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- Best medical support: LetsGetChecked
- Most comprehensive: Everlywell
- Best for specialized care: Paloma Health
- Most detailed results: ZRT Laboratory
The thyroid is a small, butterfly-shaped gland located near the throat. Your thyroid makes hormones that regulate the way your body uses energy. It also plays an important role in regulating your weight, body temperature, muscle strength, and even your mood.
Thyroid-stimulating hormone (TSH) is produced by the pituitary gland, situated at the base of the brain. When the pituitary gland releases TSH, it stimulates thyroid hormone production.
TSH tests are often performed to detect thyroid disorders, which affect about 20 million people in the United States.
If your TSH levels are too low or too high, this may indicate an overactive or underactive thyroid, respectively.
The pituitary and thyroid glands work together in a negative feedback loop.
When the thyroid gland produces too little thyroid hormone (hypothyroidism), the pituitary gland releases more TSH. In this case, the pituitary gland is trying to stimulate the thyroid gland to make more thyroid hormone. When the thyroid gland is producing too much thyroid hormone (hyperthyroidism), the pituitary gland releases less TSH in order to slow down thyroid production.
TSH is a more stable hormone than other thyroid hormones. Its levels tend to be lowest in the late afternoon and highest between 11 p.m. and 5 a.m. And since TSH secretion is very sensitive to minor increases and decreases in free T4 (fT4) hormone before fT4 abnormalities can be caught, this makes the TSH test a reliable tool for diagnosing hypothyroidism or hyperthyroidism.
At-home thyroid tests are available as a convenient, cost-effective alternative to traditional in-office testing. At-home testing options usually require a blood sample collected via a finger prick.
What are free T4 and T3? Plus, other abbreviations to know
- FT4: free thyroxine, a hormone that the thyroid produces; “free” refers to the fact that its particles do not attach to other particles
- FT3: free triiodothyronine, a hormone that the thyroid produces and that doesn’t attach itself to other particles in the bloodstream
- TSH: thyroid-stimulating hormone
- TPO antibodies (TPOab): thyroid peroxidase antibodies. Thyroid peroxidase is an enzyme that the thyroid gland makes; high levels of antibodies for this enzyme can reflect a thyroid or autoimmune issue.
- Tgbn: thyroglobulin, a protein made in the thyroid gland
Your doctor may recommend a TSH test if you’re experiencing symptoms of hypothyroidism or hyperthyroidism. A TSH test may also be used to detect thyroid disorders in people not experiencing any symptoms.
- weight gain
- hair loss
- slow heart rate
- hand tingling or pain
- irregular period
- muscle cramps
- impaired memory
- cold intolerance
- dry skin
- weight loss
- rapid heart rate
- goiter (enlarged thyroid)
- irregular period
- frequent bowel movements
- heat intolerance
- excessive sweating
- difficulty sleeping
- low sex drive
TSH tests usually involve a blood test. In a clinical setting, a healthcare professional will draw blood usually from your arm.
At-home TSH tests are much different. A small blood sample is required, but there are no needles involved. At-home TSH tests are self-administered by pricking your finger.
There are no special preparations needed for a TSH test. You aren’t required to fast or avoid beverages.
Traditional blood tests for TSH levels don’t require much preparation either. However, if you’re getting other bloodwork done in addition to a TSH test, your doctor may require you to fast.
Some medications can interfere with the results of the test. If you take any medications, check with your doctor to see if you should pause your medication before the test to avoid inaccurate results. Don’t stop taking your medication unless your doctor instructs you to.
The normal range of TSH levels is 0.4 to 4.0 milli-international units per liter. The range may be narrowed to 0.5 to 3.0 milli-international units per liter for individuals who are already being treated for a thyroid disorder.
TSH results indicate whether the thyroid is underactive, overactive, or normal:
- overactive: lower than 0.4 milli-international units per liter
- normal: 0.4 to 4.0 milli-international units per liter
- underactive: greater than 4.0 milli-international units per liter
TSH test results that are outside the normal range may warrant medication for treatment.
At-home testing tends to be more convenient and affordable than a visit to the laboratory. The
We chose the best at-home TSH tests by considering pricing, insurance coverage, and online reviews. We also ensured the companies listed offer discreet packaging, patient confidentiality, and medical support.
A note on price
We worked hard to choose the best at-home TSH tests that will fit your budget. Some of these tests you may be able to pay for with a flexible savings account (FSA) or health savings account (HSA).
- $ = under $100
- $$ = $100 – $175
- $$$ = $175 and over
Best medical support
- Price: $
- Insurance coverage: doesn’t accept health insurance, but you can pay with a flexible savings account (FSA) or health savings account (HSA)
- Results: within 2–5 days
With a team of nurses available 24/7, LetsGetChecked offers the privacy, convenience, and affordability of at-home testing, but the medical support of traditional in-office visits. The company offers two at-home thyroid testing options: thyroid test and thyroid antibody test. Both check for TSH levels.
After you receive the unmarked box in the mail, you’ll provide a small blood sample. To do this, simply follow the instructions to safely prick your finger and collect the sample. Send your sample to the lab, and await your online results in 2 to 5 days.
LetsGetChecked thyroid test pros
- Thyroid Test measures: TSH, free T4, free T3
- Thyroid Antibody Test also measures: thyroglobulin antibodies, thyroid peroxidase antibodies
- licensed medical professionals review results
- CLIA certified and CAP-accredited US laboratories
- can purchase one test or an ongoing subscription
LetsGetChecked thyroid test cons
- slightly more expensive than other options
- self-collecting blood sample can be messy
- testing doesn’t include health assessment services
- Price: $99 for nonmembers or $24.99 for members
- Insurance coverage: doesn’t accept health insurance, but you can pay with an HSA or FSA
- Results: within 5 days
The Everlywell thyroid test checks for the three main thyroid hormones, including TSH levels, and thyroid antibodies. You’ll prick your finger to collect a blood sample, return it with prepaid shipping, and view your results online within days.
Everlywell works with
Everlywell thyroid test pros
- measures free T3, free T4, and TSH, and TPO
- CLIA certified labs
- test results reviewed by a board certified physician
Everlywell thyroid test cons
- not the cheapest on the list, but discounts may be available on the website
- test results may take longer than most
- some reviewers say they wished more information was provided to contextualize their results
- some reviewers say the 10 blood spots required were difficult to obtain
Best for specialized care
- Price: $99
- Insurance coverage: doesn’t accept insurance for services and testing; but you may receive reimbursement for consultations, and your prescriptions may be covered by insurance
- Results: within 5 days
Paloma Health specializes in thyroid disorders. The company offers telemedicine services, at-home testing, and vitamin supplements for people with hypothyroidism. The at-home thyroid blood test covers TSH, T3, T4, and TPO antibodies. You can also add testing for vitamin D and reverse T3 levels at checkout.
The finger prick test can be done at home and only takes a few minutes to prepare and collect. Your results are analyzed by a CLIA certified laboratory and reviewed by a doctor.
You can expect to receive your results within 5 days. Depending on your results, you’ll receive guidance on what to do next.
Paloma Health thyroid test pros
- measures free T3, free T4, TSH, and TPO
- vitamin D test or reverse T3 test are available as add-ons
- CLIA certified labs
- reviewed by a board certified physician
- guidance on what to do next is provided through personalized explanations and a free follow-up call
Paloma Health thyroid test cons
- some reviewers complain that the results took longer than 5 days to get back
- website has many sales pop-ups
- some reviewers complain about poor customer service experience
Most detailed results
- Price: $175–$349
- Insurance coverage: bills select health insurance companies as an out-of-network provider
- Results: within 5–7 days
ZRT Laboratory has the most expensive TSH test we’ve seen, but the tests are comprehensive, and the results are detailed.
The service offers three thyroid tests that check TSH levels: two blood test kit options and one blood spot and dried urine test kit which also tests nutrients. It can be difficult to know which test to choose without guidance from a doctor.
The two blood test kits use a finger prick to collect a blood spot sample. Your results should be returned to you within 5 to 7 days of your sample arriving at the lab. The results include two graphs showing your hormone levels and symptoms, as well as an individualized evaluation of your hormones.
ZRT Laboratory thyroid test pros
- Essential Thyroid option measures TSH, free T3, free T4, and TPO antibodies
- Elite Thyroid option measures TSH, TPO, total T4, free T4, free T3
- offers detailed results from clinical consultants, including an evaluation of your hormone levels
- method of extraction does not require you to stop taking supplemental hormones prior to testing
- works with select insurance companies
ZRT Laboratory thyroid test cons
- most expensive test on this list
- test options can be complicated to choose from
- some reviewers report longer than usual wait times for results
|Price||Insurance coverage||What the test measures|
|LetsGetChecked||$99–$119||doesn’t accept health insurance, but you can pay with an HSA or FSA||TSG, T4, and T3|
|Everlywell||$99 for nonmembers or $24.99 for members||doesn’t accept health insurance, but you can pay with an HSA or FSA||TSH, T3, T4, and thyroid peroxidase antibodies (TPO)|
|Paloma Health||$99||health insurance isn’t accepted for services and tests, but you may receive reimbursement for consultations, and your prescriptions may be covered by insurance; HSA or FSA is also accepted||TSH, T3, T4, and TPO with options to add vitamin D and reverse T3|
|ZRT Laboratory||$175–$349||bills select health insurance companies as out-of-network providers||TSH, T3, T4, and TPO with options to add free T3, free T4, thyroglobulin (Tgbn), iodine, bromine, selenium, arsenic, cadmium, mercury, and creatinine|
At-home TSH tests are very similar in how they are performed and health insurance coverage.
If you don’t like getting your blood taken, you may choose to do an at-home TSH test, which requires a simple prick of the finger to draw a small blood sample.
At-home test kits usually don’t accept insurance, but most accept HSA and FSA for payment. Some companies will bill some health insurance providers as an out-of-network provider, which may help reduce the cost.
Where at-home TSA tests tend to differ are the prices and the time it takes to receive your results.
Most cost around $99 but can be as low as $24.99 or as high as $349 depending on the type of test and membership status to certain companies.
You can expect to get your results within 5 days, but some take as little as 2 days or as long as 7 days.
You can send your doctor your test results from your at-home TSH test.
If you have a history of a thyroid disorder or are currently being treated for a thyroid disorder, you may want to see your doctor if your results are outside the range of 0.5 to 3.0 milli-international units per liter.
If you’ve never been treated for a thyroid disorder, you should see a doctor if your results are outside the normal range of 0.4 to 4.0 milli-international units per liter.
What should your TSH levels be?
High TSH levels may indicate an underactive thyroid, while low TSH levels may signal an overactive thyroid.
When should TSH levels be checked?
If you have symptoms or a history of thyroid disorders, your doctor may recommend a TSH test.
If the test reveals an imbalance and you begin medication to get your levels within the standard range, your doctor will likely check your thyroid levels yearly.
If you don’t have a history of thyroid disorders, your doctor may only recommend a TSH test if you’re experiencing symptoms. In general, thyroid testing is recommended for older adults, especially women.
Are TSH tests accurate?
The accuracy of thyroid blood tests varies. Some factors may affect your results, such as an illness, medications, supplements, fasting, and pregnancy.
For this reason, endocrinologists recommend testing TSH twice to confirm hypothyroidism or hyperthyroidism. TSH is a more stable hormone, while T4 and T3 levels can vary more over a day and from day to day.
When possible, an at-home test should be followed-up by a conversation with a health professional and a lab test ordered by a doctor to confirm the results.
If you have symptoms or a history of thyroid disorders in your family, consider testing your TSH levels. This usually requires a blood test done in person at a doctor’s office or laboratory.
Most at-home TSH tests require a small blood sample collected via a finger prick. At-home tests are typically analyzed by accredited laboratories and reviewed by doctors.
Lacey Bourassa is a health, wellness, and beauty writer based in Southern California. She holds a BA in English. Her work has appeared in digital publications like Livestrong, Verywell, Business Insider, Eat This Not That, and others. When she’s not writing, Lacey is likely pursuing her other interests: skin care, plant-based cooking, pilates, and traveling. You can keep up with her by visiting her website or her blog.
Johanna Sorrentino is a writer, editor, and wayfarer. Her appetite for empowering information and great storytelling is matched only by her appetite for cheese and chocolate. Learn more about her at johannasorrentino.com.