TSH with Reflex to Free T4
Quest Diagnostics
Sample type: Serum
Requires fasting: No
Phlebotomy required
Details
TSH with Reflex to Free T4 - This test may be useful in assessing thyroid dysfunction when pituitary disease is not suspected. In patients with clinical suspicion of hyperthyroidism or hypothyroidism, testing thyroid stimulating hormone (TSH) is the initial step. An abnormal TSH result will reflex to a free thyroxine (T4) test to aid in diagnosis and guide further testing if needed.
Reflex testing uses predefined clinical logic to automatically order one or more follow-up tests based on the initial test results. Reflex tests are performed automatically without the intervention of the ordering practitioner. They are conducted using the same sample your Patient already provided. If reflex tests are required, there will be additional charges.
Initial test
- Thyroid-Stimulating Hormone
Possible reflex biomarkers
- Free T4
Estimated days for results: Results should be available in 2 - 5 business days after the sample is collected
TSH stimulates the thyroid gland to synthesize and secrete triiodothyronine (T3) and T4. TSH production is reduced in response to high T3/T4 levels and increased in response to low T3/T4 levels. When pituitary disease is not suspected, TSH serves as a sensitive marker for screening for thyroid dysfunction [1,2]. A normal TSH result excludes most cases of primary overt thyroid disease. When the TSH level is elevated, measurement of free T4 level may help diagnose subclinical or overt hypothyroidism. Thyroid peroxidase antibody testing may be needed to aid in the diagnosis of Hashimoto thyroiditis. When the TSH level is decreased, measurement of free T4 and free T3 may help identify hyperthyroidism or T3 thyrotoxicosis. In patients with thyrotoxicosis, TSH receptor antibodies testing helps confirm Graves disease [1-3].
Note: Interference due to heterophile antibodies has been known to occur [1].
The results of this test should be interpreted in the context of pertinent clinical and family history and physical examination findings.
References
1. Demers LM, et al. The thyroid: pathophysiology and thyroid function testing. In: Burtis CA, et al. eds. Tietz Textbook of Clinical Chemistry and Molecular Diagnostics. 4th ed. Elsevier; 2006:2053-2095.
2. Ross DS, et al. Thyroid. 2016;26(10):1343-1421.
3. Vasileiou M, et al; Guideline Committee. BMJ. 2020;368:m41.
2–5 business days
≥20 Years 0.40–4.50 mIU/L
Pregnancy
First Trimester 0.26–2.66 mIU/L
Second Trimester 0.55–2.73 mIU/L
Third Trimester 0.43–2.91 mIU/L
Blood Draw Options with Fullscript
Fullscript offers several convenient phlebotomy options to complete your lab testing:
Quest Diagnostics Patient Service Centers (PSC)
- Location: Visit a nearby Quest Diagnostics Patient Service Center.
- Cost: $10 sample collection fee (paid during lab order checkout).
- Scheduling: Schedule your appointment here. Appointments are recommended to reduce wait times. Walk-ins are accepted, but may experience delays. Aim to arrive 10 minutes before your appointment.
- Collection Instructions:
- Bring a valid ID.
- Bring your digital or printed requisition form, available in the Labs tab of your Fullscript account.
- Check-in: Scan the QR code from your confirmation email or follow kiosk instructions.
- More Info: Quest Diagnostics blood draw guide
Getlabs Mobile Phlebotomy
- Location: Sample collection at your home or office.
- Cost: $85 sample collection fee (paid during lab order checkout).
- Availability: Available in most locations – enter your ZIP code during checkout to confirm.
- Scheduling: Schedule your appointment here through your Fullscript account.
- Collection Instructions:
- Have your digital or printed requisition form and valid ID ready.
- Your phlebotomist will contact you by phone to coordinate arrival.
- More Info: Getlabs blood draw guide
- Preferred Specimen(s): 1 mL serum
- Alternative: NA
- Minimum Volume: 0.7 mL
- Collection Instructions: NA
- Transport Container: Serum separator tube (SST)
- Transport Temperature: Room Temperature
- Specimen Stability:
- Room temperature: 7 days
- Refrigerated: 7 days
- Frozen: 28 days
- Reject Criteria:
- Plasma
Minimum age:
1
State restrictions:
Patient can't order this test if they are located in Hawaii, Puerto Rico, New Jersey, New York, or Rhode Island
