Which
blood tests
do I need
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FIRST-TIME BASICS
Thyroid
• FT3 (triiodothyronine, free)
• FT4 (thyroxine, free)
• RT3 (reverse T3)
• Thyroid antibodies
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• TPOAb (thyroid peroxidase antibody)
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• TgAb (thyroglobulin antibody or anti thyroglobulin antibody, also
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known as ATA)
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Iron
• Serum iron (sometimes called total iron)
• TIBC (total iron binding capacity) -or- transferrin
• Saturation (this is a calculation of the first two)
• Ferritin
Plus
BMP or CMP (basic or comprehensive chemistry panel)
• CMP may be called Chemistry Panel; Chemistry Screen; Chem,
SMA, SMA or SMAC followed by number 12, 14, 20
• BMP may be called Chem, SMA or SMAC followed by number 7
• Panel will vary from lab to lab
Basic panel always includes:
• Fasting glucose
• Electrolytes
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• Calcium
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• Sodium
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• Potassium
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• CO2 (carbon dioxide, bicarbonate)
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• Chloride
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• Kidney tests
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• BUN (blood urea nitrogen)
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• Creatinine
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Comprehensive panel adds:
• Proteins
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• Albumin
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• Total protein
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• Liver tests
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• ALP (alkaline phosphatase)
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• ALT (alanine amino transferase, also called SGPT)
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• AST (aspartate amino transferase, also called SGOT)
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• Bilirubin
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Vitamin B12/Folate
Vitamin D 25(OH)D3 (calcifediol)
• The actual substance that is used in the body is 1,25(OH)2D3
(calcitriol). However, it has a very short half life (possibly only a few
hours) and circulates in serum at only 0.1 percent of its immediate
precursor 25(OH)D3 (calcifediol), which has a half life of two to four
weeks. Thus, it is 25(OH)D3, the most abundant and stable vitamin D
metabolite in human serum that is used to evaluate vitamin D status.
TESTS SPECIFIC TO RELATED HEALTH ISSUES
Symptoms of electrolyte imbalance with good serum levels
• RBC potassium
• RBC magnesium
Glucose control
• HbA1c
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• provides a measure of the average level of blood glucose over the
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previous two to three months
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• C-peptide
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• more accurate measure of insulin production than a direct blood
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test for insulin, as much of the insulin is broken down very quickly
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after release by the pancreas
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• Glucose tolerance test (GTT)
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• challenges the body with a large dose of liquid glucose
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• a healthy body will respond with enough insulin to bring glucose
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levels back into a healthy range within, usually, two hours
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• often used during pregnancy to diagnose gestational diabetes
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• may result in reactive hypoglycemia
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• a protein snack can be carried for immediately after the test
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• patient should be driven home
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Inflammation
• hs-CRP (high sensitivity, cardiac specific)
• Sed rate (sedimentation rate)
• Galectin-3
Low aldosterone symptoms
• Aldosterone
• Renin activity
• BMP or CMP for sodium and potassium
Sex hormone imbalance
• Progesterone
• Estrogens
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• Estradiol (E2)
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• Estrone (E1) particularly important post meno
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• Estriol (E3) elevated in pregnancy; blood testing is not sensitive
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enough to measure low levels at other times
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• Testosterone
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• Free testosterone
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• Bioavailable testosterone
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• Total testosterone
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• SHBG (sex hormone binding globulin)
• LH (luteinizing hormone)
• FSH (follicle stimulating hormone)
• Free and bioavailable testosterones can be calculated from total
• The most effective estrogen testing, and also the most expensive, is
24-hour urine testing. Its primary advantage is accurate testing for E3
estriol, the protective estrogen, as blood serum testing for estriol is
designed for the very high levels found in pregnancy and are not
generally sensitive enough for accurate measurement of very low
non-pregnant levels
• Prior to supplementation, saliva testing can be utilized to evaluate
levels. Once supplementing, saliva test results are not accurate and
testing should be done in blood serum. Because of this, there is an
advantage to starting out with blood serum testing
The range of normal day-by-day levels of
progesterone, estradiol, lutenizing hormone and
follicle stimulating hormone can be seen here
Note: Once supplementing sex hormones, blood serum is more accurate than
saliva. The most accurate – and also most expensive – is 24 hour urine testing.
Low ferritin and low iron not responsive to treatment
• CBC (complete blood count)
• Reticulocyte count (when hemoglobin and/or red blood cells are low)
Combination of high ferritin and low iron without inflammation
• Serum copper
• Ceruloplasmin
• Plasma zinc
• Molybdenum
Hyperthyroid
• TSI (thyroid stimulating immunoglobulin, also called TSH receptor
antibody, TRAb or TRAK)
• ANA (antinuclear antibody)
Pernicious Anemia
• MMA (methylmalonic acid)
H. pylori
• Urea breath test
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• detects infection in the stomach (not intestines or elsewhere)
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• capsule, liquid, or pudding containing urea “labeled” with a
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radioactive carbon atom is ingested
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• exhalation is evaluated
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• Serum blood test
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• reflects untreated infection at any time
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• does not prove a current, active infection
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• measures specific antibodies
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• Stool test
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• measures h. pylori antigens (foreign proteins)
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• reflects an active infection
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Atrophic gastritis
• Antibody tests for parietal cells and intrinsic factor
Celiac disease
Celiac disease can be confirmed only with a biopsy, but there are a
variety of antibodies that can be tested in blood as well as genetic
testing. A discussion of testing is found here.
• Negative celiac testing does not preclude a sensitivity to gluten
Repeat blood tests during treatment
Natural desiccated thyroid hormone
• FT3 (triiodothyronine, free)
• FT4 (thyroxine, free)
• RT3 (reverse T3)
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• at 6 weeks
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• then as needed
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T3-only thyroid hormone
• FT3 (triiodothyronine, free)
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• at 4 weeks
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• then as needed
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Iron supplementation
• Serum iron (sometimes called total iron)
• TIBC (total iron binding capacity) -or- Transferrin
• Saturation (this is a calculation of the first two)
• Ferritin
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• every five to six weeks while supplementing
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• discontinue iron and vitamin C for five days
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Hydrocortisone replacement
• BMP or CMP to monitor sodium and potassium
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• at 2 weeks
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• until potassium is stable
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• then every four to five weeks
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Fludrocortisone
• BMP or CMP to monitor sodium and potassium
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• before each dose increase
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• until potassium is stable
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• at least every four to five weeks
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