Comprehensive Thyroid Profile

The Comprehensive Thyroid Profile by ZRT Laboratory offers a comprehensive assessment of thyroid function, providing valuable insights into various aspects of thyroid health. This profile includes measurements of key thyroid hormones, including free triiodothyronine (fT3), free thyroxine (fT4), and thyroid-stimulating hormone (TSH), which play crucial roles in regulating metabolism, energy production, and overall well-being.  [14.] Additionally, the test assesses the thyroid antibody anti-thyroid peroxidase (anti-TPO) which is indicative of autoimmune thyroid conditions like Hashimoto's thyroiditis and Grave’s Disease.  [8.,14.] 

Additionally, The Comprehensive Thyroid Profile by ZRT Laboratory includes a panel of urinary elemental minerals and heavy metals to help clinicians understand whether thyroid imbalance may be driven by low nutrient status, or by the presence of toxins.  [22.]

Overall, the Comprehensive Thyroid Profile by ZRT Laboratory aids clinicians in diagnosing thyroid disorders, monitoring treatment efficacy, and guiding personalized interventions to optimize thyroid health and overall patient outcomes.

What is Included in the Comprehensive Thyroid Panel by ZRT Laboratory?

The Comprehensive Thyroid Panel by ZRT Laboratory includes the following hormones and biomarkers:

Thyroglobulin: a tyrosine-rich protein typically found inside the thyroid, it forms thyroid hormone precursors when iodine is attached.  Low iodine causes thyroglobulin to accumulate, making it an effective marker for iodine deficiency or insufficiency.  [10.]

Total Thyroxine (T4, total): thyroxine is the predominant thyroid hormone produced by the thyroid gland, and converted peripherally to the active form, T3 or triiodothyronine.  Total T4 levels reflect the thyroid gland’s ability to produce T4 thyroid hormone, and in conjunction with free T4 levels it may reflect the amount of thyroxine binding hormone in the bloodstream.  [.2]

Free Thyroxine (fT4): fT4 is the precursor to fT3 and serves as an important indicator of thyroid gland function. It helps assess thyroid hormone production and informs thyroid hormone conversion in the body.  [14.]

Free Triiodothyronine (fT3): fT3 is the active form of thyroid hormone and plays a crucial role in regulating metabolism, energy production, and overall cellular function.  [14.]

Thyroid-Stimulating Hormone (TSH): TSH is produced by the pituitary gland and regulates thyroid hormone production. Elevated or suppressed levels can indicate thyroid dysfunction and help diagnose hypothyroidism or hyperthyroidism [11.]

Anti-Thyroid Peroxidase Antibodies (anti-TPO): These antibodies target thyroid peroxidase, an enzyme involved in thyroid hormone production. Elevated levels suggest autoimmune thyroid diseases like Hashimoto's thyroiditis.  [8.]

The Comprehensive Thyroid Profile by ZRT Laboratory also assesses urinary levels of the following elements and heavy metals: 

Iodine: iodine is a trace element required to make thyroid hormone.  Optimizing iodine levels is essential for healthy thyroid function.  Iodine deficiency and iodine excess have both been implicated in suboptimal thyroid function and thyroid disease.  [4., 7.]

Bromine: bromine is a halogen element that naturally occurs in many foods including grains, nuts and fish; it is structurally similar to iodine.  Bromine has no known health benefits; it is typically excreted in the urine, but levels in excess of what can be excreted may compete with iodine for entry into the thyroid gland and cause a decrease in thyroid hormone production.  [7.]

Selenium: the thyroid gland is rich in the mineral selenium.  In cases of suboptimal or depleted selenium levels, supplementation may promote improvement in Hashimoto’s and Graves Disease.  [18.]  Adequate selenium levels may also promote optimal thyroid function.  [15.]

Lithium: elevated lithium levels may impair thyroid hormone release from the thyroid gland.  Elevated levels of lithium, often due to medication from bipolar disorder, has been correlated with hypothyroidism, hyperthyroidism, and goiter. [6.]

Arsenic: arsenic’s toxic effects on thyroid function are well documented.  [3.]  Elevated urinary arsenic levels are associated with decreases in T3 and T4 levels, and increases in TSH.  [3.]

Cadmium: cadmium is a heavy metal that is implicated in thyroid toxicity and impaired thyroid function.  [12.]  Cadmium toxicity may be associated with an increase in TSH.  [19.]

Mercury: mercury has been implicated in the pathogenesis of thyroid cancers, autoimmune thyroiditis, and hypothyroidism.  [9.]  It may also be associated with decreases in T3 and T4 [19.]

Creatinine is included to assess for normal kidney function and correct for hydration status; alterations outside of expected creatinine levels affect the validity of urine tests.  

Urinary Testing for Nutrients and Metals

Urine testing for iodine, selenium, and bromine levels, and heavy metals like arsenic, cadmium, and lead can provide valuable insights into an individual's nutritional status and exposure to environmental toxins. Studies have shown that urine iodine and selenium levels can reflect recent dietary intake, making urine testing a useful tool for assessing nutritional adequacy.  [7., 20., 21.]  Urine testing for arsenic has shown good correlation with blood levels, and have been associated with thyroid dysfunction.  [3.]  Likewise, urinary testing for mercury and cadmium levels is recommended.  [1., 16.]  

Who Could Benefit from the Comprehensive Thyroid Profile by ZRT Laboratory? 

The Complete Thyroid Profile by ZRT Laboratory provides valuable insights into thyroid function and autoimmunity, shedding insight into hormone imbalances and enabling personalized management approaches for improved patient outcomes.

The following groups of people may benefit from the Complete Thyroid Profile by ZRT Laboratory: 

Individuals with suspected thyroid dysfunction: The profile helps diagnose thyroid disorders by assessing thyroid hormone levels (TSH, T4, T3) and detecting markers of thyroid autoimmunity (TPO antibodies).  [5., 7.]

Individuals with autoimmune thyroid conditions: Monitoring TPO antibodies helps assess disease activity and guide treatment decisions in conditions like Hashimoto's thyroiditis or Graves' disease [7.]

Patients with symptoms of thyroid dysfunction: The profile aids in identifying the underlying cause of symptoms such as fatigue, weight changes, infertility, brain fog, and mood disturbances, which could be attributed to thyroid dysfunction.  [5.]

Individuals with a family history of thyroid disorders: For those with a family history, the profile can provide early detection of thyroid abnormalities and allow for preventive measures to be taken. 

Patients with unexplained infertility or menstrual irregularities: Thyroid dysfunction can affect reproductive health, and the profile helps identify thyroid imbalances that may be contributing to fertility issues or menstrual irregularities. [17.]

Individuals with unexplained fatigue: Thyroid dysfunction, particularly hypothyroidism, is a common cause of fatigue. The profile assesses thyroid hormone levels and thyroid autoimmunity markers, helping identify underlying thyroid dysfunction as a potential cause of fatigue.  [5.]

Individuals experiencing unexplained weight gain: Hypothyroidism can lead to weight gain due to a slowed metabolism. By evaluating thyroid hormone levels, the profile aids in diagnosing hypothyroidism, allowing for appropriate treatment and management to address weight gain.  [14.]

People with suspected hormone imbalances: Thyroid hormones play a crucial role in regulating various hormonal pathways in the body. Imbalances in thyroid function can disrupt other hormone systems, contributing to symptoms such as irregular menstrual cycles, mood disturbances, and libido changes. The profile provides insights into thyroid function, guiding further investigation and treatment of hormone imbalances.  [13.]

Individuals with symptoms of metabolic dysfunction: Thyroid hormones influence metabolism, and imbalances can affect metabolic rate and energy expenditure. The profile evaluates thyroid hormone levels and thyroid autoimmunity markers, aiding in the identification of thyroid-related metabolic dysfunction.  [5.]

These groups benefit from the detailed information provided by the Complete Thyroid Profile, allowing for accurate diagnosis, personalized treatment plans, and improved management of thyroid conditions.

Collection and Shipping: 

Key Details:

The Comprehensive Thyroid Profile by ZRT Laboratory allows sample collection any day of the month, except during menstruation.

Specific dietary restrictions apply 24 hours prior to and on the day of collection, including avoidance of certain foods high in iodine and selenium.

Preparation for hormone users involves careful timing, particularly for those using topical, oral, troche, or sublingual hormones.  Individuals should contact their ordering provider for more details.  

Samples should be shipped back to the lab promptly after collection to ensure accurate results.

Preparation:

Users must adhere to dietary restrictions and hormone usage guidelines to ensure accurate results.

Avoid the following foods for 24 hours prior to and on the day of urine collection:

Seafood

Seaweed/kelp

Dairy products

Brazil nuts

Any food high in iodine

Any food high in selenium

Any iodine or selenium supplement (such as Iodoral or multi-vitamins) taken periodically

If you take daily iodine or selenium supplements (Iodoral, multi-vitamins, etc.), continue taking them as normal.

Timing for sample collection varies depending on the type of hormone used, with specific guidance for different hormone delivery methods.  Individuals should contact their ordering provider for more information.

Collection Instructions: Timing

COLLECTION 1 - URINE: Immediately upon waking.

COLLECTION 2 - BLOOD SPOT: Within 1 hour of waking.

COLLECTION 3 - URINE: Before bed.

Collection Instructions: Urine:

Urine collection involves two samples: one immediately upon waking and another before bed.

For urine collection, follow these steps:

Write your name, date, and time on the collection card.

Open the card cover without touching the filter paper.

Collect urine in a clean cup.

Dip the filter paper into urine up to the marked line.

Ensure the paper is fully saturated.

Hang or tape the card to dry for at least 6 hours.

Repeat for the second collection, done before bed.

Once dry, refold the cards and place them in the baggie.

Seal the baggie and return it with the completed requisition form to the test kit box.

Collection Instructions: Blood Spot:

Blood spot collection should be done within one hour of waking.

Blood spot collection involves washing hands, pricking the finger, and saturating the filter paper with blood drops.

The blood spot card should be left to air dry for at least 4 hours before packaging.

‍

Shipping:

Samples should be shipped back to the laboratory promptly using the provided return mailer.

Users are advised to note the tracking number for their shipment to monitor its progress.

Results:

Results are typically available 3-5 business days after samples are received at the lab.

Patients will be notified by their healthcare provider when results are ready and may schedule a follow-up appointment to review them together.

Additional Resources for Practitioners:

How to Interpret the Elite Thyroid Profile Blood Spot from ZRT Laboratory:

https://www.rupauniversity.com/live-classes/how-to-interpret-the-elite-thyroid-profile-blood-spot-from-zrt-laboratory 

References:

[1.] CDC.gov, “Evaluating Mercury Exposure: Information for Healthcare Providers”.  https://www.atsdr.cdc.gov/mercury/docs/physician_hg_flier.pdf 

[2.] Chakravarthy V, Ejaz S. Thyroxine-Binding Globulin Deficiency. [Updated 2023 Jul 4]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK544274/

[3.] Esform A, Farkhondeh T, Samarghandian S, Rezaei M, Naghizadeh A. Environmental arsenic exposure and its toxicological effect on thyroid function: a systematic review. Reviews on Environmental Health. 2021;0(0). doi:https://doi.org/10.1515/reveh-2021-0025

[4.] Farebrother J, Zimmermann MB, Andersson M. Excess iodine intake: sources, assessment, and effects on thyroid function. Ann N Y Acad Sci. 2019 Jun;1446(1):44-65. doi: 10.1111/nyas.14041. Epub 2019 Mar 20. PMID: 30891786. 

[5.] Institute of Medicine (US) Committee on Medicare Coverage of Routine Thyroid Screening; Stone MB, Wallace RB, editors. Medicare Coverage of Routine Screening for Thyroid Dysfunction. Washington (DC): National Academies Press (US); 2003. 2, Pathophysiology and Diagnosis of Thyroid Disease. Available from: https://www.ncbi.nlm.nih.gov/books/NBK221541/

[6.] Lazarus JH. Lithium and thyroid. Best Pract Res Clin Endocrinol Metab. 2009 Dec;23(6):723-33. doi: 10.1016/j.beem.2009.06.002. PMID: 19942149.

[7.] Meletis CD. Iodine. Journal of Evidence-Based Complementary & Alternative Medicine. 2011;16(3):190-194. doi:https://doi.org/10.1177/2156587211414424

[8.] Mincer DL, Jialal I. Hashimoto Thyroiditis. [Updated 2023 Jul 29]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK459262/

[9.] Pamphlett R, Doble PA, Bishop DP. Mercury in the human thyroid gland: Potential implications for thyroid cancer, autoimmune thyroiditis, and hypothyroidism. PLoS One. 2021 Feb 9;16(2):e0246748. doi: 10.1371/journal.pone.0246748. PMID: 33561145; PMCID: PMC7872292. 

[10.] Pearce EN, Caldwell KL. Urinary iodine, thyroid function, and thyroglobulin as biomarkers of iodine status. The American Journal of Clinical Nutrition. 2016;104(suppl_3):898S901S. doi:https://doi.org/10.3945/ajcn.115.110395

[11.] Pirahanchi Y, Toro F, Jialal I. Physiology, Thyroid Stimulating Hormone. [Updated 2023 May 1]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK499850/ 

[12.] Ramadan MA, Saif Eldin AS. Effect of occupational cadmium exposure on the thyroid gland and associated inflammatory markers among workers of the electroplating industry. Toxicology and Industrial Health. 2022;38(4):210-220. doi:https://doi.org/10.1177/07482337221085046 

[13.] Saran S, Gupta BS, Philip R, Singh KS, Bende SA, Agroiya P, Agrawal P. Effect of hypothyroidism on female reproductive hormones. Indian J Endocrinol Metab. 2016 Jan-Feb;20(1):108-13. doi: 10.4103/2230-8210.172245. PMID: 26904478; PMCID: PMC4743370.

[14.] Shahid MA, Ashraf MA, Sharma S. Physiology, Thyroid Hormone. [Updated 2023 Jun 5]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK500006/

[15.] Triggiani V, Tafaro E, Giagulli VA, Sabbà C, Resta F, Licchelli B, Guastamacchia E. Role of iodine, selenium and other micronutrients in thyroid function and disorders. Endocr Metab Immune Disord Drug Targets. 2009 Sep;9(3):277-94. doi: 10.2174/187153009789044392. Epub 2009 Sep 1. PMID: 19594417.

[16.] Vacchi-Suzzi C, Kruse D, Harrington J, Levine K, Meliker JR. Is Urinary Cadmium a Biomarker of Long-term Exposure in Humans? A Review. Curr Environ Health Rep. 2016 Dec;3(4):450-458. doi: 10.1007/s40572-016-0107-y. Erratum in: Curr Environ Health Rep. 2016 Dec;3(4):493-494. PMID: 27696280; PMCID: PMC5453507. 

[17.] Verma I, Sood R, Juneja S, Kaur S. Prevalence of hypothyroidism in infertile women and evaluation of response of treatment for hypothyroidism on infertility. Int J Appl Basic Med Res. 2012 Jan;2(1):17-9. doi: 10.4103/2229-516X.96795. PMID: 23776802; PMCID: PMC3657979.

[18.] Wang F, Li C, Li S, Cui L, Zhao J, Liao L. Selenium and thyroid diseases. Front Endocrinol (Lausanne). 2023 Mar 24;14:1133000. doi: 10.3389/fendo.2023.1133000. PMID: 37033262; PMCID: PMC10080082. 

[19.] Yorita Christensen KL. Metals in blood and urine, and thyroid function among adults in the United States 2007-2008. Int J Hyg Environ Health. 2013 Nov;216(6):624-32. doi: 10.1016/j.ijheh.2012.08.005. Epub 2012 Oct 6. PMID: 23044211. 

[20.] Zava TT, Kapur S, Zava DT. Iodine and creatinine testing in urine dried on filter paper. Anal Chim Acta. 2013 Feb 18;764:64-9. doi: 10.1016/j.aca.2012.12.021. Epub 2012 Dec 22. PMID: 23374216.

[21.] Zava TT, Zava DT. Determination of iodine, bromine, selenium and arsenic by

ICP-DRC-MS using urine dried on filter paper. Poster presented at: The 83rd

Annual Meeting of the American Thyroid Association; October 16-20, 2013; San

Juan, Puerto Rico.

[22.] Zimmermann MB, Köhrle J. The impact of iron and selenium deficiencies on iodine and thyroid metabolism: biochemistry and relevance to public health. Thyroid. 2002 Oct;12(10):867-78. doi: 10.1089/105072502761016494. PMID: 12487769.