This panel includes comprehensive testing of the thyroid stimulating hormone (TSH) in addition to free thyroxine (T4) and free triiodothyronine (T3).

The thyroid stimulating hormone (TSH) is produced and secreted by the pituitary gland and stimulates the thyroid to produce T3 and T4. When TSH is elevated, low thyroid function may be indicated. If TSH is low it is indicative of high thyroid function. 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.

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.

These two tests measure antithyroglobulin antibodies and Anti-TPO antibodies that are commonly present in patients with Hashimoto's thyroiditis, Graves disease and other thyroid-related conditions. Antibodies against the protein thyroglobulin can result in the destruction of thyroid cells. TPO antibodies are created when the immune system of a person targets by pure error elements of the thyroid gland or protein, leading to chronic thyroid inflammation, tissue damage, and damage to the thyroid function. Leaving this untreated may cause severe health issues. 

Patients with diabetes may get a C-peptide test as a means of distinguishing type 1 diabetes from type 2 diabetes or Maturity onset diabetes of the young (MODY). Measuring C-peptide can help to determine how much of their own natural insulin a person is producing as C-peptide is secreted in equimolar amounts to insulin. C-peptide levels are measured instead of insulin levels because C-peptide can assess a person's own insulin secretion even if they receive insulin injections, and because the liver metabolizes a large and variable amount of insulin secreted into the portal vein but does not metabolize C-peptide, meaning blood C-peptide may be a better measure of portal insulin secretion than insulin itself.