Reflex Testing

If TSH is outside of the reference range (high or low) for any age, a T4 Free (LAB127) will be automatically ordered and performed.

Turnaround Time

Varies by site.

Use

 

TSH
Patients Without Pituitary Disease

 

 

 

 

 

 

 

 

Below age specific reference range

 

Within age
specific
reference range

 

Above age
specific
reference range

¯

 

¯

 

¯

Suspect hyperthyroid

 

No metabolic thyroid disease

 

Suspect hypothyroid

¯

 

¯

 

¯

Free T4

 

No further testing

 

Free T4

 

 

 

 

 

 

Thyroid gland function testing is based upon the normal response of the pituitary gland to decreased or increased levels of thyroid hormones, principally triidothyronine (T3) and thyroxine (T4). Pituitary and/or hypothalamic hypothyroidism may not be detected through this algorithmic approach and requires both TSH as well as FT4 measurements.

 

Specimen Type

Blood

Collection Containers

Green (lithium heparin, gel)
Alternate Containers: Green (lithium heparin, no gel), Green (lithium heparin, gel) on ICE, Red (no gel), Red or gold (gel)

Collection Volume

2.5 mL

Minimum Collection Volume

0.6 mL

Specimen Preparation

Separate from cells within 2 hours of collection for optimal results. Within 6 hours is also acceptable.
Non-gel tubes: transfer serum/plasma to approved aliquot container.
Optimal testing volume:1.25 mL serum/plasma; Minimum testing volume: 0.2 mL

Storage/Transport Temperature

Refrigerated

Stability (from collection to initiation)

After separation from cells:
Room temperature: 8 days
Refrigerated: 14 days
Frozen: 24 months, freeze once

Containers

Green (Lithium Heparin, Gel)

Alternate Containers

Green (Lithium Heparin, No Gel)

Green (Lithium Heparin, Gel) on ICE

Red (No Gel)

Red or Gold (Gel)

Reference Interval

Age TSH
uIU/mL
0-5 d 0.70-15.20
6 d - 2 mo 0.70-11.00
3-12 mo 0.70-8.40
1-5 y 0.70-6.00
6-10 y 0.60-4.80
11-19 y 0.50-4.30
20 y & older 0.30-4.20

Critical Range

0-3 years: >23.00 uIU/mL

Contraindications

Large doses of biotin (10 mg or more per day) may cause clinically significant interference in TSH levels. If interference is suspected, it is strongly recommended that biotin is discontinued for at least one week prior to retesting.

CPT Disclaimer

The Current Procedural Terminology (CPT) Codes published in the M Health Fairview Test Directory are based on American Medical Association (AMA) guidelines and are provided for informational purposes only. CPT codes are provided only as guidance to assist clients with billing. CPT coding is the responsibility of the billing party. M Health Fairview Laboratories does not assume responsibility for billing errors due to reliance on the CPT codes listed in this Test Directory. Charges may vary due to reflexing, susceptibilities, specimen source, patient age, methodology requirements, etc..

Patient Price Inquiries

Requester Contact Information
Patient and UMP/FV Care Team Fairview Consumer Line at 612-672-1048
MRL Outreach Client dept-mrl-business-assessment@fairview.org
Research research@fairview.org

CPT Codes

CPTQtyHC HospitalPR ClinicNote
84443130084443028444301HC TSH W/FREE T4 REFLEX

Methodology

Electrochemiluminescence immunoassay (ECLIA) which is a sensitive method

MRL Test Build

Test Name Component Required Description Type LOINC
LAB3795     TSH with Reflex to Free T4 Orderable  
  SRC_1001 Y Blood specimen source: Prompt  
  1231002031   TSH Result 11580-8

Data Type / Multiple Choice Response

SRC_1001
Blood specimen source:
Arm, Left|Arm, Right|Hand, Left|Hand, Right|Blood, Capillary|Other|Peripheral Blood
Default: Peripheral Blood

Contact

For questions regarding the test code Interface Map, please contact DEPT-LAB-CLIENT-INTERFACE@fairview.org
Ordering

Reflex Testing

If TSH is outside of the reference range (high or low) for any age, a T4 Free (LAB127) will be automatically ordered and performed.

Turnaround Time

Varies by site.

Use

 

TSH
Patients Without Pituitary Disease

 

 

 

 

 

 

 

 

Below age specific reference range

 

Within age
specific
reference range

 

Above age
specific
reference range

¯

 

¯

 

¯

Suspect hyperthyroid

 

No metabolic thyroid disease

 

Suspect hypothyroid

¯

 

¯

 

¯

Free T4

 

No further testing

 

Free T4

 

 

 

 

 

 

Thyroid gland function testing is based upon the normal response of the pituitary gland to decreased or increased levels of thyroid hormones, principally triidothyronine (T3) and thyroxine (T4). Pituitary and/or hypothalamic hypothyroidism may not be detected through this algorithmic approach and requires both TSH as well as FT4 measurements.

 

Collection & Processing

Specimen Type

Blood

Collection Containers

Green (lithium heparin, gel)
Alternate Containers: Green (lithium heparin, no gel), Green (lithium heparin, gel) on ICE, Red (no gel), Red or gold (gel)

Collection Volume

2.5 mL

Minimum Collection Volume

0.6 mL

Specimen Preparation

Separate from cells within 2 hours of collection for optimal results. Within 6 hours is also acceptable.
Non-gel tubes: transfer serum/plasma to approved aliquot container.
Optimal testing volume:1.25 mL serum/plasma; Minimum testing volume: 0.2 mL

Storage/Transport Temperature

Refrigerated

Stability (from collection to initiation)

After separation from cells:
Room temperature: 8 days
Refrigerated: 14 days
Frozen: 24 months, freeze once
Containers

Containers

Green (Lithium Heparin, Gel)

Alternate Containers

Green (Lithium Heparin, No Gel)

Green (Lithium Heparin, Gel) on ICE

Red (No Gel)

Red or Gold (Gel)

Result Interpretation

Reference Interval

Age TSH
uIU/mL
0-5 d 0.70-15.20
6 d - 2 mo 0.70-11.00
3-12 mo 0.70-8.40
1-5 y 0.70-6.00
6-10 y 0.60-4.80
11-19 y 0.50-4.30
20 y & older 0.30-4.20

Critical Range

0-3 years: >23.00 uIU/mL

Contraindications

Large doses of biotin (10 mg or more per day) may cause clinically significant interference in TSH levels. If interference is suspected, it is strongly recommended that biotin is discontinued for at least one week prior to retesting.
Administrative

CPT Disclaimer

The Current Procedural Terminology (CPT) Codes published in the M Health Fairview Test Directory are based on American Medical Association (AMA) guidelines and are provided for informational purposes only. CPT codes are provided only as guidance to assist clients with billing. CPT coding is the responsibility of the billing party. M Health Fairview Laboratories does not assume responsibility for billing errors due to reliance on the CPT codes listed in this Test Directory. Charges may vary due to reflexing, susceptibilities, specimen source, patient age, methodology requirements, etc..

Patient Price Inquiries

Requester Contact Information
Patient and UMP/FV Care Team Fairview Consumer Line at 612-672-1048
MRL Outreach Client dept-mrl-business-assessment@fairview.org
Research research@fairview.org

CPT Codes

CPTQtyHC HospitalPR ClinicNote
84443130084443028444301HC TSH W/FREE T4 REFLEX

Methodology

Electrochemiluminescence immunoassay (ECLIA) which is a sensitive method

Interface Mapping

MRL Test Build

Test Name Component Required Description Type LOINC
LAB3795     TSH with Reflex to Free T4 Orderable  
  SRC_1001 Y Blood specimen source: Prompt  
  1231002031   TSH Result 11580-8

Data Type / Multiple Choice Response

SRC_1001
Blood specimen source:
Arm, Left|Arm, Right|Hand, Left|Hand, Right|Blood, Capillary|Other|Peripheral Blood
Default: Peripheral Blood

Contact

For questions regarding the test code Interface Map, please contact DEPT-LAB-CLIENT-INTERFACE@fairview.org
Private Details

Test Detail

Processing Key

Abbreviation
TSHR
Performing Lab
CSC Maple Grove, Grand Itasca, Lakes, Northland, Range, Ridges, Southdale, St. John's, UMMC East Bank, UMMC West Bank, Woodwinds
Department
Chemistry
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