How to Choose a Blood Panel in Bangkok in 2026

A friend handed me his Bangkok hospital "executive package" report last week. 187 markers. 38 pages. He'd paid over 50,000 baht for the panel and another 90 minutes trying to read it.

He thought he'd bought thoroughness. He'd bought paperwork.

When we went through it together, three numbers were actually worth doing something about. The other 184 were either normal, irrelevant to a healthy 38-year-old, or paired tests that nobody had bothered to interpret together.

This is the trap. More markers feels like more insight. It isn't. It's more pages.

A blood panel is only useful if every marker on it can change what you do next. Everything else is paperwork that costs you money, time, and a small amount of confidence in your own body. The American Board of Internal Medicine launched its Choosing Wisely campaign in 2012 specifically to reduce low-value testing of exactly this kind, and the first of its five questions for any test is: “Do I really need this?”

I've spent 28 years coaching people through this. Here's how I think about choosing a panel in Bangkok, what most of them get wrong, and the rule our medical team built our own panel around.

The 200-marker checkup is theatre

Walk into any major hospital chain in Bangkok and ask for a "premium executive checkup." You'll get a menu. The top option will list 150 to 200 markers, a chest X-ray, an ultrasound, a stress ECG, and a glossy folder. It can run from 15,000 baht at the mid-tier to over 50,000 baht for the premium option.

You'll leave with a binder.

Inside that binder are things like serum copper, magnesium, oxidised ◦LDLLDL cholesterolCardiovascularLDL cholesterol estimates the amount of cholesterol carried inside low-density lipoprotein particles. It is a long-standing cardiovascular-risk marker, though it measures the cargo rather than the particle count that ApoB captures directly., ◦IGF-1IGF-1HormoneIGF-1 (insulin-like growth factor 1) is a growth-related hormone marker. It is sometimes included in premium panels, but there is no agreed screening pathway for it in an asymptomatic adult., ◦reverse T3Reverse T3ThyroidReverse T3 is an inactive form of thyroid hormone. No validated screening cutoff exists for it — it is a specialist's tool used when there is already a specific clinical question, not a general screening marker., and a methylation panel. Some of those markers are useful in specialist hands when there's a specific question being asked. None of them belong in a screening panel for a healthy adult, because none of them, alone or together, would change what a doctor told you to do in the next 90 days.

The actual signal in a screening panel sits in three buckets: cardiometabolic risk, kidney and liver function, and a small set of nutrient and hormone gates. Outside those buckets, in a screening context, you're paying for noise dressed as data. The bigger the binder, the harder it is to find the three things you should fix this quarter.

There's a quiet incentive at work. Hospitals charge per line item. Your panel is sized to the price tier you bought, not to the question you asked. You wanted to know "am I okay?" and they answered "here are 187 numbers, you figure it out."

“Patients receive significant low-value care that not only adds costs, but is associated with potential harms from unnecessary tests, treatments, and procedures.”

— Choosing Wisely campaign, American Board of Internal Medicine Foundation

A good panel is the opposite. It's small. Every marker on it earns its place. And you can hold the whole result in your head.

The one question every marker has to answer

Before any marker goes on a panel, it should pass one filter: “What would I do differently if this came back abnormal?”

If the answer is "nothing," or "we'd need another test before we knew," it doesn't belong. It's not a useless number. It's just not a screening number.

Markers that pass the filter cleanly

• ◦ApoBApoBCardiovascularApoB counts the actual number of atherogenic (plaque-forming) particles in your blood, which makes it a more accurate cardiovascular-risk marker than LDL cholesterol — two people with the same LDL-C can have very different ApoB. high. You start a serious conversation about statins, you change the dietary fat profile, and you target ApoB instead of LDL going forward (Sniderman et al, Lancet 2021). Action is obvious.
• ◦HbA1cHbA1cGlucoseHbA1c reflects your average blood sugar over roughly the past three months. It is a later signal than fasting insulin — it confirms a glucose problem once it is further along rather than catching it early. creeping up. You shift refined carbs out of the diet, add a bit of post-meal walking, retest in 90 days. Action is obvious.
• ◦Vitamin DVitamin DNutrientsVitamin D (measured as 25-hydroxyvitamin D) reflects vitamin D status, a common nutrient gate that influences bone, immune and metabolic health. A low level is a clear, actionable result. low. You supplement 2,000 to 5,000 IU per day and retest in 3 months. Action is obvious.
• ◦Lp(a)Lp(a)CardiovascularLp(a) is a largely genetic, lifelong cardiovascular-risk particle that stays mostly silent until a cardiac event. It changes how aggressively other heart-risk factors are managed, and consensus guidance is to measure it at least once in adulthood. elevated. It's genetic, you can't move it much with lifestyle, but it changes how aggressively you treat everything else cardiac (Nordestgaard et al, European Heart Journal 2022). Action changes.
• ◦FerritinFerritinIron / BloodFerritin reflects the body's stored iron. A low ferritin signals iron deficiency, which prompts a look at the underlying cause; it is one of the markers benchmarked against optimal rather than broad lab ranges. under 30. Iron deficiency. You investigate the cause and supplement.

Markers that fail the filter

• IGF-1. A number. Maybe interesting. There's no agreed-upon screening pathway for an asymptomatic adult.
• Reverse T3. No validated screening cutoff exists. It's a specialist's tool when there's already a question.
• ◦AM serum cortisolCortisolHormoneCortisol is the body's main stress hormone. A single morning (AM) draw is a noisy snapshot — values can swing 20–30% within an hour — and there is no validated cutoff for screening 'stress' in an otherwise well adult., single draw. Has 20 to 30% biological variability. A single number tells you almost nothing about your stress system.
• Most tumour markers (◦CEACEATumour markerCEA (carcinoembryonic antigen) is a tumour marker validated for monitoring known cancers, not for finding new ones. As a screening test in healthy adults, false positives far outnumber true positives., ◦CA-125CA-125Tumour markerCA-125 is a tumour marker used to monitor known cancers. Used to screen healthy adults it produces many false positives, leading to downstream tests that carry real risk and cost., ◦AFPAFPTumour markerAFP (alpha-fetoprotein) is a tumour marker meant for monitoring known cancers rather than screening healthy adults, where false positives outweigh genuine findings.) in healthy adults. False positives wildly outnumber true positives. They're meant for monitoring known cancers, not finding new ones.

A good test for any marker: if you can't write down, in one short sentence, what you'd do with an abnormal result, the marker isn't ready to be on your panel. Take it off. That's the whole filter.

The Bangkok-specific markers most panels skip

Most off-the-shelf executive packages in Bangkok are translated almost line-for-line from American panels. They miss things that matter here.

◦UACRUACRKidneyUACR (urine albumin-to-creatinine ratio) detects small amounts of albumin leaking into the urine — the earliest sign of kidney damage in metabolic disease, often appearing years before creatinine moves. It is a cheap single morning sample. (urine albumin to creatinine ratio) is the earliest sign of kidney damage in people with metabolic disease. Bangkok has a high diabetes burden. Microalbumin appears in urine years before ◦creatinineCreatinineKidneyCreatinine is a muscle-breakdown product cleared by the kidneys, used to estimate kidney filtration (eGFR). It can move late in kidney decline, which is why it is often paired with Cystatin C and UACR. moves. UACR is cheap, it's a single morning sample, and it changes management. Almost no executive panel includes it.

◦Anti-TPO antibodiesAnti-TPOThyroidAnti-TPO (thyroid peroxidase) antibodies flag thyroid autoimmunity such as Hashimoto's, which is far more common in women. They can rise before TSH starts to move, sometimes years before, making them a high-signal addition for women. for women catch thyroid autoimmunity (Hashimoto's), which is 5 to 8 times more common in women than men, with a long-term incidence of 3.5 per 1,000 women per year in the Whickham Survey 20-year follow-up (Vanderpump et al, Clinical Endocrinology 1995). Anti-TPO catches it before ◦TSHTSHThyroidTSH (thyroid-stimulating hormone) is the first-line thyroid screening test. An abnormal TSH typically triggers a follow-up such as Free T4 or Anti-TPO, since it is most useful as part of a paired thyroid work-up. starts moving, sometimes years before — one of the highest-signal additions for women.

◦Free PSA RatioPSAProstate · ng/mLPSA (prostate-specific antigen) is a prostate marker; the Free PSA Ratio refines it by filtering out much of the noise in the 4–10 ng/mL gray zone where plain PSA produces false positives, supporting risk-stratified rather than blanket screening. for men over 45 filters out most of the noise in the 4 to 10 ng/mL gray zone where plain PSA throws false positives. The BMJ analysis of detection strategy based on PSA at age 40 to 55 supports risk-stratified rather than blanket screening (Vickers et al, BMJ 2013). Most Bangkok packages still order plain PSA, then chase the false positives with biopsies.

◦Cystatin CCystatin CKidneyCystatin C is a kidney-function marker that, alongside creatinine, catches early kidney decline which creatinine alone can miss — especially in people with low muscle mass. Guidelines recommend it as a confirmatory measure of kidney filtration. alongside creatinine catches early kidney decline that creatinine alone misses, especially in people with low muscle mass — the 2024 KDIGO kidney guidelines recommend it as a confirmatory marker (KDIGO 2024 CKD Guideline). It's one extra line on the order form.

These aren't exotic markers. They're cheap. They're well-validated. They're missing because nobody updated the package. A panel built for Bangkok puts them back.

The markers most panels include that don't change anything

Now the other side. Some markers are on every premium Bangkok panel that don't earn their place. The evidence isn't borderline. It's settled, and it doesn't favour these tests.

◦HomocysteineHomocysteineCardiometabolicHomocysteine is an amino acid associated with cardiovascular and cognitive risk. It can be lowered with B vitamins, but randomised trials show that lowering it does not reduce heart attacks or cardiovascular death — the marker is real, the intervention is not. is the clearest example. Yes, elevated homocysteine is associated with cardiovascular and cognitive risk. But lowering it with B vitamins achieves a 20 to 25% biochemical reduction without lowering the risk of heart attack, cardiovascular death, or all-cause mortality. A small protective effect on stroke (~12%) is the only positive signal, and it hasn't changed clinical practice.

“Combined B-vitamin supplementation significantly reduced serum homocysteine levels, yet exerted no significant impact on major cardiovascular events or mortality.”

— Guo et al., Annals of Medicine (2026), meta-analysis of 13 RCTs / 14,539 participants

“Every randomised trial of B-vitamin therapy for elevated homocysteine has come back negative for clinically meaningful cardiovascular events. The marker is real. The intervention doesn't work. That's not a marker we should be charging people to test.”

— Zeth, MD · Founding Medical Director, Orba Health

AM serum cortisol, single draw, is a noisy snapshot of one of the most variable systems in the body — two draws an hour apart can disagree by 20 to 30%, and there is no validated cutoff for screening "stress" in an asymptomatic adult. ◦DHEA-SDHEA-SHormoneDHEA-S is an adrenal hormone marker often marketed for longevity, but randomised trials of DHEA supplementation in healthy older adults have not shown clinically meaningful benefit, so it adds little to a screening panel. is marketed as a longevity marker, but randomised trials of DHEA supplementation in healthy older adults have failed to show clinically meaningful benefit (Nair et al, NEJM 2006). GGT on its own isn't part of the standard liver panel and mostly generates borderline results that lead nowhere.

◦ANAANAAutoimmuneANA (antinuclear antibodies) is an autoimmune screening test. It is frequently positive in healthy people who never develop autoimmune disease, so a positive ANA on its own carries little screening value in asymptomatic adults. screening in asymptomatic adults is worse than useless: up to 33% of healthy adults test positive at the 1:40 titer, without ever developing autoimmune disease.

“ANA are often present in healthy people who will not develop autoimmune disease, and due to this fact, the positive ANA result alone has no diagnostic value.”

— UNC Division of Rheumatology, Allergy, and Immunology — clinical guide to ANA testing

And tumour marker panels (CEA, CA-125, AFP) in healthy adults are validated for monitoring known cancers, not finding new ones — as a screening tool the false positive rate is high and the downstream investigations carry real risk and cost. If your "premium" panel includes most of this list, you're paying for the appearance of comprehensiveness, not the substance.

Why your panel shouldn't look like everyone else's

The standard Bangkok package gives the same 100-plus markers to every adult. A 28-year-old marathon runner. A 52-year-old executive. A 35-year-old woman trying to conceive. Same panel. That's wasteful, and it's also lower-signal than it sounds.

A better way to think about it: a panel should have a small, universal base that everyone gets, plus add-ons triggered by who you are, what you're feeling, and what your numbers say.

• Triggered by who you are. A woman gets Anti-TPO at baseline; a man over 45 gets Free PSA Ratio (Vickers et al, BMJ 2013). A 28-year-old needs neither.
• Triggered by what you're feeling. Fatigue, low libido, irregular cycles unlock a focused sex-hormone panel. ◦Free TestosteroneTestosteroneHormoneTestosterone can be measured as total or free (unbound). Free testosterone has higher diagnostic sensitivity than total for conditions like PCOS, which is why an abnormal total result often reflexes to a free testosterone test. has higher diagnostic sensitivity than Total Testosterone for conditions like PCOS (0.89 vs 0.74; Bizuneh et al, Human Reproduction Update 2025).
• Triggered by what your numbers say. An abnormal TSH triggers a follow-up ◦Free T3Free T3ThyroidFree T3 measures the active, unbound form of triiodothyronine, the most metabolically active thyroid hormone. It is used as a follow-up marker when thyroid screening flags a question.; a low MCV on the CBC triggers a fructosamine because it might be thalassemia; a borderline ferritin triggers a full ◦iron panelFerritin / iron panelIron / BloodA full iron panel measures iron, transferrin and related markers to characterise iron status. It is the follow-up when a screening ferritin comes back abnormal, clarifying the cause of an iron problem..

“We don't test everything on everyone. That's not personalisation, that's just paying more. We test the right things on you, based on who you are, what you tell us, and what we found last time.”

— Zeth, MD · Founding Medical Director

The 22-marker base we built at Orba

Twenty-two markers is the easy half. The harder half is who reads them. Most premium packages give you a binder and a different doctor every year — nobody owns the trajectory of your numbers across visits. We built Orba so the same doctor, coach and nutritionist look at the same screen between visits, and the panel itself adapts to what the last result told us.

“For every marker on the panel, I have to be able to answer one question: what would I tell this patient to do differently if it came back abnormal? If I can't, the marker isn't a screening tool, it's a fishing trip.”

— Zeth, MD · Founding Medical Director

This is the panel our medical team built after a year of arguing about it: 22 base markers, sex-neutral and age-neutral, everyone gets the same starting point — just under 9,000 baht per year on an amortised basis. Here's how it compares against a typical Bangkok premium executive package.

The base covers cardiometabolic risk (lipid panel, ApoB, Lp(a), ◦fasting glucoseFasting glucoseGlucoseFasting glucose measures blood sugar after an overnight fast. It is a useful but late marker of glucose regulation, often still reading normal for years while insulin resistance is already building., HbA1c, ◦fasting insulinFasting insulinGlucoseFasting insulin is the early-warning marker of insulin resistance: insulin rises first as the body works harder to keep blood sugar normal, so a normal glucose paired with elevated insulin can flag trouble years before HbA1c moves., ◦hs-CRPhs-CRPInflammationHigh-sensitivity C-reactive protein is an inexpensive marker of low-grade chronic inflammation. It predicts cardiovascular events independently of cholesterol, adding risk information even when LDL looks reassuringly low., uric acid), kidney and liver (creatinine with ◦eGFReGFRKidneyeGFR (estimated glomerular filtration rate) is a calculated measure of how well the kidneys filter blood, derived from markers such as creatinine and Cystatin C. It summarises overall kidney function in a single number., cystatin C, BUN, UACR, full liver panel, urine examination), inflammation and red-cell health (CBC with differential, ferritin), thyroid and key endocrine (TSH, ◦Free T4Free T4ThyroidFree T4 measures the active, unbound form of the thyroid hormone thyroxine. It is the standard follow-up when TSH comes back abnormal, helping interpret what the thyroid is actually doing., total testosterone), key nutrient gates (Vitamin D, B12) and electrolytes. On top of that sit three triggered tiers.

1. 1.Demographic add-ons at sign-up: Anti-TPO for women, Free PSA Ratio for men 45 and over.
2. 2.Symptom-triggered add-ons: a sex-hormone panel (Free T, estradiol, FSH, LH, progesterone) when symptoms or planning concerns justify it.
3. 3.Result-triggered add-ons: abnormal Total T reflexes to Free T; abnormal TSH reflexes to Anti-TPO; low MCV reflexes to fructosamine; abnormal ferritin reflexes to a full iron panel.

Every marker on the base earned its slot through one scoring question: how much does this marker change what we'd recommend, divided by what it costs to run? Below the threshold, it came off. What didn't make the cut — homocysteine, AM cortisol, DHEA-S, GGT alone, ANA, tumour markers in healthy adults, IGF-1, reverse T3, oxidised LDL, methylation panels, serum copper and magnesium — was each reviewed against the evidence and demoted with reasons we can show. You can see exactly which markers are in each tier, and how each one is benchmarked against optimal ranges rather than broad lab intervals.

Five questions to take to any clinic in Bangkok

Choosing Wisely's "5 Questions to Ask Your Doctor" framework was designed for exactly this situation. Below, the FAQ adapts each one for choosing a blood panel in Bangkok — if a panel can answer all five honestly, it's a serious panel. If it can't, you're paying for theatre.