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Hashimoto's thyroiditis
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==== T<sub>3</sub> or T<sub>4</sub> levels test ==== These tests detect levels of two thyroid hormones: [[Thyroxine]] ([[Thyroxine|T<sub>4</sub>]]) and [[Triiodothyronine|Tri-iodothyronine]] ([[Triiodothyronine|T<sub>3</sub>]]). Low levels of these hormones (hypothyroidism) may indicate autoimmune damage to the thyroid due to Hashimoto's, while elevated levels may indicate an attack of destructive thyrotoxicosis.<ref name="Ramos-Levi2023" /> Hashimotos with normal levels is possible however. Free or total levels can be measured. Typically, Free T<sub>4</sub> is the preferred test for hypothyroidism,<ref name="Van Uytfanghe-2023">{{cite journal | vauthors = Van Uytfanghe K, Ehrenkranz J, Halsall D, Hoff K, Loh TP, Spencer CA, Köhrle J | title = Thyroid Stimulating Hormone and Thyroid Hormones (Triiodothyronine and Thyroxine): An American Thyroid Association-Commissioned Review of Current Clinical and Laboratory Status | journal = Thyroid | volume = 33 | issue = 9 | pages = 1013–1028 | date = September 2023 | pmid = 37655789 | pmc = 10517335 | doi = 10.1089/thy.2023.0169 }}</ref> as Free T<sub>3</sub> [[Immunoassay|immunoassay tests]] are less reliable at detecting low levels of thyroid hormone,<ref>{{Cite book | author = Royal College of Pathologists of Australasia | chapter = Free T3 | chapter-url=https://www.rcpa.edu.au/Manuals/RCPA-Manual/Pathology-Tests/F/Free-T3 | title = Royal College of Pathologists of Australasia Manual}}</ref> and they are more susceptible to interference.<ref name="Van Uytfanghe-2023" /> Both immunoassay tests of Free T<sub>4</sub> and Free T<sub>3</sub> may overestimate concentrations, particularly at low thyroid hormone levels, which is why results are typically read in conjunction with TSH, a more sensitive measure.<ref name="Welsh-2016">{{cite journal |vauthors=Welsh KJ, Soldin SJ |date=December 2016 |title=DIAGNOSIS OF ENDOCRINE DISEASE: How reliable are free thyroid and total T3 hormone assays? |journal=European Journal of Endocrinology |volume=175 |issue=6 |pages=R255–R263 |doi=10.1530/EJE-16-0193 |pmc=5113291 |pmid=27737898}}</ref> [[Liquid chromatography–mass spectrometry|LC-MSMS]] assays are rarer, but they are "highly specific, sensitive, precise, and can detect hormones found in low concentrations."<ref name="Welsh-2016" />
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