Has NHS routine thyroid testing changed? Now getting free T3/free T4 as well as TSH

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I get routine thyroid monitoring tests every six months (because of a medication I take that can affect it), and it's always just been TSH, with occasionally a follow-up free T4 or TPO Ab test if the TSH result is a bit wonky.

I just got the form for my latest routine test, and there's suddenly free T3 and T4 on there too, for no reason I can think of. My last TSH was in the normal range, so that's not what's triggered it. I can't find anything about guidance having changed — has anyone else who gets routine thyroid tests come across a change like this recently? If not, I guess my doctor is just having a bit of a thorough moment…

Wow, lucky you! (Seriously!)

I've changed doctors and my new GP has requested on mine TFT and FT3 which I don't usually have
He actually requested 16 tests

Fair enough, I'll take that Woolly 😅 It must be very frustrating if it's a test you think could reveal something important, but the doctors refuse to order it. I'm not sure why they'd have decided I needed it TBH… that's why I wondered if it was a routine blanket change. I mean, I'm not unhappy about an extra test, and maybe it'll be useful — it just surprised me

Blooming eck awkward, they'd better leave some blood behind for you I have to have regular blood tests for three completely separate chronic conditions, so I sympathise with the huge list of tests thing, though all of mine are pretty dull, routine ones. I hope your doctors aren't concerned about something serious. (Well, all health stuff is serious, but hopefully you know what I mean.)

It's always possible the lab will decline to do the tests, too, I suppose, if they think they're unnecessary.

Who can fathom the mind of a doctor 😅 One of mine once decided to do a coeliac test on me for practically no reason, and it came back off-the-scale positive. Sometimes I don't think even they know how their uncanny hunches work.

I’ve been lucky as I’ve always had my T3 etc done. Also had an amazing doctor once who looked through my notes and said “you need testing for something else asap”. Sent me off to hospital and I was diagnosed with lupus and seen by a rheumatologist that week… some doctors are just amazing. She was a locum as well 😊

Well, I got my blood results back a few days ago, and the lab did indeed test the requested TSH, free T3 and free T4, all of which came back within reference ranges.

Still no clue why the doctor requested them, but good to know they're normal, I guess 😅 (I mean, my TSH was upper end of reference range, but there's reasons for that.)

I'd be extremely surprised if a lab declined to do tests. It isn't their job to specify which tests the doctor's patient should have.

It's not totally unusual for labs to decline to do certain tests IME, if it's an unusual/arduous/expensive test and sufficient justification hasn't been given. They're professionals with their own guidelines to follow and judgements to make, not just an automated service.

They have some discretion as to what tests they'll do, and what follow-up tests, too. For example, a while back my GP requested a TTG (coeliac disease marker) test for me, and because that came back positive, the lab did a follow-up, more expensive/difficult EMA test, which wasn't explicitly requested but I think is part of their protocol. But because the (extreme, off-the-scale) positive TTG result was such a surprise to me and my doctor, my GP had my TTG tested again in case of error. That came back equally positive, but they didn't do the expensive follow-up test again because there was no need.

Just testing TSH alone tells you nothing, my TSH might be in range but my t4 maybe below reference range which leaves me feeling like rubbish and the GP doesn't always test t3 t4 which then means I can feel like crap for months on end. It should be routine to test all 3.

Labs do decline believe it or believe it not.

They absolutely do. I've had them refuse to do my T3 test twice, even when the GP put it on the form. And there is a similar story in the many thyroid groups I belong to.

The medical establish has basically been indoctrinated into believing that TSH will tell you all you need to know. Clearly that is not true, and I don't know how it's been allowed.

Our lab will basically only test your T3 if your TSH or T4 are out of range. Fortunately for me, both of mine are, as I am on T3 only medication, and that can make your blood test results look very odd (and actually is pretty pointless doing them, as the range wasn't designed for people on liothyronine). The last 2 tests I've had, I've had the GP phoning me in a panic as my T4 is basically zero - not a surprise since I've not take levothyroxine since December, but they can't seem to get their head round that at all!