<img height="1" width="1" alt="" style="display:none" src="https://www.facebook.com/tr?ev=6048136207047&amp;cd[value]=0.01&amp;cd[currency]=USD&amp;noscript=1"> These are additional tests in Hashimoto
April 24, 2023
In Thyroid
5 min reading time

What additional tests can I do for Hashimoto?

Question of the Day from Gerard: "When testing for " Hashimoto'sdisease," additional thyroid testing is advised. There are lots of them. Which one is important?"

Hello Gerard,

If you are on this page:


chooses "read more," and then you see this:

The thyroid plays a major role in our body's growth and metabolism. Do you want to know how your thyroid is doing? Then get a thyroid test.

In this section you will find various tests that can be done when thyroid disease is suspected:

Measure all thyroid values; including antibodies and reverse T3.

Antibodies Thyroid

In what % of cases are antibodies elevated when thyroid autoimmune disease is diagnosed:

Graves' diseaseHashimoto's disease
free T4, free T3increasedfree T4, free T3reduced
TSH receptor antibodies(mostly stimulatory)  TRAK 80-100%TSH receptor antibodies
(mostly blocking)
Anti TPO
microsomal al (TPO) MAK
45-80%TPO autoantibodies (high titer)95%
Anti Tg
Tg autoantibodies
Thyreoglobulin antibodies TAK
12-30%Tg autoantibodies (high titer)50-60%

The second and last columns indicate the percentage in which blood values deviate within the patient population of patients with graves' disease and Hashimoto's disease, respectively

Symptoms thyroid autoimmunity:


Another word for an overly fast thyroid gland is "hyperthyroidism." This is a condition in which the thyroid gland produces too many thyroid hormones, which can lead to symptoms such as weight loss, increased appetite, irritability, tremors, heart palpitations and fatigue.

Graves' disease symptoms (thyroid gland working too fast)

  • lose weight
  • palpitations
  • sweating
  • an agitated feeling
  • vibrate
  • muscle weakness
  • diarrhea
  • be easily irritated
  • fatigue
  • a warm and clammy skin
  • An overactive thyroid, or Hyperthyroidism, is usually due to Graves' disease.


Another word for a thyroid gland that works too slowly is "hypothyroidism." This is a condition in which the thyroid gland does not produce enough thyroid hormones, which can lead to symptoms such as fatigue, weight gain, sensitivity to cold, sluggishness, slowed heart rate, dry skin and hair loss.

Symptoms of Hashimoto's disease (thyroid gland working too slowly)

  • unexplained weight gain
  • fluid retention (edema), bloated face
  • tired and listless, apathetic: unable to move forward, sleeping late, sleepy during the day
  • dizzy and lightheaded
  • low body temperature (35 - 36.6 °C) low blood pressure, slow heart rate
  • chilly (chills, chills) cold hands and feet
  • heart rhythm disturbance
  • swollen thyroid gland (goiter)
  • menstrual complaints
  • tingling in limbs
  • hair loss; dry, lackluster and brittle hair
  • bulging eyes & drooping eyelids, vision deteriorates
  • weak nails (brittle and ridged)
  • dry skin, chapped, scaly & blotchy
  • vitiligo (loss of pigmentation of the skin)
  • memory and concentration problems
  • upset stomach and intestinal congestion
  • muscle pain and muscle cramp
  • reduced appetite
  • emotionally unstable and melancholic
  • depression and burnout

The above symptoms of need by no means always or all (at the same time) occur.

Hypothyroidism, a sluggish thyroid, is usually due to Hashimoto's disease.

Take a look at all of our thyroid tests to see which thyroid test best suits your situation.

Which of the two types (hashimoto or graves) do you identify with the most?

The standard thyroid panel is always important if you haven't already done so at your doctor's office:


Reverse T3

Reverse T3 (rT3) is a hormone produced by the conversion of T4 (thyroxine) and usually has no biologically active function. It is produced by the body in response to stress or illness, and may also be elevated in people with hypothyroidism. (Hashimo's disease)

The measurement of rT3 can be useful in assessing thyroid function in people who experience symptoms of hypothyroidism but have normal levels of T4 and T3. This is also known as "non-thyroidal illness syndrome." An elevated level of rT3 may indicate decreased conversion of T4 to T3, which can be caused by stress, inflammation, infections or other health problems. In these cases, measuring rT3 can help determine the cause of symptoms and adjust treatment accordingly.

It is important to note that measurement of rT3 is not routinely performed in the diagnosis and treatment of thyroid disease, and is only performed as part of a comprehensive assessment of thyroid function, often at your own expense.

Keep in mind that if you produce antibodies against the thyroid gland, it is an autoimmune disease. It is also common in combination with other autoimmune disorders.

Having multiple autoimmune diseases means that your body has problems with its immune system, causing it to attack itself and damage healthy tissues. It is not entirely clear why some people are more prone to autoimmune diseases than others. Possible reasons include genetic predisposition, exposure to environmental factors, and problems with the immune system itself.

Once a person has an autoimmune disease, their body may become more susceptible to other autoimmune diseases. It is important to have regular medical checkups and good care coordination between specialists if you have multiple autoimmune diseases, as this can make managing the diseases easier and reduce the risk of complications.

Having multiple autoimmune diseases at the same time is common and is associated with an increased risk of developing additional autoimmune diseases in the future. The exact reasons for this are not yet fully known, but these explanations for this are thought to exist;

  1. Heredity: There is a genetic component to autoimmune diseases, and some people have a genetic predisposition to developing multiple autoimmune diseases.
  2. Common causes: Autoimmune diseases are often caused by a combination of genetic and environmental factors, such as infections, hormonal changes, stress and exposure to certain chemicals. It is possible that these common causes contribute to the development of multiple autoimmune diseases.
  3. Immune system dysfunction: Autoimmune diseases occur when the immune system attacks one's own body. In some people, there may be a general disturbance of the immune system, making the body more susceptible to autoimmune diseases.
  4. Epitope spreading: It is possible that autoimmune diseases can stimulate the production of new autoantibodies directed against other parts of the body. This process is known as "epitope spreading" and may contribute to the development of multiple autoimmune diseases.

In general, more research is needed to understand the exact reasons for the association between multiple autoimmune diseases. However, it is known that having multiple autoimmune diseases makes it important to have regular medical monitoring and good care coordination between specialists.

Free T4 or Free T3 or total T4 and Total T3?

Total T4 and T3 are usually measured first in patients with suspected thyroid problems. These tests are useful as screening tests to assess overall thyroid function. Total T4 measures the total amount of thyroxine in the blood, while Total T3 measures the total amount of triiodothyronine in the blood, including the free and bound forms of these hormones.

Free T4 and Free T3 are usually used as more specific tests to assess actual thyroid function. Free T4 measures the amount of thyroxine in the blood that is not bound to proteins and available for the body to use. Free T3 measures the amount of triiodothyronine in the blood that is not bound to proteins and available for the body to use.

In general, free T4 and free T3 are usually measured when a patient shows symptoms suggestive of a thyroid problem, such as fatigue, weight changes, hair loss, a change in the menstrual cycle and mood swings. The physician may also order these tests when the results of Total T4 and T3 tests are abnormal and further evaluation is needed.

In some cases, a doctor may order both tests to get a better picture of thyroid function.

But people who want to request a study themselves you should choose Free t4 (FT4) and Free T3 (FT3) F here stands for free, it is the English name for free.

If we know what your budget is and what the doctor has already tested, we can provide more specific advice.


About the Author
Ellen is the founder of Blood Value Testing. She gained her experience with health examinations for companies, schools and government institutions at HumanCapitalCare arbo- en gezondheidsdienst. In 2009 she became director of Diagnostics Netherlands, a collaboration between all major general practitioner laboratories in the Netherlands. At the U- Diagnostics laboratory in Utrecht, she was responsible for blood testing at GPs. Until she founded Blood Values Test for individuals in 2013.
Post comment