The short answer
A blood test panel that shows whether your thyroid is underactive or overactive. In the US the most common cause of an underactive thyroid is an autoimmune one, Hashimoto’s.1 It measures TSH, free T4 and T3, and checks inflammation, blood count, kidneys and liver, all from one blood draw. It also adds ANA and rheumatoid factor, which mean most if you have signs of a disease such as lupus or rheumatoid arthritis, like swollen joints or a rash.6,7
- Who it’s for
- Anyone with symptoms that could come from the thyroid, such as tiredness, weight change or feeling too hot or cold, especially if you have another autoimmune condition or one runs in your family.[1][2] The ANA and rheumatoid factor results matter most if you also have swollen joints, rashes, mouth sores, or dry eyes and mouth.[6][7][8]
- What it costs
- $76.50. That’s the whole cost, and it’s HSA and FSA eligible.
- How it works
- Fast for 12 hours, get a blood draw at a Labcorp location of your choice for free or at home for $75, and see your results in the Picardo app in 2 to 3 days.
What the panel tests
13 tests from one visit: 12 that everyone gets, plus one that depends on your sex.
Thyroid function
TSH is the best first test. Free T4 and T3 show how much hormone your thyroid is making.1,4
- Thyroid cascade TSH, with more thyroid tests added if it’s abnormal
- Free T4 Thyroxine, the main thyroid hormone, converted into the more active T3
- Free T3 The active thyroid hormone, which regulates metabolism and energy use
- Total T3 All the T3 in your blood, bound and free
Autoimmune markers
ANA looks for lupus and related diseases, and rheumatoid factor for rheumatoid arthritis. They mean something if you have signs of one, such as painful, swollen joints, a rash across your cheeks, mouth sores, fingers and toes that change color, or dry eyes and mouth.6,7,8 Without those, a positive result is common and usually means nothing, and tiredness or weight change on their own don’t make it more meaningful.3,6
- ANA Antinuclear antibodies, with the strength and pattern if positive
- Rheumatoid factor An antibody often found in rheumatoid arthritis
Inflammation
General signs of inflammation anywhere in your body.
- Sedimentation rate (ESR) An older, broad inflammation test
- hs-CRP High-sensitivity C-reactive protein
Blood count, kidneys and liver
Common, fixable problems worth ruling out from the same draw.
- Complete blood count Red cells, white cells and platelets
- Comprehensive metabolic panel Kidney and liver function, glucose and electrolytes
- Uric acid Linked to gout and kidney disease
- Urinalysis A urine sample at the same visit
One test by sex
Men get a prostate test and women a pregnancy test.
- PSA Total PSA, with free PSA added if it’s borderline, for men
- hCG A pregnancy test, for women
Why check your thyroid and autoimmunity together?
Autoimmune conditions tend to run together. Hashimoto’s is more common in people who have another autoimmune disease, and in their families.1 That’s why guidelines advise thyroid tests for anyone with type 1 diabetes or another autoimmune condition.2
When do ANA and rheumatoid factor mean something?
When you have signs of the diseases they look for. For ANA, that’s lupus and related conditions, such as painful, swollen joints, a rash across your cheeks and nose, mouth sores, fingers and toes that change color, or dry eyes and mouth.7,8 For rheumatoid factor, it’s joint pain with signs that point to rheumatoid arthritis, such as swelling, long morning stiffness or pain in the knuckles.6
Without those signs, a positive result is common and usually means nothing: in an international study, 13% of healthy people had a positive ANA at a 1:80 dilution.3 Tiredness or weight change on their own don’t make it more meaningful, so read these two results alongside your other symptoms, not as a screen for hidden disease.6
Does the panel test for Hashimoto’s or Graves’ disease?
It shows whether your thyroid is underactive or overactive, but not always why. The antibody tests that point to the cause aren’t a set part of the panel:
- TPO antibodies, the main sign of Hashimoto’s. Labcorp’s thyroid cascade adds them in some cases when TSH is high, depending on free T4.5 Guidelines suggest checking them once if your TSH is high.1,2
- TSH receptor antibodies, if your thyroid is overactive. A positive result confirms Graves’ disease.4
How it works
- 01
Order online
The price is the whole cost, and you can pay with an HSA or FSA card.
- 02
Blood draw
Fast for 12 hours first: water is fine, but skip food, coffee and tea. Go to any Labcorp location for free, or have blood drawn at home for $75.
- 03
Get your results
Results arrive in the Picardo app in 2 to 3 days, with a first explanation of what they mean. You can ask for a follow-up with a physician.
Questions people ask
Do I need to fast for the Thyroid & Autoimmunity panel?
Yes. Fast for at least 12 hours before your blood draw. Water is fine, but skip food and other drinks, including coffee and tea. If you take biotin, a common hair and nail supplement, stop it at least 72 hours before, as Labcorp asks, because it can throw off thyroid results.2,5
How much does the Thyroid & Autoimmunity panel cost?
$76.50. That covers every test and a blood draw at Labcorp; a draw at home is $75 more. You can pay with an HSA or FSA card.
Should I take my thyroid medicine before the blood draw?
Take levothyroxine after the draw on test day. Free T4 rises for several hours after a dose, which can make a normal result look high.1
I only wanted a TSH test. Is the panel worth it?
For checking your thyroid, TSH on its own is usually the right first test.2 The panel makes more sense if your TSH has come back low or high, or if you also have swollen joints, rashes or other signs of autoimmune disease, where the ANA and rheumatoid factor results mean most.6,7
My ANA is positive, but I feel fine. Should I worry?
Usually not. A positive ANA is common in healthy people. In an international study, 32% tested positive at the lowest dilution, 1:40, 13% at 1:80 and 5% at 1:160.3 It matters when it comes with signs of a disease such as lupus. Without them, chasing a positive result tends to lead to extra tests that find nothing.6
How often should I get it?
Repeat it if symptoms come back or change, but no sooner than 6 weeks after your last test. If you take levothyroxine, a TSH check once a year is usual once your dose is settled.2
Sources
- 1 Garber JR, Cobin RH, Gharib H, et al. Clinical practice guidelines for hypothyroidism in adults: cosponsored by the American Association of Clinical Endocrinologists and the American Thyroid Association. Thyroid. 2012;22(12):1200–1235. doi.org/10.1089/thy.2012.0205
- 2 National Institute for Health and Care Excellence. Thyroid disease: assessment and management. NICE guideline NG145. London: NICE; 2019. Updated October 12, 2023. www.nice.org.uk/guidance/ng145
- 3 Tan EM, Feltkamp TE, Smolen JS, et al. Range of antinuclear antibodies in “healthy” individuals. Arthritis Rheum. 1997;40(9):1601–1611. doi.org/10.1002/art.1780400909
- 4 Ross DS, Burch HB, Cooper DS, et al. 2016 American Thyroid Association guidelines for diagnosis and management of hyperthyroidism and other causes of thyrotoxicosis. Thyroid. 2016;26(10):1343–1421. doi.org/10.1089/thy.2016.0229
- 5 Labcorp. Thyroid cascade profile, test 330015. Labcorp test menu. Accessed October 28, 2026. www.labcorp.com/tests/330015/thyroid-cascade-profile
- 6 Canadian Rheumatology Association. Eleven tests and treatments to question in rheumatology. Choosing Wisely Canada. Updated May 2024. Accessed November 3, 2026. choosingwiselycanada.org/recommendation/rheumatology/
- 7 National Institute of Arthritis and Musculoskeletal and Skin Diseases. Lupus. Last reviewed October 2022. Accessed November 3, 2026. www.niams.nih.gov/health-topics/lupus
- 8 National Institute of Arthritis and Musculoskeletal and Skin Diseases. Sjögren’s disease. Last reviewed June 2024. Accessed November 3, 2026. www.niams.nih.gov/health-topics/sjogrens-disease
Updated 4 Nov 2026.
This is general health information, not medical advice: talk to your clinician about your results and before changing any treatment.