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The determination of TPO antibody levels is the most sensitive test for detecting autoimmune thyroid disease (eg, Hashimoto's thyroiditis, idiopathic myxedema, and Graves disease) and detectable concentrations of anti-TPO antibodies are observed in most patients with these disorders. The highest TPO antibody levels are observed in patients suffering from Hashimoto thyroiditis. In this disease, the prevalence of TPO antibodies is about 90% of cases, confirming the autoimmune origin of the disease. These autoantibodies also frequently occur (60%–80%) in the course of Graves disease.

This test panel includes most tests needed to more deeply explore the possibility of hypothyroidism and/or Hashimoto's disease diagnosis. It includes: TSH, Free T3, Free T4, Reverse T3, Thyroglobulin Antibody and Thyroid Peroxidase Antibody (Anti-TPO). If you are taking biotin, please stop it 72 hours before the blood draw since it may interfere with hormone blood tests. A study found that TSH was suppressed in all subjects after food, so fasting may be suggested although it is not reqired by Quest. Free T4 and Free T4 values did not change significantly after eating. NOTE: Reverse T3 is analyzed using a specific technique called liquid chromatography/tandem mass spectrometry (LC/MS-MS). There's a special place in the U.S. where these precise machines needed for LC/MS panels run only on two specific days a week. So, sometimes the clock ticks a bit while we wait for samples to return from their initial collection points. Results may take 7 business days.

Thyroxine-binding globulin (TBG) is a globulin that binds thyroid hormones in circulation. It is one of three transport proteins (along with transthyretin and serum albumin) responsible for carrying the thyroid hormones thyroxine (T4) and triiodothyronine (T3) in the bloodstream. Of these three proteins, TBG has the highest affinity for T4 and T3 but is present in the lowest concentration. Despite its low concentration, TBG carries the majority of T4 in the blood plasma.