The history and physical examination generally reveal the characteristic symptoms and physical signs that suggest hypothyroidism; however, laboratory evaluation is necessary to establish the diagnosis and cause of hypothyroidism. Diagnostic lab tests include measuring the blood levels of: 1  Thyroid stimulating hormone (TSH). 2  This hormone will be elevated in cases of hypothyroidism. 3  The TSH assay is the most sensitive test for the diagnosis of hypothyroidism. 4  Free T4 (free thyroxine) and T3 thyroid hormones.
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