clinical practice, the measurement of free T4 is more valuable than the measurement of T3 or free T3 in most cases.

What is the Role of TSH?

The amount of T3 and T4 produced by the thyroid gland is carefully regulated by the central nervous system, specifically the pituitary gland, located at the base of the brain.

In people with a healthy thyroid gland, the amount of free thyroid hormone in the blood is kept at a level that is neither too high nor too low. When there is too much free T4 in the blood, the thyroid gland reduces its production of T3 and T4. On the other hand, if there are signs that free T4 levels are becoming insufficient, the thyroid gland quickly begins producing more T3 and T4 to keep the body’s metabolism from slowing down.

The signal for the thyroid to increase or decrease its production of T3 and T4 comes from the pituitary gland, via a hormone called thyroid stimulating hormone (TSH).

TSH and Free T4 production by the thyroid gland

See the figure above and follow the reasoning. When circulating levels of thyroid hormones (T3 and T4) are low, the pituitary gland detects this shortage and responds by increasing the secretion of Thyroid Stimulating Hormone (TSH). This elevation in TSH signals the thyroid gland to enhance the production of T3 and T4.

As the concentrations of T3 and T4 rise to optimal levels, the pituitary gland recognizes this equilibrium and correspondingly decreases TSH production. This reduction in TSH lessens the stimulation of the thyroid gland, thereby preventing the overproduction of thyroid hormones.

The interplay between TSH and free T4 levels is a finely tuned mechanism. The pituitary gland continually adjusts TSH concentrations to maintain a delicate balance. It ensures sufficient thyroid hormone production to meet the body’s needs while avoiding excessive stimulation of the thyroid gland.

What are the Normal Values of TSH and Free T4?

In most cases, the TSH and free T4 measurements are enough to assess the functioning of the thyroid.

Before we explain how to interpret the results of these two hormones, we need to know their reference values (these values can vary slightly from one laboratory to another).

Normal TSH values : 0.4 to 4.5 mU/L (some centers accept up to 5.0 mU/L as an upper value).
Normal free T4 values : 0.7 to 1.8 ng/dl.

Note : A study by the National Academy of Clinical Biochemistry suggested that the normal range for a healthy thyroid should be up to 2.5 mU/L. This is because they found that 95% of the healthy people they tested had thyroid levels (TSH levels) between 0.4 and 2.5 mU/L. However, another study from Germany, which also carefully selected participants, found the normal range to be slightly wider, from 0.3 to 3.63 mU/L. If we start using 2.5 mU/L as the upper normal limit for TSH, it means that many more people could be diagnosed with a mild form of low thyroid function, known as subclinical hypothyroidism. However, no clear evidence exists that TSH levels between 2.5 and 5.0 mU/L are harmful. So it’s debatable whether we should label people with these levels as having a thyroid problem.

The latest method for measuring TSH is known as the Third-generation TSH chemiluminometric assays. This advanced technique is more sensitive than earlier versions, allowing it to detect very low TSH levels, down to 0.01 mU/L. This improvement means it can identify even the smallest changes in TSH levels in the body.

What Does It Mean to Have an Elevated TSH Level?

TSH levels rise whenever the pituitary gland senses a drop in circulating thyroid hormone levels.

In patients with hypothyroidism, the pituitary needs to maintain higher than normal TSH levels (above 4.5 or 5 mU/L) to constantly stimulate the thyroid to increase its production of T3 and T4.

Different Scenarios of High TSH:

Subclinical Hypothyroidism

If the thyroid disease is still mild and the elevation of TSH can stimulate the production of thyroid hormones to keep them at adequate levels, the patient will not show any symptoms, as the symptoms of hypothyroidism only appear when free T4 levels are low. This is the case of subclinical hypothyroidism, which is an early form of hypothyroidism (suggested reading: Subclinical Hypothyroidism ).

Overt hypothyroidism

If the thyroid disease is severe, no matter how much the pituitary increases TSH production, the patient’s thyroid will be unable to respond by producing more thyroid hormones to normalize blood levels. In these cases, the patient has elevated TSH, generally above 10.0 mU/L, and low levels of free T4. As their free T4 is low, the patient usually has the typical symptoms of hypothyroidism.

Patients with untreated hypothyroidism can have very high levels of TSH, sometimes above 100.0 mU/L.

Central Hyperthyroidism

This condition occurs when TSH and free T4 levels are both elevated.

The issue in this scenario is with the pituitary, not the thyroid. The pituitary produces too much TSH despite already high levels of thyroid hormones in the blood, leading to symptoms of hyperthyroidism. This pituitary-driven hyperthyroidism is less common than thyroid-related hyperthyroidism.

In Summary, What Could a High TSH Level Indicate?

Subclinical Hypothyroidism : Mild thyroid disorder with slightly elevated TSH (5.0-10.0 mU/L) but normal thyroid hormones (T3 and T4), presenting no symptoms.
Clinical Hypothyroidism : Advanced thyroid disease with very high TSH (often above 10 mU/L) and low T4 levels, leading to typical hypothyroidism symptoms.
Central Hyperthyroidism : Uncommon condition where both TSH and T4 are high, caused by pituitary dysfunction, resulting in hyperthyroidism symptoms.

What Does It Mean to Have a Low TSH Level?

The logic applied to low TSH is the same as that for high TSH. If there is an abundance of thyroid hormone circulating in the blood, the pituitary gland responds by decreasing its release of TSH, thereby reducing the stimulation of the thyroid.

Similarly, there are three distinct situations that can occur when TSH levels are low:

Subclinical Hyperthyroidism

In cases where the thyroid is overactive, TSH levels plummet to halt further stimulation of the gland. In subclinical hyperthyroidism, TSH is typically below 0.4 mU/L, but free T4 levels remain normal. This occurs because the gland is highly responsive, and minimal amounts of TSH are enough for the thyroid to produce hormones. Therefore, patients usually do not show symptoms at this stage.

Overt Hyperthyroidism

Certain conditions can cause the thyroid to become excessively active and operate independently of the pituitary gland, producing hormones even without TSH stimulation.

When there’s a high level of free T4 in the bloodstream, the pituitary is essentially “inhibited”, producing almost no TSH, with blood levels below 0.1 mU/L. The patient therefore has very low levels of TSH, but high levels of free T4, resulting in overt hyperthyroidism.

Central Hypothyroidism

When both TSH and free T4 levels are low, it suggests a normally functioning thyroid that is adequately responding to reduced TSH levels.

The problem primarily resides in the pituitary gland. Despite low free T4 levels, the pituitary fails to sufficiently elevate TSH secretion to stimulate the thyroid into producing additional hormones, thus safeguarding the patient from developing hypothyroidism.

This type of hypothyroidism, stemming from the pituitary gland, is less common compared to hypothyroidism that originates directly from the thyroid.

In Summary, What Could a low TSH Level Indicate?

Subclinical Hyperthyroidism : overactive thyroid, leading to TSH levels falling below 0.4 mU/L to minimize gland stimulation, while free T4 levels remain normal. Patients usually don’t exhibit symptoms.
Overt Hyperthyroidism : the thyroid gland becomes excessively active and functions independently of the pituitary gland. This results in a high concentration of free T4 and extremely low TSH levels (below 0.1 mU/L), leading to obvious symptoms of hyperthyroidism due to the elevated free T4.
Central Hypothyroidism : both TSH and free T4 levels are low, indicating a normally functioning thyroid that’s responding appropriately to reduced TSH. The underlying issue is with the pituitary gland, which fails to increase TSH production in response to low T4.
Laboratory assessment of thyroid function – UpToDate.
Thyroid Function Tests – American Thyroid Association.
Assessment of Thyroid Function: Towards an Integrated Laboratory – Clinical Approach – The Clinical biochemist. Reviews.
American Thyroid Association guidelines for use of laboratory tests in thyroid disorders – JAMA.

Dr. Pedro Pinheiro

Pedro Pinheiro holds a medical degree from the Federal University of Rio de Janeiro (UFRJ) and is a specialist in Internal Medicine and Nephrology, certified by the State University of Rio de Janeiro (UERJ) and the Brazilian Society of Nephrology (SBN). He is currently based in Lisbon, Portugal, with his credentials recognized by the University of Porto and the Portuguese Nephrology Specialty College.

Doenças da tireoide , Endocrinology , Endocrinology

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Thyroid Function Tests

What is the thyroid gland.

The thyroid gland is a butterfly-shaped endocrine gland that is normally located in the lower front of the neck. The thyroid’s job is to make thyroid hormones, which are secreted into the blood and then carried to every tissue in the body. Thyroid hormones help the body use energy, stay warm and keep the brain, heart, muscles, and other organs working as they should.

HOW DOES THE THYROID GLAND FUNCTION?

The major thyroid hormone secreted by the thyroid gland is thyroxine, also called T4 because it contains four iodine atoms. To exert its effects, T4 is converted to triiodothyronine (T3) by the removal of an iodine atom. This occurs mainly in the liver and in certain tissues where T3 acts, such as in the brain. The amount of T4 produced by the thyroid gland is controlled by another hormone, which is made in the pituitary gland located at the base of the brain, called thyroid stimulating hormone (abbreviated TSH). The amount of TSH that the pituitary sends into the bloodstream depends on the amount of T4 that the pituitary sees. If the pituitary sees very little T4, then it produces more TSH to tell the thyroid gland to produce more T4. Once the T4 in the bloodstream goes above a certain level, the pituitary’s production of TSH is shut off. In fact, the thyroid and pituitary act in many ways like a heater and a thermostat. When the heater is off and it becomes cold, the thermostat reads the temperature and turns on the heater. When the heat rises to an appropriate level, the thermostat senses this and turns off the heater. Thus, the thyroid and the pituitary, like a heater and thermostat, turn on and off. This is illustrated in the figure below.

T4 and T3 circulate almost entirely bound to specific transport proteins. If the levels of these transport proteins changes, there can be changes in how much bound T4 and T3 is measured. This frequently happens during pregnancy and with the use of birth control pills. The “free” T4 or T3 is the hormone that is unbound and able to enter and affect the body tissues.

Blood tests to measure these hormones are readily available and widely used, but not all are useful in all situations. Tests to evaluate thyroid function include the following:

TSH TESTS The best way to initially test thyroid function is to measure the TSH level in a blood sample. Changes in TSH can serve as an “early warning system” – often occurring before the actual level of thyroid hormones in the body becomes too high or too low. A high TSH level indicates that the thyroid gland is not making enough thyroid hormone (primary hypothyroidism). The opposite situation, in which the TSH level is low, usually indicates that the thyroid is producing too much thyroid hormone (hyperthyroidism). Occasionally, a low TSH may result from an abnormality in the pituitary gland, which prevents it from making enough TSH to stimulate the thyroid (secondary hypothyroidism). In most healthy individuals, a normal TSH value means that the thyroid is functioning properly.

T4 TESTS T4 is the main form of thyroid hormone circulating in the blood. A Total T4 measures the bound and free hormone and can change when binding proteins differ (see above). A Free T4 measures what is not bound and able to enter and affect the body tissues. Tests measuring free T4 – either a free T4 (FT4) or free T4 index (FTI) – more accurately reflect how the thyroid gland is functioning when checked with a TSH.

The finding of an elevated TSH and low FT4 or FTI indicates primary hypothyroidism due to disease in the thyroid gland. A low TSH and low FT4 or FTI indicates hypothyroidism due to a problem involving the pituitary gland. A low TSH with an elevated FT4 or FTI is found in individuals who have hyperthyroidism .

T3 TESTS T3 tests are often useful to diagnosis hyperthyroidism or to determine the severity of the hyperthyroidism. Patients who are hyperthyroid will have an elevated T3 level. In some individuals with a low TSH, only the T3 is elevated and the FT4 or FTI is normal. T3 testing rarely is helpful in the hypothyroid patient, since it is the last test to become abnormal. Patients can be severely hypothyroid with a high TSH and low FT4 or FTI, but have a normal T3.

FREE T3 Measurement of free T3 is possible, but is often not reliable and therefore not typically helpful.

REVERSE T3 Reverse T3 is a biologically inactive protein that is structurally very similar to T3, but the iodine atoms are placed in different locations, which makes it inactive. Some reverse T3 is produced normally in the body, but is then rapidly degraded. In healthy, non-hospitalized people, measurement of reverse T3 does not help determine whether hypothyroidism exists or not, and is not clinically useful.

THYROID ANTIBODY TESTS

The immune system of the body normally protects us from foreign invaders such as bacteria and viruses by destroying these invaders with substances called antibodies produced by blood cells known as lymphocytes. In many patients with hypothyroidism or hyperthyroidism, lymphocytes react against the thyroid (thyroid autoimmunity) and make antibodies against thyroid cell proteins. Two common antibodies are thyroid peroxidase antibody and thyroglobulin antibody. Measuring levels of thyroid antibodies may help diagnose the cause of the thyroid problem. For example, positive anti-thyroid peroxidase and/or anti-thyroglobulin antibodies in a patient with hypothyroidism result in a diagnosis of Hashimoto’s thyroiditis. While detecting antibodies is helpful in the initial diagnosis of hypothyroidism due to autoimmune thyroiditis, following their levels over time is not helpful in detecting the development of hypothyroidism or response to therapy. TSH and FT4 are what tell us about the actual thyroid function or levels.

A different antibody that may be positive in a patient with hyperthyroidism is the stimulatory TSH receptor antibody (TSI). This antibody causes the thyroid to be overactive in Graves’ Disease . If you have Graves’ disease, your doctor might also order a thyrotropin receptor antibody test (TSHR or TRAb), which detects both stimulating and blocking antibodies. Following antibody levels in Graves’ patients may help to assess response to treatment of hyperthyroidism, to determine when it is appropriate to discontinue antithyroid medication, and to assess the risk of passing antibodies to the fetus during pregnancy.

THYROGLOBULIN Thyroglobulin (Tg) is a protein produced by normal thyroid cells and thyroid cancer cells. It is not a measure of thyroid function and it does not diagnose thyroid cancer when the thyroid gland is still present. It is used most often in patients who have had surgery for thyroid cancer in order to monitor them after treatment. Tg is included in this brochure of thyroid function tests to communicate that, although measured frequently in certain scenarios and individuals, Tg is not a primary measure of thyroid hormone function.

NON-BLOOD TESTS

RADIOACTIVE IODINE UPTAKE Because T4 contains iodine, the thyroid gland must pull a large amount of iodine from the bloodstream in order to make an appropriate amount of T4. The thyroid has developed a very active mechanism for doing this. Therefore, this activity can be measured by having an individual swallow a small amount of iodine, which is radioactive. The radioactivity allows the doctor to track where the iodine goes. By measuring the amount of radioactivity that is taken up by the thyroid gland (radioactive iodine uptake, RAIU), doctors may determine whether the gland is functioning normally. A very high RAIU is seen in individuals whose thyroid gland is overactive ( hyperthyroidism ), while a low RAIU is seen when the thyroid gland is underactive ( hypothyroidism ). In addition to the radioactive iodine uptake, a thyroid scan may be obtained, which shows a picture of the thyroid gland and reveals what parts of the thyroid have taken up the iodine (see Thyroid Nodules brochure ).

MEDICATIONS THAT INTERFERE WITH THYROID FUNCTION TESTING

There are many medications that can affect thyroid function testing. Some common examples include:

Estrogens , such as in birth control pills, or in pregnancy, cause high levels of total T4 and T3. This is because estrogens increase the level of the binding proteins. In these situations, it is better to ask both for TSH and free T4 for thyroid evaluation, which will typically be in the normal range.
Biotin , a commonly taken over-the-counter supplement, can cause the measurement of several thyroid function tests to appear abnormal, when they are in fact normal in the blood. Biotin should not be taken for 2 days before blood is drawn for thyroid function testing to avoid this effect.

Adult Thyroid Information

Pediatric thyroid information, printable brochures.

Thyroid Function Tests Brochure PDF

Thyroid Function Tests FAQ

El folleto de Pruebas De Función Tiroidea

Press Release: Thyroid stimulating hormone and thyroid hormones (T3 and T4): an ATA-commissioned review of current clinical and laboratory status

Disorders of thyroid function presentations at american thyroid association: 89th annual meeting, disorders of thyroid function presentations at american thyroid association: 88 th annual meeting, further information.

For information on thyroid patient support organizations, please visit the Patient Support Links section on the ATA website at www.thyroid.org

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Endocrine System Health
Thyroid Gland Health

How to Read Thyroid Test Results

Last Updated: January 5, 2024 References

This article was medically reviewed by Shari Forschen, NP, MA . Shari Forschen is a Registered Nurse at Sanford Health in North Dakota. Shari has worked in healthcare since 1996 and her expertise lies in acute care bedside nursing on a medical oncology floor. She received her degree from Medcenter one College of Nursing in 2003 and her Family Nurse Practitioner Masters from the University of North Dakota in 2014. Shari is a member of the American Nurses Association. There are 14 references cited in this article, which can be found at the bottom of the page. This article has been viewed 98,942 times.

The thyroid is a butterfly-shaped gland located in the neck that produces thyroid hormone. Thyroid disorders, in which the gland produces too much or too little of the hormone, can influence many functions in your body, from your heart rate to your metabolism. If your doctor thinks you are suffering from an overactive or under-active thyroid, she may order tests. Reading the results can seem like a complex task; however, if you have a systematic approach and understand what each test represents, you can determine whether or not you have a thyroid problem and, if so, what the problem is. Remember that only your doctor can diagnose thyroid disease, so make sure you talk with her about the results so you can begin treatment if necessary.

Understanding TSH Results

Step 1 Check to see if your TSH reading is in the normal range.

TSH can be thought of as the metaphorical "engine" of the thyroid gland, in that it determines the amount of thyroid hormone that is synthesized and then released from the thyroid into the body.
A normal value for TSH is between 0.5 – 5.0 mIU/L. [2] X Research source
If your TSH is in this range, that is a good sign; however, a normal TSH value does not completely rule out thyroid problems. TSH values on the high end of normal can indicate potential thyroid problems that are evolving.
Most thyroid problems require two or more tests to detect and diagnose, given the complex interplay of the various hormones that contribute to thyroid function.
Your doctor may order more tests, even if your TSH is normal, if he still suspects that you may have a thyroid problem.

Step 2 Interpret the possible meanings of a high TSH reading.

Thus, a high TSH may be a sign of hypothyroidism (a condition in which your thyroid gland is producing insufficient amounts of hormones). [4] X Trustworthy Source National Institute of Diabetes and Digestive and Kidney Diseases Health information from the National Institute of Diabetes and Digestive and Kidney Diseases, a division of the U.S. National Institutes of Health Go to source
You will need further testing, however, to further investigate and to confirm such a diagnosis.

Step 3 Look out for signs and symptoms of hypothyroidism.

Increased cold sensitivity
Unexplained weight gain
Unusually dry skin
Constipation
Muscle aches and stiffness
Joint pain and swelling
Depression and/or other mood changes
A slower than normal heart rate
Thinning hair
Changes to your menstrual cycle
Slowed thinking or speaking

Step 4 Evaluate the possible meaning of a very low TSH reading.

Again, further blood tests will be required to confirm such a diagnosis.
A TSH reading alone can point your physician down a certain path, but in itself it is usually not diagnostic.

Step 5 Take note of signs and symptoms of hyperthyroidism.

A faster than normal heart rate
Unexplained weight loss
Increased appetite
A tremor, often in your hands
Anxiety, irritability, and/or other mood changes
More frequent bowel movements
An enlarged thyroid gland (which can be felt in your neck, and is called a "goiter")
Trouble sleeping
Eyes that bulge or protrude more than they normally do (this sign is present in a certain type of hyperthyroidism called Grave's disease — specifically, the eye abnormality is called "Grave's ophthalmopathy")

Step 6 Use your TSH value to monitor ongoing thyroid treatment.

The treatment for hypothyroid and hyperthyroid conditions are very different.
The target range for thyroid treatment is normally a TSH between 0.5.–5.0 mIU/L, although this may vary depending upon the type of thyroid disorder you have.
You will likely receive more frequent monitoring at the start of your treatment, until you settle into a routine where your TSH becomes quite consistent (at which point less frequent monitoring may be appropriate, usually about once every 12 months).

Interpreting Free T4 and T3 Results

Step 1 Check to see if your T4 reading is in the normal range.

The exact numbers may vary depending on the lab and the specific form of test that is performed.
However, most laboratory results have, next to your reading, a designated normal range so that you can easily see whether your T4 is low, normal, or elevated.

Step 2 Interpret your T4 value in relationship to your TSH value.

As previously mentioned, the results are best interpreted in conjunction with the TSH value and under the guidance of the medical professional.

Step 3 Assess the T3 value in cases of possible hyperthyroidism.

If the T4 is normal but the TSH is low, a high T3 can confirm the diagnosis of hyperthyroidism.
While the T3 can provide valuable information in diagnosing hyperthyroidism, it does not help to diagnose hypothyroidism.
Free T3 is normally between 130-450 pg/dL. [12] X Trustworthy Source University of California San Francisco Health Center Research hospital associated with UCSF, a leading medical university, providing innovative patient care and public health resources Go to source
Again, the exact numbers may vary depending on the lab and the specific form of test that is performed. Most laboratory results have, next to your reading, a designated normal range so that you can easily see whether your T3 is low, normal, or elevated.

Reading Other Thyroid Test Results

Ordering your own tests can be very dangerous and often lead to misguided treatment. You would not try to fix an engine if you did not have training — this is no different.

Step 2 Interpret thyroid antibody testing to differentiate between various types of thyroid diseases.

Thyroid antibody testing can help to differentiate between types of thyroiditis and also autoimmune conditions of the thyroid.
TPO (thyroid peroxidase antibody) may be elevated in autoimmune thyroid conditions such as Grave's Disease or Hashimoto's Thyroiditis.
TG (thyroglobulin antibody) may also be elevated in Grave's Disease or Hashimoto's Thyroiditis.
TSHR (TSH receptor antibodies) may be elevated in Grave's Disease.

A thyroid ultrasound may be used to identify thyroid nodules. If any nodules are found, the ultrasound can provide insight as to whether they are solid or cystic (fluid-filled) nodules, both of which are require different modes of treatment. Ultrasound can also be used to monitor any growth or changes to the nodules over time.
A thyroid biopsy can take a sample of a suspicious nodule and rule in or rule out the possibility of cancer.
An iodine uptake scan can measure which areas of the thyroid are appropriately active (i.e. functional). It can also identify which areas are inactive (non-functional) or hyperactive (excessively functional).

Expert Q&A

This information is purely for education purposes of the condition and value-specific information. All conditions are unique and specific to the individual and, as such, interpretation should be left to the physician treating each case. Thanks Helpful 0 Not Helpful 0

↑ https://www.uclahealth.org/endocrine-center/normal-thyroid-hormone-levels
↑ https://medlineplus.gov/ency/article/003684.htm
↑ https://www.niddk.nih.gov/health-information/endocrine-diseases/hypothyroidism
↑ https://www.niddk.nih.gov/health-information/endocrine-diseases/hypothyroidism#symptoms
↑ https://medlineplus.gov/lab-tests/tsh-thyroid-stimulating-hormone-test/
↑ https://www.niddk.nih.gov/health-information/endocrine-diseases/hyperthyroidism#symptoms
↑ https://my.clevelandclinic.org/health/diagnostics/17556-thyroid-blood-tests
↑ https://medlineplus.gov/ency/article/003517.htm
↑ https://www.thyroid.org/thyroid-function-tests/
↑ https://medlineplus.gov/lab-tests/triiodothyronine-t3-tests/
↑ https://www.ucsfhealth.org/medical-tests/t3-test
↑ https://medlineplus.gov/lab-tests/thyroid-antibodies/
↑ https://medlineplus.gov/lab-tests/calcitonin-test/
↑ https://www.niddk.nih.gov/health-information/diagnostic-tests/thyroid

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Medical Disclaimer

The content of this article is not intended to be a substitute for professional medical advice, examination, diagnosis, or treatment. You should always contact your doctor or other qualified healthcare professional before starting, changing, or stopping any kind of health treatment.

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What Is a T4 Test?

What is free t4 and bound t4.

The T4 test measures thyroxine in your blood to show how well your thyroid is working.

T4 stands for thyroxine, one of two hormones your thyroid gland makes. The thyroid is a butterfly-shaped gland in your neck that helps control your body's growth and energy use. The T4 test measures the amount of T4 in your blood to show whether your thyroid works as well as it should.

You have two kinds of T4 hormone:

Free T4 travels around your bloodstream on its own and goes wherever you need it.
Bound T4 attaches to proteins to travel through your blood.

A total T4 test measures both free and bound T4. A free T4 test measures only thyroxine that's not bound to proteins. Many doctors today use the free T4 test because it's more accurate than the test for bound T4.

The T4 test can also detect problems with your pituitary gland . This gland releases TSH (thyroid-stimulating hormone) that directs the thyroid to release its hormones.

The information that follows will help you understand why your doctor has asked for a T4 test. It will also help you know what the results might mean in terms of your own health.

Why You Might Have a T4 Test

Hypothyroidism and Hyperthyroidism Symptoms: Swollen Neck

Your doctor may order a T4 test if:

You have symptoms of a thyroid problem.
Your thyroid gland is swollen.
You had an abnormal result on a TSH test.

Or you might have this test if your doctor has already diagnosed you with a thyroid disease and wants to see how well your treatment is working.

The T4 test helps your doctor diagnose hypothyroidism and hyperthyroidism .

Hypothyroidism is an underactive thyroid gland. That means your thyroid produces too little of its hormones, which slows your body down. Symptoms of hypothyroidism include:

Feeling cold
Weight gain
Constipation
Weak muscles
Irregular periods

Hyperthyroidism is an overactive thyroid gland. Your thyroid produces too much hormone and your body speeds up. Symptoms of hyperthyroidism include:

Fast heart rate
Increased appetite
Weight loss without trying
Anxiety , nervousness
Shaky hands
Feeling hot
Trouble sleeping
Dry, puffy eyes
Thin hair that breaks easily

The T4 Blood Test Procedure

How to prepare.

You don't need to do anything special before this test. But, do tell your doctor about any medicines or supplements you take -- even ones you bought without a prescription. Some drugs , including seizure medicines, heart drugs, and birth control pills , can affect test results. The supplement biotin can cause a false-positive result, where your test results are abnormal but you don't really have a thyroid problem.

Also tell your doctor if you've been sick. Some infections can alter your test results. You may need to wait until you feel better to have this test. Chronic diseases like kidney failure and cirrhosis may also affect T4 test results.

What to Expect

The T4 test is a blood test. Your health care provider will use a needle to draw blood from a vein in your arm. You may feel a slight prick as the needle goes in. Afterward, the provider will remove the needle and place a bandage over the site.

What Your T4 Blood Test Results Mean

You should get the results of your test within a day or so. Results can vary based on your age, gender, and the method your lab uses to read the result.

Normal Range

The normal range for free T4 in adults is 4.6 to 11.2 micrograms per deciliter (mcg/dL).

A normal T4 test result means your thyroid gland works like it should.

High or Low T4

A high T4 result could mean you have hyperthyroidism. A low T4 test result is a sign of hypothyroidism.

Your hypothalamus and pituitary glands control the release of T4. An abnormal result on the T4 test could also be a sign of a problem with one of these glands.

Other Thyroid Tests You Might Need

To help your doctor diagnose the exact problem you have, you may also need tests of the following:

T3 -- the other hormone your thyroid gland makes, works with T4 to control your body's energy use
Thyroid-stimulating hormone (TSH) -- a hormone your pituitary gland makes, tells your thyroid to make T3 and T4
Thyroid antibodies -- proteins your immune system makes if it mistakenly sees your thyroid gland as foreign, like in Hashimoto's thyroiditis or Graves' disease

T4 Blood Test Side Effects

The T4 test is just a basic blood test. Any side effects it might cause are minor, including:

Pain from the needle stick
Dizziness or fainting
A lump under the skin

After Your T4 Lab Test

Your test results will help your doctor decide what you should do next. If your results are normal, you may not need to do anything else. An abnormal result on this and other thyroid tests may mean you need treatment for a thyroid condition.

A to Z Guides

What Is a Thyroxine (T4) Blood Test?

What Is T4?

Thyroxine (T4) is one of the hormones made by your thyroid gland. Your thyroid gland is the small, butterfly-shaped organ in your throat that wraps around your windpipe (trachea). It makes and releases a few different hormones, including T4, that help control the following processes:

How your body turns the food you eat into energy (metabolism)
How fast food moves through your digestive system
Your heart rate and body temperature
Brain development in children
How your muscles contract
The rate at which your body replaces dying cells

T4 is the inactive form of your thyroid hormone; it must be changed into the active form, triiodothyronine (T3), for your organs and cells to use. The cells in a few of your organs can convert T4 into T3, including your:

Brain and spinal cord
Pituitary gland
Brown fat tissue (the kind of fat that stores and burns energy to keep your body temperature stable)

Reason for a T4 Blood Test

Your doctor may have you take a T4 blood test for a few different reasons, such as:

To help diagnose and monitor you for thyroid disease, like an underactive or overactive thyroid.
To help diagnose for disorders in your pituitary gland, which is a walnut-sized organ in your brain that, among other hormones, makes thyroid-stimulating hormone (TSH), which tells your thyroid how much T4 and T3 to make.
To check how well your thyroid is working if you have had an abnormal finding on other thyroid functions tests (such as a TSH or T3 test), a lump or nodule on your thyroid, an enlarged or irregular thyroid gland, or trouble getting pregnant.

Low T4 symptoms

When your thyroid is underactive, it doesn't make enough thyroid hormone for your body to function well, and your metabolism will slow down. This is called hypothyroidism.

Symptoms of hypothyroidism include:

Inability to concentrate and remember things
Swelling around your eyes
Swelling in your thyroid (also called goiter)
Severe tiredness
Low tolerance for cold
Weight gain
Not feeling hungry
Cold, dry skin
Slow heart rate
Shortness of breath
Constipation
Irregular periods

High T4 symptoms

When your thyroid is overactive, it makes too much thyroid hormone, and your metabolism speeds up. Doctors may call this hyperthyroidism.

Symptoms of hyperthyroidism may include:

Anxiety and depression
Restlessness
Irritability
Inability to sleep
Swelling around your eyes that makes them bulge out (Graves' eye disease)
Weight loss
Feeling extra hungry
Low tolerance for heat
Raised sweating
Fine tremors in your fingers, head, face, or tongue
Fast heart rate
Feeling like your heart is fluttering, pounding, or skipping beats
High blood pressure

About the T4 Blood Test

Your body makes two different forms of T4 hormone:

Free T4, which flows through your bloodstream without being attached to anything. This form is ready to be taken up into any cells that need thyroid hormone right away.
Bound T4, which travels through your bloodstream by attaching to transport proteins. These transport proteins make sure your T4 gets to the places in your body it needs to go and also keeps it from getting taken up into other organs and cells along the way. Almost all the T4 your body makes is bound.

Procedures for the T4 blood test

Tell your doctor about medications, vitamins, or supplements you're taking. Medications for seizures, heart conditions, and birth control may affect the results of the test. If you take a biotin supplement, the test may show that you have a higher T4 level than you actually do. This may cause your doctor to miss that you have a thyroid problem.

Tell your doctor if you are pregnant or have any medical conditions or infections because they may affect your test results. This includes chronic diseases like kidney failure or cirrhosis. Cirrhosis is scarring on your liver which can be caused by different diseases and conditions, including hepatitis and alcoholism. If you have a short-term infection, your doctor may want to wait to do the test until you feel better.

T4 blood test risks

The procedure for the T4 blood test is similar to other blood tests you may have had done. A technician will draw your blood with a small needle, and then cover the area with a bandage.

The risks from having your blood drawn are slight, but they can include:

Pain following the needle stick (for most people this is mild)
Bruising, if blood leaks under your skin
Infection, if the area isn't kept clean
Dizziness or fainting
Feeling a lump under your skin

Understanding T4 Blood Test Results

Normal T4 range

Normal range on the free T4 test vary by age, sex assigned at birth, and lab testing method, but in general, they are as follows:

Children up to 5 years old: 0.8-2.8 nanograms per deciliter (ng/dL)
Children 6-15 years old: 0.8-2.1 ng/dL
Teens 16-17 years old assigned male at birth: 0.8-2.8 ng/dL
Teens 16-17 years old assigned female at birth: 0.8-1.5 ng/dL
Adults over 18 years old: 0.9-1.7 ng/dL

For adults who are pregnant, the normal range on the free T4 test varies by trimester:

First trimester: 0.8-1.53 ng/dL
Second and third trimester: 0.7-1.20 ng/dL

Normal ranges (also called reference ranges) may vary between labs. Reference ranges are also set from studying large populations of people, so your result could be outside of the reference range but still normal for you. Ask your doctor about what your test results mean for you and your medical situation.

Low T4 levels

A few different conditions can cause low levels on a free T4 test, including:

Hypothyroidism, which can be caused by not getting enough iodine in your diet. However, the main cause in most places where iodized salt is available is Hashimoto's thyroiditis, which is an autoimmune condition. An autoimmune condition is when your immune system mistakenly attacks your organs as if they were an invader, like a virus or bacteria.
Untreated congenital (before you are born) hypothyroidism
Severe short-term illness
Malnutrition
Some medicines, including such as amiodarone, dexamethasone, lithium, propranolol, and thionamide

High T4 levels

A few different conditions can cause high levels on a free T4 test, including:

Too much iodine in your diet
Benign (not cancer) tumor (thyroid adenoma) or nodules on your thyroid
Graves' disease, an autoimmune condition
Swelling of your thyroid (goiter)
Taking too much thyroid replacement hormone
Some tumors on the testes or ovaries (rare)
Having medical imaging with a contrast dye that contains iodine (also rare)

Additional testing. While a free T4 test may show that there is a problem with your thyroid, it won't tell your doctor what the problem is. The next step is to figure out why your thyroid isn't working correctly. If your T4 levels aren't in a normal range, your doctor may order additional tests, such as:

TSH blood test. This is usually the first thyroid function test that your doctor will order, but if not, they may check it after your free T4 test comes back abnormal. Your TSH and T4 levels directly affect each other because TSH tells your thyroid when to make T4 and how much to make.

Free T3 blood test. Your doctor may want to check the levels of this other main hormone made by your thyroid gland.

Thyroid antibodies blood test. If you have a health condition like Hashimoto's thyroiditis or Graves' disease, your body may make proteins that attack your thyroid. If you're positive for thyroid antibodies, you may have one of these autoimmune conditions.

Radioactive iodine uptake imaging. Your thyroid needs iodine from your diet to make thyroid hormones. This test requires you to swallow a small amount of radioactive iodine. The technician will be able to see this iodine as it is being taken up into your thyroid using a special camera.

A T4 blood test measures your thyroxine hormone levels, which can show how well your thyroid is working. Low T4 levels are called hypothyroidism, and high T4 levels are called hyperthyroidism. Abnormal levels can be a short-term or long-term problem. Your doctor may order other thyroid function tests to help figure this out and decide on a treatment plan if you need one.

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Is Donetsk safe for a woman travelling on her own?

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Hello everyone I am travelling to Donetsk on my own and as a single woman I am concerned i will be there for 4 nights and i would like to make sure it is a safe place to travel alone.

Just beware of over friendly men, rest i reckon you will have a fab time :) myself visiting in Oct as well, had a previous trip last year which was proper fun ...... hope you get the best out ;)

Thanks very much Dee should be ok with that i'm going to watch football but well i will be there for 3 days after most of my fellow fans have left so just wanted to make sure is safe etc.

Hello Sarah C and welcome to Ukraine forum :)

It is very well worthy to apply the usual common sense rules and approach that you would in any large city (that Donetsk is) and in unknown environment.

Other than that there is not much special about Donetsk to be worried about. Dunno – avoid drunken companies perhaps..

And learn some Russian words to get around easier – English is still not largely spoken in the city (except in the hotels).

Enjoy your stay!

Hi everyone,

I had the same concern about the Donetsk but as I will be alone for just one day I don't think to be in a much trouble.

Thank you very much for your advice i arrive very late in the evening but i am being collected by the people that i am renting an apartment from at the airport which is good. And will just try and be careful when i am around. Not sure about learning russian though but will give it a go

Hi Bavshvi and welcome to Ukraine forum :)

Well, I'd say any official taxi should be safe.

If you are staying in a hotel, I'm sure they can help you with calling a cab for the desired time.

Well, as I said it will merely be easier for you to get around, if you master some basics. No one expects you to start speaking fluently :)

Most of the street signs and establishment titles will be written in Russian, so it helps to at least know how to differ a bank sign from a restaurant ;)

This topic has been closed to new posts due to inactivity.

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8 Relationship between area and perimeter
9 Area and perimeter: word problems
10 Rectangles: relationship between perimeter and area word problems
11 Use area and perimeter to determine cost

II. Lines and angles

1 Points, lines, line segments, rays, and angles
2 Parallel, perpendicular, and intersecting lines
3 Identify parallel, perpendicular, and intersecting lines

JJ. Angle measurement

1 Acute, right, obtuse, and straight angles
2 Angles as fractions of a circle
3 Use fractions to find the measure of an angle
4 Angles of 90, 180, 270, and 360 degrees
5 Measure angles on a circle
6 Measure angles with a protractor
7 Draw angles with a protractor
8 Estimate angle measurements
9 Adjacent angles
10 Angle measures: word problems

KK. Triangles

1 Acute, obtuse, and right triangles
2 Scalene, isosceles, and equilateral triangles
3 Classify triangles

LL. Quadrilaterals

1 Parallel sides in quadrilaterals
2 Sides and angles of quadrilaterals
3 Identify parallelograms
4 Identify trapezoids
5 Identify rectangles
6 Identify rhombuses
7 Classify quadrilaterals
8 Pick all the names for a quadrilateral
9 Draw quadrilaterals

MM. Symmetry

1 Identify lines of symmetry
2 Draw lines of symmetry
3 Count lines of symmetry

NN. Financial literacy

1 Identify fixed and variable expenses
2 Calculate profit: word problems
3 Compare savings options
4 Budget a weekly allowance: word problems
5 Financial institution vocabulary

Fourth grade lessons

These lessons help you brush up on important math topics and prepare you to dive into skill practice!

Number sense

Place value
Writing numbers in expanded form
Writing numbers in word form
Rounding numbers
Comparing numbers
Prime and composite numbers

Multiplication

Multiplying multiples of 10
Estimating products
Area model multiplication
Partial products
Lattice multiplication
Multiplying by 1-digit numbers
Multiplying by 2-digit numbers
Long multiplication
Square numbers
Dividing multiples of 10
Estimating quotients
Partial quotients
Area model division
Dividing by 1-digit numbers
Long division
Divisibility rules

Properties and mixed operations

The distributive property
Order of operations
Fractions overview
Understanding fractions
Fraction area models
Fractions on a number line
Fractions of a set
Equivalent fractions
Comparing fractions
Least common denominator
Simplest form
Mixed numbers and improper fractions

Adding fractions

Adding fractions with like denominators
Adding mixed numbers

Subtracting fractions

Subtracting fractions with like denominators
Subtracting mixed numbers

Multiplying fractions

Multiplying fractions and whole numbers
What is a decimal?
Fractions and decimals
Decimal place value
Equivalent decimals
Comparing decimals
Lines, line segments, and rays
Parallel and perpendicular lines
What is an angle?
Types of angles
Measuring angles with a protractor
Types of triangles
Types of quadrilaterals
Parallelograms
Regular polygons
Area of rectangles
Area of compound shapes
Lines of symmetry

Data and measurement

Elapsed time
Metric units of measurement
Customary units of measurement

Thyroxine or T4 is a hormone produced by the thyroid gland. The term “free T4” means measured T4 that is not bound to proteins in the blood. T4 is about one-tenth as potent as T3 in humans. Nonetheless, T4 acts on almost every cell in the body, helping to setting the metabolic rate of the cell. T4 is important for growth and development, especially in fetuses and children. The thyroid gland produces and stores T4 until it is needed for release. Thyroid-stimulating hormone, also known as TSH or thyrotropin, is produced in the pituitary gland. TSH stimulates the thyroid gland to produce and release of T4. Greater than 99% of T4 is bound to a serum proteins, but the portion that is not, free T4, is the biologically active portion. In most cases, free T4 is good indicator of thyroid function, along with TSH and other measures. Free T4 is often more useful than total T4 in assessing thyroid function.

Normal Ranges for Free T4:

1-23 Months 0.9-1.4 ng/dL

2-12 Years 0.9-1.4 ng/dL

13-20 Years 0.8-1.4 ng/dL

>20 Years 0.8-1.8 ng/dL

http://www.ncbi.nlm.nih.gov/books/NBK285568/

http://www.uptodate.com/contents/laboratory-assessment-of-thyroid-function

http://www.ncbi.nlm.nih.gov/pubmed/12625976

http://www.questdiagnostics.com/testcenter/TestDetail.action?ntc=866

http://dx.doi.org/10.1001/jama.1990.03440110095035

http://www.uptodate.com/contents/thyroid-function-in-nonthyroidal-illness

http://www.ncbi.nlm.nih.gov/pubmed?term=7920008

http://www.ncbi.nlm.nih.gov/pubmed/6687730

http://www.uptodate.com/contents/overview-of-thyroid-disease-in-pregnancy

http://www.uptodate.com/contents/diagnosis-of-and-screening-for-hypothyroidism-in-nonpregnant-adults

https://www.uptodate.com/contents/diagnosis-of-hyperthyroidis

For Personal Health

Embracing a state of well-being is a commitment to oneself., state of well-being is a commitment to oneself..

Keeping track of your medical data and laboratory results while understanding what they mean empowers positive health outcomes.

Keeping track of your medical data and lab results while understanding what they mean empowers positive health outcomes.

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What does it mean if your T4, Free result is too high?

Elevated free T4 levels may indicate hyperthyroidism, thyroid hormone resistance syndrome, or T4 toxicosis. Elevated free T4 may cause symptoms of hyperthyroidism including excessive appetite, anxiety, heart palpitations, sweating, shortness of breath, weight loss, and intolerance to heat.

Some specific causes of high free T4 are:

- Hyperthyroidism

- Euthyroid hyperthyroxinemia

- TSH-mediated hyperthyroidism

- Acute thyroiditis

- Pregnancy

- Familial dysalbuminemic hyperthyroxinemia

- Medications (e.g. estrogens, tamoxifen, opioids)

Embarking on a journey to wellness and sticking with it is all about commitment.

Stay on top of your lab results with healthmatters — your trusted tool for understanding and improving health., stay on top of your lab results with healthmatters., trusted tool for understanding and improving well-being., how does it work.

Bring all results from any laboratories to your account. You can enter your tests yourself, or we'll be happy to organize your files—whether in PDF, JPEG, CSV, or even screenshots.

Learn and improve

Once your information is stored in your account, dive into a wealth of insights about your results. If you have any more questions, we are here to answer them.

What does it mean if your T4, Free result is too low?

Decreased free T4 levels in the serum usually indicate hypothyroidism or chronic or subacute thyroiditis. Abnormally low T4 may cause symptoms of hypothyroidism including weakness and fatigue, cold intolerance, shortness of breath, weight gain, constipation, cognitive problems, dry skin, hoarseness, and swelling (edema).

Some specific causes of low free T4 are:

- Hypothyroidism

- Chronic thyroiditis

- Subacute thyroiditis

- Nephrosis

- Congenital thyroid agenesis, dysgenesis, or defects in hormone synthesis

- Synthetic T3 treatment

- Medications anabolic steroids such as glucocorticoids, phenytoin, carbamazepine, phenobarbital

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What Is a Free Thyroxine Test?

What to expect when undergoing this test

Purpose of Test

Risks and contraindications, before the test, interpreting results, a word from verywell.

A free thyroxine test, often called a free T4 test, measures the amount of free thyroxine in your blood. Thyroxine (also called T4) is one of the major hormones produced by your thyroid. When T4 is created, some of the hormone gets bound to proteins, while the rest circulates freely.

The free T4 that is being tested for is unbound and is available to the cells in the body to be used for things like heart and digestive function, metabolism, brain development, and bone and muscle health.

A healthcare provider may order a free T4 test if a patient is having symptoms of a thyroid disease , such as weight loss, a rapid heart rate, and sweating associated with hyperthyroidism (when your thyroid produces too many hormones). A free T4 test may also be performed if you are experiencing weight gain, feeling cold, or have a sense of general fatigue that might be associated with hypothyroidism (when the thyroid isn’t producing enough hormones).

Even if you aren’t showing any signs or symptoms of thyroid disease, your healthcare provider may want to run a free T4 test if you have a family history of thyroid conditions. A free T4 test is considered the most accurate test for assessing T4, as opposed to a total T4 test.

There are similar tests used to evaluate thyroid function, including a thyroid stimulating hormone (TSH) test and a triiodothyronine (T3) test. TSH is the hormone produced by the pituitary gland that informs the thyroid how much T4 and T3 hormones to produce in the body.

A T3 test may also be done alongside a free T4 test to help inform a diagnosis, as the measurement of free T4 together with T3 may be useful in identifying hyperthyroidism.

Since a T4 test is done simply with a blood draw, there are few to no risks of the procedure, aside from the risks you may have when getting blood drawn . You may have a headache or feel slightly queasy during the draw and notice tenderness, redness, or slight bruising at the site where the draw took place. If you feel nervous about having blood taken, make sure to tell the technician before they start the test so they can be aware and help make you feel more comfortable during and after the test.

For example, a small snack and drink after the blood draw may help with lightheadedness and any anxiety you may have that is associated with needles.

There are no preparations that need to be done ahead of time with a free T4 test, but you do need to tell your healthcare provider about any medications, vitamins, or herbs you are taking ahead of time, as these can interfere with the results of the test. Most healthcare providers will recommend having your blood drawn before you take any medications, if possible.

If you’re suffering from an illness such as a cold, your healthcare provider may also choose to postpone the blood draw until you’ve recovered. The test itself should only take a few minutes, and the results should be available a few days after your healthcare provider sends your blood vial off to the lab to be examined.

A free T4 test will likely take place right in your healthcare provider’s office. In certain cases, you may have to go to a separate lab to get your blood drawn at a time that is convenient for you.

What to Wear

Remember to wear a shirt that can be easily rolled up, or a sweatshirt with a t-shirt underneath so that you can remove it for the blood draw. It’s important for the technician performing the blood draw to be able to access your arm to find the best vein from which to take blood with minimal discomfort to you.

Food and Drink

Unless specified by your healthcare provider, hold off on any vitamins or medications until after your free T4 test. Supplements containing biotin should be ceased four days before the test. Make sure you eat a healthy meal or snack an hour or two before your free T4 test to prevent getting dizzy or lightheaded during the blood draw.

Cost and Health Insurance

When medically necessary, a free T4 test is usually covered by health insurance. Depending on your plan coverage, you may have to pay a coinsurance fee, which is usually anywhere from 10% to 50%.

Once your healthcare provider sends the blood draw off to the lab for analysis, the results should take no more than a few days to a week to come in. The results of a free T4 test vary depending on your age, gender, and health history. A normal free T4 range in adults is .8 to about 1.8 nanograms per deciliter (ng/dL). Higher T4 levels could indicate you have an overactive thyroid, while lower T4 levels could indicate you have an underactive thyroid.

Results from a free T4 test will help your healthcare provider determine the next set of tests to run as well as a treatment course, if necessary.

The results can also help show if the current prescribed treatment course for a previously diagnosed thyroid disease is working successfully. Free T4 tests are typically evaluated with other diagnostic thyroid tests, including a TSH test and sometimes a T3 test. For example, if the results show a high TSH level and a low free T4 level, this indicates hypothyroidism due to a defect in the thyroid.

A low TSH level and a low free T4 level is likely hypothyroidism due to a defect in the pituitary gland, and a low TSH level with a high free T4 level can be hyperthyroidism due to a defect in the thyroid.

While there are no lifestyle changes that can increase or decrease free T4 in the body, medication can be prescribed to help adjust the amount entering the bloodstream and ensure your body is operating with optimal levels of the hormone. In certain circumstances, such as pregnancy, free T4 levels may increase but are not necessarily a sign of thyroid disease. In cases like these, free T4 levels return to normal after the birth.

Reading free T4 test results alone without a comprehensive thyroid panel, including a TSH test, can give you an incomplete look into your thyroid function. This is because even if you see abnormal free T4 levels, it’s important to understand why those levels are abnormal, whether it’s an issue with your thyroid or with your pituitary gland.

Results of a free T4 test are just a glimpse of how your thyroid is functioning overall. As a result, it’s important to discuss all of the test results with your healthcare provider so they can determine what a normal T4 level and range for your health history is. Together, you can treat your specific thyroid disorder effectively with minimal side effects.

Harvard Health Publishing. Thyroid hormone: How it affects your heart .

Carvalho GA, Perez CL, Ward LS. The clinical use of thyroid function tests . Arq Bras Endocrinol Metabol . 2013;57(3):193-204. doi:10.1590/S0004-27302013000300005

Soh SB, Aw TC. Laboratory testing in thyroid conditions - pitfalls and clinical utility . Ann Lab Med . 2019;39(1):3-14. doi:10.3343/alm.2019.39.1.3

Gupta S, Kaiti R, Gupta G. Evaluation of the female patients with subclinical hypothyroidism by brainstem auditory evoked potentials: Case-control study . J Clin Diagn Res . 2017;11(6):CC13-CC16. doi:10.7860/JCDR/2017/25604.9989

American Thyroid Association. Thyroid function tests .

Blood Test: T4 (Thyroxine ). Kids Health From Nemours website.

Thyroxine (T4) Test . U.S. National Library of Medicine Medline Plus website.

Thyroid Function Tests . American Thyroid Association website.

Free T4 . University of Rochester Medical Center website.

By Colleen Travers Travers is a freelance writer and editor specializing in health, wellness, and fitness based in New York City.

Half of Donetsk under Moscow control: Russian-backed official

More than half of the eastern region is under Russian control, but military advancement in some areas is difficult, occupation official says.

A man walks down a war-torn street, as Russia's attack on Ukraine continues, in the city Slovyansk, Donetsk region of Ukraine, December 12, 2022. REUTERS/Shannon Stapleton

More than half of Ukraine’s eastern Donetsk region is under Russian control but heavy fighting has stalled further advances, a Moscow-installed official said.

The so-called Donetsk People’s Republic is one of four areas in Ukraine that Moscow annexed in September in an exercise Ukraine and its allies denounced as a “sham” coercive referendum .

Keep reading

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“A little more than 50 percent of the territory of the Donetsk People’s Republic has been liberated,” Denis Pushilin, the Russian-backed administrator, told Russian state-owned news agency RIA on Tuesday.

Fierce battles in the region in recent weeks have left it unclear which parts of Donetsk are under Russian and Ukrainian control.

Russia has claimed to be gradually advancing its positions, with the defence ministry saying on Monday its offensive killed 30 Ukrainian military personnel the day before.

INTERACTIVE - WHO CONTROLS WHAT IN UKRAINE

However, Pushilin said the situation was tough along the Lyman line of contact in the region’s north. Ukraine liberated Lyman hours after Russian President Vladimir Putin proclaimed the annexation of Donetsk.

“The situation remains difficult, the enemy is trying to counterattack, but our units are now holding all positions,” said Pushilin. “It is not always possible to move forward.”

Russia’s sustained shelling of the front line in Donetsk has destroyed the city of Bakhmut and heavily damaged the city of Avdiivka, which lies in the region’s centre, Ukraine’s President Volodymyr Zelenskyy said on Friday.

On Monday, the general staff of Ukraine’s armed forces said Russia kept concentrating its efforts to advance and capture both cities.

“Near Bakhmut, the occupiers rained mortar and artillery fire on nearly 20 settlements,” it said in an evening update. Nine settlements came under shelling near Avdiivka, the military said.

The United Kingdom’s defence ministry said Russia was still likely to be planning deeper advances within Donetsk, but it cast doubt on its ability to do so.

“It is highly unlikely that the Russian military is currently able to generate an effective striking force capable of retaking these areas,” it said.

“Russian ground forces are unlikely to make operationally significant advances within the next several months.”

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COMMENTS

T4 levels: What is a normal T4 level, and how it is tested?
Normal levels of free T4 range from 0.8-1.8 nanograms per deciliter (ng/dl) of blood. Normal T4 levels also vary across trimesters of pregnancy. A 2011 study in the Journal of Thyroid Research ...
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Free T4 and TSH Levels: Understanding Thyroid Blood Tests
Normal TSH values: 0.4 to 4.5 mU/L (some centers accept up to 5.0 mU/L as an upper value). Normal free T4 values: 0.7 to 1.8 ng/dl. Note: A study by the National Academy of Clinical Biochemistry suggested that the normal range for a healthy thyroid should be up to 2.5 mU/L. This is because they found that 95% of the healthy people they tested ...
T4 (Thyroxine) Test: What It Is, Function, Purpose & Levels
A T4 (thyroxine) test helps diagnose thyroid conditions. Your thyroid is a small, butterfly-shaped gland located at the front of your lower neck, above your clavicle. It's a part of your endocrine system. Your thyroid gland makes and releases thyroid hormones into your blood, which then travel to your organs to exert their effect.
Thyroid Test Analyzer: Understanding High and Low TSH, T3, T4, and More
Print. This thyroid test analyzer will help you understand your TSH, T3, T4, and other thyroid function test results. Select a test and enter your lab value to learn more. "This tool is aimed to help you interpret your thyroid function test in order to clarify your diagnosis or track the progression of treatment.
Thyroid Blood Test: Types, Normal Levels, Analyzing Results
As with T4, there is both bound and free T3. T3 blood tests include: Total T3: The total amount of T3 (bound and unbound) in your bloodstream. Free T3: The amount of unbound T3 available for use in tissues. Reverse T3: An inactive form of T3 that has no utility but can block free T3 from entering tissues.
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Thyroid Function Tests
Tests measuring free T4 - either a free T4 (FT4) or free T4 index (FTI) - more accurately reflect how the thyroid gland is functioning when checked with a TSH. The finding of an elevated TSH and low FT4 or FTI indicates primary hypothyroidism due to disease in the thyroid gland. A low TSH and low FT4 or FTI indicates hypothyroidism due to a ...
How to Read Thyroid Test Results: Free T4, Free T3 & More
The normal range for free T4 is between 0.8 - 2.3 ng/dL. [9] The exact numbers may vary depending on the lab and the specific form of test that is performed. However, most laboratory results have, next to your reading, a designated normal range so that you can easily see whether your T4 is low, normal, or elevated. 2.
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T4 Blood Test: Purpose, Symptoms, High/Low Range
The normal range for free T4 in adults is 4.6 to 11.2 micrograms per deciliter (mcg/dL). A normal T4 test result means your thyroid gland works like it should. High or Low T4. A high T4 result could mean you have hyperthyroidism. A low T4 test result is a sign of hypothyroidism. Your hypothalamus and pituitary glands control the release of T4.
Total Thyroxine (T4) Test: Uses, Side Effects, Results
The total thyroxine test is used to diagnose thyroid disorders. Thyroxine (T4) is a thyroid hormone, and the test measures how much is in your blood. Some thyroid diseases are tied to too little T4, and others are tied to too much. Other names for this test are a total T4 test, total T4 concentration, and a thyroxine screen.
T4 Blood Test: What Is it Used For?
Abnormal levels can be a short-term or long-term problem. Your doctor may order other thyroid function tests to help figure this out and decide on a treatment plan if you need one. A T4 blood test ...
Free T4 test Information
Free T4 test. Free thyroxine test; Thyroxine test by equilibrium dialysis. T4 (thyroxine) is the main hormone produced by the thyroid gland. A laboratory test can be done to measure the amount of free T4 in your blood. Free T4 is the thyroxine that is not attached to a protein in the blood.
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T4, Free
T4, Free. Serum. Optimal Result: 0.82 - 1.77 ng/dL, or 10.55 - 22.78 pmol/L. Interpret your laboratory results now. Get Started. Thyroxine or T4 is a hormone produced by the thyroid gland. The term "free T4" means measured T4 that is not bound to proteins in the blood. T4 is about one-tenth as potent as T3 in humans.
Free Thyroxine Test: Uses, Side Effects, Procedure, and Results
A free thyroxine test, often called a free T4 test, measures the amount of free thyroxine in your blood. Thyroxine (also called T4) is one of the major hormones produced by your thyroid. When T4 is created, some of the hormone gets bound to proteins, while the rest circulates freely. The free T4 that is being tested for is unbound and is ...
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Thyroid Blood Tests: Free T4 & TSH Levels

Hypothyroidism and Hyperthyroidism

How Does the Thyroid Gland Work?

What is Free T4?

What is the Role of TSH?

What are the Normal Values of TSH and Free T4?

What Does It Mean to Have an Elevated TSH Level?

Overt hypothyroidism

Central Hyperthyroidism

In Summary, What Could a High TSH Level Indicate?

What Does It Mean to Have a Low TSH Level?

Subclinical Hyperthyroidism

Overt Hyperthyroidism

Central Hypothyroidism

In Summary, What Could a low TSH Level Indicate?

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Thyroid Function Tests

HOW DOES THE THYROID GLAND FUNCTION?

THYROID ANTIBODY TESTS

NON-BLOOD TESTS

Adult Thyroid Information

Press Release: Thyroid stimulating hormone and thyroid hormones (T3 and T4): an ATA-commissioned review of current clinical and laboratory status

THYROID NEWS

Publications

How to Read Thyroid Test Results

Understanding TSH Results

Interpreting Free T4 and T3 Results

Reading Other Thyroid Test Results

Expert Q&A

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What Is a T4 Test?

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The T4 Blood Test Procedure

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What Your T4 Blood Test Results Mean

Normal Range

High or Low T4

Other Thyroid Tests You Might Need

T4 Blood Test Side Effects

After Your T4 Lab Test

What Is a Thyroxine (T4) Blood Test?

What Is T4?

Reason for a T4 Blood Test

About the T4 Blood Test

Understanding T4 Blood Test Results

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Is Donetsk safe for a woman travelling on her own?

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