The analysis of thyroid hormones and antibodies together may improve the accuracy of diagnosis and clinical success. The American Thyroid Association estimates that approximately 20 million Americans have thyroid disease, and approximately 60% of those with thyroid disease areunaware of their condition. Many patients with thyroid disorders may remain undiagnosed in many patients with asymptomatic or non-specific clinical presentations.
Patients with conditions such as osteoporosis, dyslipidemia, atrial fibrillation, or infertility may be evaluated for thyroid disorders. Current recommendations for diabetic women planning pregnancies include a full thyroid panel with antibodies preconception, with monitoring during pregnancy and three months post-partum.

Measuring only thyroid stimulating hormone (TSH) may be misleading in a variety of circumstances, including the recent treatment of thyrotoxicosis, pituitary disease, non-thyroid illness, thyroid hormone resistance and rare TSH-secreting tumors. Joshi (2011) recommends monitoring free T3 and T4 in patients with low serum TSH levels, to establish patterns of increasing or decreasing values over time. The main purpose of free-T4 and free-T3 assays is to discern thyrotoxicosis from hypothyroidism and the euthyroid state. Less than one percent of thyroid hormone is free unbound hormone; this one percent is the biologically active fraction. Total T4 and T3 values cannot reliably distinguish between these conditions due to hereditary and acquired variations in the concentrations of thyroid hormone binding proteins. Measuring T3 levels during treatment with antithyroid medication may have predictive value in the management of autoimmune thyroiditis, such as Grave’s disease.
The recognition of auto-immunity as a leading cause of thyroid dysfunction has led to the evaluation of auto-antibodies in thyroid testing. Thyroid antibody tests are used to distinguish autoimmune thyroid disorders from other thyroid dysfunction. Thyroid antibody tests, such as thyroid peroxidise antibodies (TPOAb) and thyroglobulin antibodies (TgAb), are most important in patients with other, pre-existing autoimmune conditions, for example, systemic lupus erythematosus, rheumatoid arthritis, and Celiac disease.

Elevations of thyroid antibodies or low levels of thyroid hormones may prompt the evaluation of iodine and selenium status, as iodine deficiency may be exacerbated by deficiencies of selenium, iron or Vitamin A. Iodine is an essential component of thyroid hormones, and iodine deficiency is a world-wide health problem. Declining levels of urinary iodine in the US population has been documented by Centers for Disease Control and Prevention (CDC, 2002). The enzymes that convert T3 to T4 are selenium dependent. Low selenium levels have been associated with goiter and thyroid nodules in European women.
The evaluation of thyroid hormones and thyroid antibodies is an opportunity to discover and treat the functional cause of vague symptoms and chronic complaints. The analysis of thyroid hormones and antibodies together may improve the accuracy of diagnosis and clinical success.