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23088 Thyroid Stimulating Hormone

Thyroid Stimulating Hormone
Test Code: TSH
Synonyms/Keywords
TSH, Thyrotropin, s-TSH
Useful For

Aid in evaluating thyroid axis. As an aid in the diagnosis of primary hyperthyroidism. For differential diagnosis of primary hypothyroidism from normal, and the differential diagnosis of primary hypothyroidism from pituitary/hypothalamic hypothyroidism.

Monitoring patients on thyroid replacement therapy.

Confirmation of thyroid-stimulating hormone (TSH) suppression in thyroid cancer patients on thyroxine therapy.

Specimen Requirements
Fasting Required Specimen Type Preferred Container/Tube Acceptable Container/Tube Specimen Volume Specimen Minimum Volume
(allows for 1 repeat)
Pediatric Minimum Volume
(no repeat)
No​ Serum or Plasma​

Serum Separator Tube (SST), Lithium-heparin Plasma Separator Tube (PST)

 

Red Top Tube (RTT),
​Sodium-heparin Green Top Tube (GTT)​

 

0.5 mL​ 0.5 mL​ 0.4 mL​
Collection Processing Instructions
Separate serum or plasma from the blood within 60 minutes of venipuncture. Specimen must be free of particulate matter including fibrin. Specimens collected in the RTT must be removed from the cells within one hour for storage or transport. Specimens collected in gel-barrier tubes must be removed from the primary tube prior to transporting to Marshfield. Do not send primary collection tube. Specimen should be transported refrigerated (2 - 8°C). If sent frozen, specimens must be completely thawed, thoroughly mixed, and centrifuged before analysis. 1 freeze/thaw cycle has shown to have no qualitative difference in results.
Specimen Stability Information
Specimen Type Temperature Time
Serum/Plasma​ ​ Ambient​ 8 hours​
Refrigerated​ 7 days
Frozen​ at -20 deg Celsius 30 days​
Rejection Criteria
Plasma samples in wrong anticoagulant​
Specimen not separated from cells within 60 minutes​
Samples not transported refrigerated​
Interference
Some patients who have been exposed to animal antigens, either in the environment or as part of treatment or imaging procedure, may have circulating anti-animal antibodies present. These antibodies may interfere with the assay reagents to produce unreliable results.
 
High doses of exogenous biotin (also termed Vitamin B7, Vitamin H or Coenzyme R) may interfere with this assay. It is recommended that patients refrain from consuming any multivitamin or supplement containing biotin for at least 72 hours prior to collection of a blood sample.
Performing Laboratory Information
Performing Location Day(s) Test Performed Analytical Time Methodology/Instrumentation
​Chippewa Falls ​Monday through Friday ​Less than 2 hours​ ​Enzyme Immunoassay/Siemens Dimension
​Diagnostic Treatment Center ​Monday through Sunday​ ​Less than 2 hours​ ​Enzyme Immunoassay/Siemens Dimension
​Eau Claire ​Monday through Sunday​ ​Less than 2 hours​ ​Enzyme Immunoassay/Siemens Dimension
​Flambeau Hospital ​Monday through Sunday​ ​Less than 2 hours​ ​Enzyme Immunoassay/Siemens Dimension
​Ladysmith Medical Center ​​Monday through Sunday ​Less than 2 hours​ ​Enzyme Immunoassay/Siemens Dimension
​Lakeview Medical Center ​Monday through Sunday​ ​Less than 2 hours​ ​Enzyme Immunoassay/Siemens Dimension
​Marshfield Monday through Sunday​ Less than 2 hours​ Chemiluminescent Immunoassay/Siemens Centaur
​Merrill ​Monday through Saturday ​Less than 2 hours​ ​Enzyme Immunoassay/Siemens Dimension
​Minocqua ​Monday through Sunday​ ​Less than 2 hours​ ​Enzyme Immunoassay/Siemens Dimension
​Stevens Point ​​Monday through Friday ​Less than 2 hours​ ​Enzyme Immunoassay/Siemens Dimension
Wausau​ ​Monday through Sunday​ ​Less than 2 hours​ ​Enzyme Immunoassay/Siemens Dimension
​Wisconsin Rapids ​​Monday through Friday Less than 2 hours​​ ​Enzyme Immunoassay/Siemens Dimension
Test Information

The TSH assay exhibits performance consistent with the definition of “third generation”. TSH is most often used for the evaluation of the thyroid axis, proper understanding of its utility and limitations is thus clinically important.

The principal clinical use for TSH measurement is for the assessment of thyroid status. In patients with intact hypothalamic-pituitary function, TSH is measured to: 1) exclude hypothyroidism (elevated levels of TSH) or hyperthyroidism (depressed or non-detectable levels of TSH); 2) monitor T4 replacement treatment in primary hypothyroidism or antithyroid treatment in hyperthyroidism; 3) follow T4 suppression of the trophic influence of TSH in “cold nodules” and non-toxic goiter; and 4) assess the response to TRH stimulation testing.

TSH concentrations follow a diurnal rhythm: it typically peaks around midnight and nadir around mid-day. Reference intervals are generally obtained from subjects tested in the daytime, close to nadir than peak, therefore, when evaluating patient’s serial TSH concentrations, differences in sample collection time should be considered.

TSH Variability: TSH has moderate intra-individual variability and marked inter-individual variability. Since the intra-individual variation is considerably less, when comparing a specific patient’s current TSH level a better approach is to compare with any past level than comparing the patient’s current TSH level to the reference interval. A difference of 0.7 mIU/L or greater is considered significant when evaluating a patient’s serial TSH values.

Method Dependency: TSH methods do not always yield the same result. As much as a 10% difference between results may be generated from different TSH methods. Therefore, the same method should be used when monitoring TSH concentration over time. Similarly TSH reference intervals are also method-dependent and are appropriately applied only to patient results generated from the same method.

Pregnancy: It is reasonable to consider serum TSH measurement for pregnant women or women planning to become pregnant with a family history of thyroid disease, prior thyroid dysfunction, symptoms or physical findings suggestive of hypo- or hyperthyroidism, an abnormal thyroid gland on examination, type 1 diabetes mellitus, or a personal history of autoimmune disorder. Suggested upper limit for the TSH reference range for pregnant women and preconception is: first trimester − <2.5 μIU/mL, and 3.0 μIU/mL in the second and third trimesters (The American Thyroid Association (ATA), 2011).

Reference Range Information
Performing Location Reference Range
All Performing Sites using Siemens Dimension All ages:     0.35 - 4.50 uIU/mL 
​Marshfield
<1 years:   0.70 - 8.21 uIU/mL
1-11 years:  0.64 - 6.27 ulU/mL
12-17 years:  0.51 - 4.94 ulU/mL
>=18 years:  0.55 - 4.78 ulU/mL
Interpretation

​​The TSH results should be interpreted in light of the total clinical presentation of the patient, including: symptoms, clinical history, data from additional tests, and other appropriate information. This assay is not validated for testing neonatal serum TSH levels.

TSH may be affected by glucocorticoids, dopamine, and by severe illness. TSH is not elevated in secondary hypothyroidism

Outreach CPTs
CPT Modifier
(if needed)
Quantity Description Comments
84443 ​
Synonyms/Keywords
TSH, Thyrotropin, s-TSH
Ordering Applications
Ordering Application Description
​Centricity

​a. TSH

b. TSH-Thyroid Stimulating Hormone

​Cerner Thyroid Stimulating Hormone​
​COM ​Thyroid Stim. Hormone
If the ordering application you are looking for is not listed, contact your local laboratory for assistance.
Specimen Requirements
Fasting Required Specimen Type Preferred Container/Tube Acceptable Container/Tube Specimen Volume Specimen Minimum Volume
(allows for 1 repeat)
Pediatric Minimum Volume
(no repeat)
No​ Serum or Plasma​

Serum Separator Tube (SST), Lithium-heparin Plasma Separator Tube (PST)

 

Red Top Tube (RTT),
​Sodium-heparin Green Top Tube (GTT)​

 

0.5 mL​ 0.5 mL​ 0.4 mL​
Collection Processing
Separate serum or plasma from the blood within 60 minutes of venipuncture. Specimen must be free of particulate matter including fibrin. Specimens collected in the RTT must be removed from the cells within one hour for storage or transport. Specimens collected in gel-barrier tubes must be removed from the primary tube prior to transporting to Marshfield. Do not send primary collection tube. Specimen should be transported refrigerated (2 - 8°C). If sent frozen, specimens must be completely thawed, thoroughly mixed, and centrifuged before analysis. 1 freeze/thaw cycle has shown to have no qualitative difference in results.
Specimen Stability Information
Specimen Type Temperature Time
Serum/Plasma​ ​ Ambient​ 8 hours​
Refrigerated​ 7 days
Frozen​ at -20 deg Celsius 30 days​
Rejection Criteria
Plasma samples in wrong anticoagulant​
Specimen not separated from cells within 60 minutes​
Samples not transported refrigerated​
Interference
Some patients who have been exposed to animal antigens, either in the environment or as part of treatment or imaging procedure, may have circulating anti-animal antibodies present. These antibodies may interfere with the assay reagents to produce unreliable results.
 
High doses of exogenous biotin (also termed Vitamin B7, Vitamin H or Coenzyme R) may interfere with this assay. It is recommended that patients refrain from consuming any multivitamin or supplement containing biotin for at least 72 hours prior to collection of a blood sample.
Useful For

Aid in evaluating thyroid axis. As an aid in the diagnosis of primary hyperthyroidism. For differential diagnosis of primary hypothyroidism from normal, and the differential diagnosis of primary hypothyroidism from pituitary/hypothalamic hypothyroidism.

Monitoring patients on thyroid replacement therapy.

Confirmation of thyroid-stimulating hormone (TSH) suppression in thyroid cancer patients on thyroxine therapy.

Reference Range Information
Performing Location Reference Range
All Performing Sites using Siemens Dimension All ages:     0.35 - 4.50 uIU/mL 
​Marshfield
<1 years:   0.70 - 8.21 uIU/mL
1-11 years:  0.64 - 6.27 ulU/mL
12-17 years:  0.51 - 4.94 ulU/mL
>=18 years:  0.55 - 4.78 ulU/mL
Interpretation

​​The TSH results should be interpreted in light of the total clinical presentation of the patient, including: symptoms, clinical history, data from additional tests, and other appropriate information. This assay is not validated for testing neonatal serum TSH levels.

TSH may be affected by glucocorticoids, dopamine, and by severe illness. TSH is not elevated in secondary hypothyroidism

For more information visit:
Performing Laboratory Information
Performing Location Day(s) Test Performed Analytical Time Methodology/Instrumentation
​Chippewa Falls ​Monday through Friday ​Less than 2 hours​ ​Enzyme Immunoassay/Siemens Dimension
​Diagnostic Treatment Center ​Monday through Sunday​ ​Less than 2 hours​ ​Enzyme Immunoassay/Siemens Dimension
​Eau Claire ​Monday through Sunday​ ​Less than 2 hours​ ​Enzyme Immunoassay/Siemens Dimension
​Flambeau Hospital ​Monday through Sunday​ ​Less than 2 hours​ ​Enzyme Immunoassay/Siemens Dimension
​Ladysmith Medical Center ​​Monday through Sunday ​Less than 2 hours​ ​Enzyme Immunoassay/Siemens Dimension
​Lakeview Medical Center ​Monday through Sunday​ ​Less than 2 hours​ ​Enzyme Immunoassay/Siemens Dimension
​Marshfield Monday through Sunday​ Less than 2 hours​ Chemiluminescent Immunoassay/Siemens Centaur
​Merrill ​Monday through Saturday ​Less than 2 hours​ ​Enzyme Immunoassay/Siemens Dimension
​Minocqua ​Monday through Sunday​ ​Less than 2 hours​ ​Enzyme Immunoassay/Siemens Dimension
​Stevens Point ​​Monday through Friday ​Less than 2 hours​ ​Enzyme Immunoassay/Siemens Dimension
Wausau​ ​Monday through Sunday​ ​Less than 2 hours​ ​Enzyme Immunoassay/Siemens Dimension
​Wisconsin Rapids ​​Monday through Friday Less than 2 hours​​ ​Enzyme Immunoassay/Siemens Dimension
For billing questions, see Contacts
Outreach CPTs
CPT Modifier
(if needed)
Quantity Description Comments
84443 ​
For most current information refer to the Marshfield Laboratory online reference manual.