Structural optimization has been shown to be an invaluable tool for solving large-scale challenging design problems, and this work concerns such optimization of a state-of-the-art laminated composite wind turbine blade root section. For laminated composites structures, the key design parameters are material choice, fiber orientation, stacking sequence, and layer thickness, however a framework for treating these simultaneously in optimization, on the current wind turbine blade scale, has not been demonstrated. Thus, the motivation and novelty of the present work is providing and demonstrating a general gradient-based approach applicable to wind turbine blades, where the key design parameters and structural criteria, i.e., buckling, static strength, and fatigue damage, are considered for multiple design load cases. The optimization framework is based on a variation of the Discrete Material and Thickness Optimization approach, where the thickness is directly parametrized, allowing for appropriately treating the sandwich parts of the blade. It is demonstrated how optimization leads to a design consisting of complex variable-thickness laminates, a good overall distribution of the structural criteria in the model, and a significant reduction in mass compared to the initial design.