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Test Code TSHR THYROID-STIMULATING HORMONE (TSH) REFLEX THYROXINE (T4), FREE

Additional Codes

Software Test Code
Label Text                                                     TSHR
EPIC LAB10153                                                      

Performing Laboratory

NorDx Laboratories

Useful For

Providing differential diagnosis of primary (thyroid) from secondary (pituitary) and tertiary (hypothalamus) hypothyroidism; aiding in the diagnosis of primary hyperthyroidism; monitoring patients on thyroid replacement therapy

 

A T4, Free will reflex if the TSH result is ≤ 0.270 µIU/mL or ≥ 4.200 µIU/mL at an additonal charge.

Method Name

Electrochemiluminescent Immunoassay (ECLIA)

Reference Values

TSH:

LOD 0.014 µIU/mL interassay variability < 20%

Female
0 - < 5 years: 0.84 - 6.22 µIU/L
5 - < 10 years: 0.48 - 4.81 µIU/L
10 - < 15 years: 0.76 - 4.20 µIU/L
15 - < 20 years: 0.45 - 4.50 µIU/L

Male
0 - < 5 years: 0.84 - 6.22 µIU/L
5 - < 10 years: 1.18 - 5.33 µIU/L
10 - < 15 years: 0.76 - 4.20 µIU/L
15 - < 20 years: 0.64 - 5.37 µIU/L

All Patients ≥ 20 years: 0.270 - 4.20 µIU/mL

 

T4, Free (if indicated): 0.93 – 1.7 ng/dL

Days and Times Test Performed

Monday through Sunday

Report Available

1 Day

Specimen Type

Serum

Preferred Container

Serum Separator Tube (SST)

Preferred Volume

Serum: 1 mL (Serum Separator Tube (SST))

Minimum Volume

Serum: 0.5 mL (Serum Separator Tube (SST))

Specimen Collection and Handling

1. Spin specimen, separate from clot and send refrigerated.

2. Sample should not be collected on patients receiving therapy with high biotin doses (i.e. >5 mg/day) until at least 8 hours after the last biotin administration.

Specimen Stability Information

Specimen Type: Serum

Frozen: 1 Month

Refrigerated: 7 Days

Must be spun/separated within: 2 Hours

Add On Capable

Yes

Advance Beneficiary Notice Requirements

This test, when ordered on Medicare patients, is subject to the National Coverage Determination (NCD) policies. Please verify that the diagnosis code (ICD code) you have chosen demonstrates medical necessity for the test as documented in the physician’s patient record. The CMS web site is available to assist you with this verification. A properly executed Advance Beneficiary Notice (ABN) must be submitted with the specimen if medical necessity is not demonstrated by the ICD code chosen.

CPT Code Information

CPT Code

CPT Description

CPT Disclaimer
84439 Thyroxine, Free, Quantitative  
84443 Thyroid Stimulating Hormone (TSH), Quantitative  

Performing Laboratory Location

NorDx Laboratories

LOINC Code Information

3016-3

Acceptable Alternative Container(s)

Plasma Separator Tube (PST)

Red Top Tube