Thyroid Hormone Panel (T3, T4 Total and Free, TSH)

T3 (Triiodothyronine) T3 is the more metabolically active hormone out of T4 and T3. When levels are below normal it's generally safe to assume that the individual is suffering from hypothyroidism. Drugs that may increase T3 levels include estrogen and oral contraceptives. Drugs that may decrease T3 levels include anabolic steroids/androgens as well as propanolol (a beta adrenergic blocker) and high dosages of salicylates. Increased levels can be indicative of Graves disease, acute thyroiditis, pregnancy, hepatitis, etc. Decreased levels can be indicative of hypothyroidism, protein malnutrition, kidney failure, Cushing's syndrome, cirrhosis, and liver diseases.

Normal ranges:

16-20 years old 80-210 ng/dl
20-50 years 75-220 ng/dl (or 1.2-3.4 nmol/L)
> 50 yrs old 40-180 ng/dl (or 0.6-2.8 nmol/L)


T4 (Thyroxine) T4 is indicator of whether or not someone is in a hypo- or hyper-thyroid state. It too is rather reliable but free thyroxine levels should be assessed as well. Drugs that increase of decrease T3 will, in most cases, do the same with T4. Increased levels are indicative of the same conditions as T3 and a decrease can be indicative of protein depleted states, iodine insufficiency, kidney failure, Cushing's syndrome, and cirrhosis.

Normal ranges:
Adult Male 4-12 ug/dl or 51-154 nmol/L
Adult Female 5-12 ug/dl or 64-154 nmol/L


Free T4 or Thyroxine: Since only 1-5% of the total amount of T4 is actually free and useable, this test is a far better indicator of the thyroid status of the patient. An increase indicates a hyperthyroid state and a decrease indicates a hypothyroid state. Drugs that increase free T4 are heparin, aspirin, danazol, and propanolol. Drugs that decrease it are furosemide, methadone, and rifampicin. Increased and decreased levels are indicative of the same possible diseases and states that are seen with T4 and T3.

Normal range: 0.8-2.8 ng/dl or 10-36 pmol/L


TSH (Thyroid Stimulating Hormone): Measuring the level of TSH can be very helpful in terms of determining if hormoone problem resides with the thyroid itself (primary) or the pituitary gland (secondary). If TSH levels are high, then it's merely the thyroid gland not responding for some reason but if TSH levels are low, it's the hypothalamus or pituitary gland that has something wrong with it. The problem could be a tumor, some type of trauma or immune response.

Drugs that can increase levels of TSH include lithium, potassium iodide and TSH itself. Drugs that may decrease TSH are aspirin, heparin, dopamine, T3, etc. Increased TSH is indicative of thyroiditis, hypothyroidism, and congenital cretinism. Decreased levels are indicative of hypothyroidism (pituitary dysfunction), hyperthyroidism, and pituitary hypofunction.

Normal Adult Range: 2-10 uU/ml or 2-10 mU/L

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