The market for "direct-to-consumer" (DTC) laboratory services and home thyroid test kits is growing quickly. Now, it’s possible for most Americans to order their own thyroid tests and get the results before they even see a doctor. What types of thyroid tests can you order yourself? Why would you want to? And what are the pros and cons of this type of testing? Let's take a look.
You've Got Options: Thyroid Self-test Basics
First, let's clarify the two ways you can order your own thyroid tests. The first is called "direct-to-consumer" — or DTC — testing. With this type of testing, you set up an online account with a DTC service provider. You can then select and pay for the laboratory tests you want. You print a lab slip and take it to a local laboratory collection facility for blood collection. Test results are then delivered to you electronically via a secure portal.
"Home" thyroid tests are typically fingerstick bloodspot tests. After ordering and paying for a test, the collection kit is mailed to you. After you prick your finger with a lancet, you apply the blood to a special filter card, and send the collection kit back to the lab. Again, test results are then delivered to you electronically via a secure portal.
Both types of testing offer you access to popular thyroid blood tests including thyroid stimulating hormone (TSH), free thyroxine (Free T4),free triiodothyronine (Free T3), and thyroid peroxidase antibodies (TPO).
How Self-tests Stack Up
DTC lab testing is almost identical to conventional lab testing. Direct-to-consumer testing services use the same laboratories most doctors use—like LabCorp and Quest—and the test process and results are identical to those ordered by your doctor. There are two differences, however. First, instead of your doctor ordering the tests, you choose them yourself. Second, the results go directly to you, not your doctor.
Home bloodspot testing is somewhat different. There is no blood draw. Instead, the fingerprick blood is processed, and results are sent electronically or by mail.
When done by a reputable provider, bloodspot testing results are considered highly accurate, and the results correlate well with traditional laboratory blood tests.
The Pros of Being Proactive
Because of the nature of today's healthcare, many patients have been forced to become proactive medical consumers. You may be unable to get certain tests when you ask for them. Your HMO or health insurer may deny coverage for certain tests. Or you may come up against an overreliance on the thyroid stimulating hormone (TSH) test. Some doctors use only this test to diagnose or manage thyroid disease. They won't test for autoimmune thyroid antibodies, actual thyroid hormone levels such as Free T4 and Free T3, or complicating factors such as elevated reverse T3. Getting tested yourself can be a starting point for a discussion, and it's pretty easy to do:
- To order DTC or bloodspot tests, you don't need to first visit your doctor, or have your doctor order the tests.
- You—not your doctor—get to decide which tests you will get.
- The results are private and are delivered only to you. They do not go to your doctor, health maintenance organization (HMO), or health insurer.
- Your results often include added, easy-to-understand descriptions of the findings and implications, as well as recommended other resources for reading.
For home bloodspot testing:
- You don't need to leave home.
- You don’t need a blood draw (no needles!).
- The cost is often less than DTC or conventional lab testing.
What You Need to Watch Out For
Costs: Health insurance rarely covers the cost of home bloodspot testing, and only some insurers reimburse all or part of DTC testing. In most cases, the costs can, however, be paid from flexible spending and health savings accounts
Overlooking or misinterpreting errors in your test results: A 2017 article in the Annals of Clinical and Laboratory Research explained that even under the best of circumstances, test results can have errors. Physicians may be able to detect those mistakes and make the necessary adjustments in diagnosis. Consumers, on the other hand, may not have that same level of knowledge and could make decisions based on incorrect information. Health conditions can worsen—or be overlooked—as a result.
Poor healthcare decisions: Some patients may decide on their own to increase or decrease the dosage of prescribed medications, or stop treatments all together, based on test results. Experts caution against making these types of healthcare decisions without first consulting your healthcare provider and having confirmatory testing."The tests are reliable and use the exact same testing labs that I use, so I have no problem using the test results," says integrative physician David Borenstein, M.D., founder of Manhattan Integrative Medicine in New York City. "However, I've had patients order thousands of dollars of tests that turned out to be unrelated and completely unnecessary."
Choosing a Lab
If you're interested in ordering your own thyroid tests, here are three key steps:
First, verify what, if any, coverage or reimbursement is available. You can get more information from your health insurance provider or benefits manager. Also, determine whether the costs of testing can be paid from your flexible spending or health savings account.
Second, choose a reliable and certified company. Poor-quality companies can deliver poor-quality test results. This can be avoided in large part by making sure that you work with a reputable, nationally-known company. In the case of a DTC service, make sure they are working with licensed testing labs. The American Association for Clinical Chemistry (AACC) recommends that "only CLIA (Clinical Laboratory Improvement Amendments) laboratories perform DTC testing. If the prospective DTC provider is collecting samples and processing tests using nationally-known CLIA-certified labs like LabCorp or Quest, you should be able to trust their results. Several that have good reputations include TrueHealthLabs, MyMedLab, and HealthCheckUSA. If the DTC provider doesn't list which labs it partners with, ask them. You can also check with your regional CLIA office to get details about a particular laboratory.
For bloodspot testing, you should choose an established company that has a reputation doing bloodspot testing. (One company I've successfully used, and is recommended by providers, is ZRT Labs, who originated thyroid bloodspot testing. ZRT even has a Home Test Kit for thyroid available on Amazon!)
Third, compare prices. Some providers offer discounts, discounted bundles, or volume discounts that can make tests less expensive.
You've Got the Results. Now What?
Call your doctor--and don't make any changes to your treatment until you do. There's no getting around this one. "Make sure to share the results with your physician, who can help you interpret the results, make an appropriate diagnosis, and recommend treatment," says Dr. Borenstein. "These tests should not be a license for patients to practice do-it-yourself
doctoring on themselves. That can be a recipe for disaster."
If your M.D. is reluctant to accept your DTC lab test results, ask for an explanation of his or her concerns. Brady Hurst, clinical director of the direct-to-consumer laboratory TrueHealthLabs.com also recommends that you show the doctor that your results are coming from labs they already use such as LabCorp and Quest Diagnostics. According to Hurst: “Doctors may need to have it pointed out that the results would be no different if they ordered the test vs. you ordering the test.”
If the push back centers on function test results, show them that the lab is CLIA-certified and bring in any research that is available on the tests. Most labs have these documents to share, he says.
Ultimately, though, if your doctor is completely opposed to self-testing, or refuses to consider valid test results, it's time to find a new provider.
My Own Experience
I have used direct-to-consumer laboratory testing services several times. It's an easy process to log-on to an account, select the tests I want, and process payment. I then print out the lab test order, make an appointment for blood work at a local lab—I use a nearby LabCorp—and bring the test order. Because it's prepaid, there's nothing else to do but have the test samples taken. A few days later, I received an email notification that my test results were in. I log in again to the secure portal, and there are my results. I can save them, print them, and send them to my healthcare providers if I want to share them. I have also used home bloodspot testing and was surprised to find that the results were quite accurate and tracked almost exactly with my conventional blood work.