Graves' disease laboratory findings

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1],Associate Editor(s)-in-Chief: Seyedmahdi Pahlavani, M.D. [2]


The laboratory findings in Graves' disease are elevated levels of serum thyroxine (T4) and triiodothyronine (T3), and undetectable levels of serum TSH.

Laboratory Findings

The laboratory findings in Graves' disease are:

  • Elevated levels of serum thyroxine (T4) and triiodothyronine (T3).
  • Undetectable serum TSH.
  • Total T4 and T3 measurements are influenced by multiple conditions affecting serum thyroxine-binding globulin (TBG). Thus, measurement of free thyroid hormone; free T4 (FT4) and free T3 (fT3), is the gold standard for the diagnosis of Graves' disease.[1]
  • Antibodies against the TSH receptor (TRAbs) are pathognomonic for Graves' disease. They are detectable in the serum of about 98% of untreated patients.[2] Detection of TRAbs rules out other causes of thyrotoxicosis.[3]
  • Anti-thyroid peroxidase (TPO) and antithyroglobulin (Tg) antibodies are also detectable in many patients with Graves' disease but it is not recommended to measure these antibodies for diagnosis in all patients.


  1. Dufour DR (2007). "Laboratory tests of thyroid function: uses and limitations". Endocrinol. Metab. Clin. North Am. 36 (3): 579–94, v. doi:10.1016/j.ecl.2007.04.003. PMID 17673120.
  2. Zöphel K, Roggenbuck D, Schott M (2010). "Clinical review about TRAb assay's history". Autoimmun Rev. 9 (10): 695–700. doi:10.1016/j.autrev.2010.05.021. PMID 20594972.
  3. Barbesino G, Tomer Y (2013). "Clinical review: Clinical utility of TSH receptor antibodies". J. Clin. Endocrinol. Metab. 98 (6): 2247–55. doi:10.1210/jc.2012-4309. PMC 3667257. PMID 23539719.

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