The thyroid gland produces and secretes T4, otherwise known as thyroxine. Proteins bind to T4 and carry it throughout the bloodstream. Once in the tissues, T4 is released from the proteins and is now free to convert into the more active form called T3. For this reason, many doctors believe that measuring free T4 is a more sensitive test for thyroid hormone production.

T3 or triiodothyronine is the active form of the thyroid hormone. T3 acts as a metabolic throttle for fueling all of the daily cellular functions. Free T3 is the unbound portion of T3 that is biologically active.

This test measures thyroglobulin antibodies commonly present in patients with Hashimoto's thyroiditis. Antibodies against the protein thyroglobulin can result in the destruction of thyroid cells. This destruction can lead to hypothyroidism. NOTE: Dietary supplements containing biotin may interfere in assays and may skew results to be either falsely high or falsely low. For patients receiving the recommended daily doses of biotin, draw samples at least 8 hours following the last biotin supplementation. For patients on mega doses of biotin supplements, draw samples at least 72 hours following the last biotin supplementation.

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.