Laboratory testing of thyroid stimulating hormone levels in the blood is considered the best initial test for hypothyroidism; a second TSH level is often obtained several weeks later for confirmation.[33] Levels may be abnormal in the context of other illnesses, and TSH testing in hospitalized people is discouraged unless thyroid dysfunction is strongly suspected.[2] An elevated TSH level indicates that the thyroid gland is not producing enough thyroid hormone, and free T4 levels are then often obtained.[7][3] Measuring T3 is discouraged by the AACE in the assessment for hypothyroidism.[7] There are a number of symptom rating scales for hypothyroidism; they provide a degree of objectivity but have limited use for diagnosis.[7]