What blood tests should be ordered for a patient with severe agoraphobia?

Blood Tests for Patients with Severe Agoraphobia

For patients with severe agoraphobia, a comprehensive thyroid panel including TSH, free T3, and free T4 should be ordered as the primary blood test, along with basic metabolic and hematologic panels to rule out underlying medical conditions that may contribute to anxiety symptoms. 1

Thyroid Function Testing

• Thyroid function tests are particularly important as research has shown potential associations between anxiety disorders and thyroid function abnormalities 1
• Order TSH (thyroid-stimulating hormone) as the first-line screening test for thyroid dysfunction 1
• Include free T3 and free T4 measurements, as some studies have found that patients with panic disorder and agoraphobia may have higher free T3 levels compared to those with panic disorder alone 1
• Consider testing for thyroid peroxidase (TPO) and thyroglobulin antibodies (TGA) to assess for autoimmune thyroid conditions that can manifest with psychiatric symptoms 1

Basic Metabolic Panel

• Order a complete metabolic panel including:
  • Electrolytes (sodium, potassium, chloride, bicarbonate) 1
  • Glucose levels (fasting when possible) to rule out hypoglycemia which can mimic anxiety symptoms 1
  • Calcium and magnesium levels, as abnormalities can present with anxiety-like symptoms 1
  • Renal function tests (BUN, creatinine) 1
  • Liver function tests 1

Complete Blood Count

• A complete blood count with differential should be ordered to:
  • Rule out anemia which can cause fatigue and exacerbate anxiety symptoms 1
  • Assess for signs of infection or inflammation that might contribute to psychiatric symptoms 1

Additional Relevant Tests

• Consider vitamin B12 and folate levels, as deficiencies can contribute to neuropsychiatric symptoms 1
• HbA1c to assess for diabetes, which can be associated with anxiety symptoms 1
• If clinically indicated based on history and presentation, consider:
  • ESR or CRP to assess for inflammatory conditions 1
  • Drug screening if substance-induced anxiety is suspected 1

Special Considerations for Patients with Agoraphobia

• Patients with severe agoraphobia may have difficulty attending medical appointments, so consider:
  • Scheduling blood draws during times when the facility is less crowded 2
  • Arranging for a support person to accompany the patient 3
  • In extreme cases where the patient cannot leave home, consider home phlebotomy services if available 2

Clinical Pearls and Pitfalls

• Patients with agoraphobia often have comorbid panic disorder, which has been associated with blunted TSH response in some studies 1
• Be aware that some studies have found differences in thyroid hormone levels between medicated and unmedicated patients with panic disorder and agoraphobia 1
• Avoid attributing all symptoms to psychological causes without appropriate medical workup, as underlying medical conditions can exacerbate anxiety disorders 1
• Remember that patients with severe agoraphobia may have delayed medical care due to avoidance behaviors, making a thorough medical evaluation particularly important 3