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Test ID: T4 T4 (Thyroxine), Total Only, Serum

Reporting Name

T4 (Thyroxine), Total Only, S

Useful For

Monitoring treatment with synthetic hormones (synthetic triiodothyronine [T3] will cause a low total thyroxine [T4])

 

Monitoring treatment of hyperthyroidism with thiouracil and other anti-thyroid drugs

 

Index of thyroid function when the thyroxine-binding globulin is normal and non-thyroidal illness is not present

Clinical Information

Thyroxine (T4) is synthesized in the thyroid gland. T4 is metabolized to triiodothyronine (T3) peripherally by deiodination. T4 is considered a reservoir or prohormone for T3, the biologically most active thyroid hormone. About 0.05% of circulating T4 is in the free, ie, unbound, portion. The remainder is bound to thyroxine-binding globulin, prealbumin, and albumin.

 

The hypothalamus secretes thyrotropin-releasing hormone, which stimulates the pituitary to release thyrotropin, formerly thyroid-stimulating hormone (TSH). TSH stimulates the thyroid to secrete T4. T4 is partially converted peripherally to T3. High amounts of T4 and T3 (mostly from peripheral conversion of T4) cause hyperthyroidism.

 

T4 and T3 cause positive feedback to the pituitary and hypothalamus with resultant suppression or stimulation of the thyroid gland as follows: decrease of TSH if T3 or T4 is high (hyperthyroidism) and increase of TSH if T3 or T4 is low (hypothyroidism).

 

Measurement of total T4 gives a reliable reflection of clinical thyroid status in the absence of protein-binding abnormalities and non-thyroidal illness. However, changes in binding proteins can occur that affect the level of total T4 but leave the level of unbound hormone unchanged.

Interpretation

Values of more than 11.7 mcg/dL in adults or more than the age-related cutoffs in children are seen in hyperthyroidism and in patients with acute thyroiditis.

 

Values below 4.5 mcg/dL in adults or below the age-related cutoffs in children are seen in hypothyroidism, myxedema, cretinism, chronic thyroiditis, and occasionally, subacute thyroiditis.

 

Increased total thyroxine (T4) is seen in pregnancy and patients who are on estrogen medication. These patients have increased total T4 levels due to increased thyroxine-binding globulin (TBG) levels.

 

Decreased total T4 is seen in patients on treatment with anabolic steroids or nephrosis (decreased TBG levels).

 

A thyrotropin-releasing hormone stimulation test may be required for certain cases of hyperthyroidism.

 

Clinical findings are necessary to determine if thyrotropin, TBG, or free T4 testing is needed.

Testing Algorithm

For information see Thyroid Function Ordering Algorithm.

Report Available

1 to 3 days

Day(s) Performed

Monday through Friday

Clinical Reference

1. Peyro Saint Paul L, Debruyne D, Bernard D, Mock DM, Defer GL: Pharmacokinetics and pharmacodynamics of MD1003 (high-dose biotin) in the treatment of progressive multiple sclerosis. Expert Opin Drug Metab Toxicol. 2016;12(3):327-344

2. Grimsey P, Frey N, Bendig G, et al: Population pharmacokinetics of exogenous biotin and the relationship between biotin serum levels and in vitro immunoassay interference. J Pharmacokinet Pharmacodyn. 2017 Sept;2(4):247-256. doi: 10.4155/ipk-2017-0013

3. Ross DS, Burch HB, Cooper DS, et al: 2016 American Thyroid Association guidelines for diagnosis and management of hyperthyroidism and other causes of thyrotoxicosis. Thyroid. 2016 Oct 26(10):1343-14214

4. Persani L, Cangiano B, Bonomi M: The diagnosis and management of central hypothyroidism in 2018. Endocr Connect. 2019 Feb;8(2):R44–R54 doi:10.1530/EC-18-0515

Method Name

Electrochemiluminescence Immunoassay

Specimen Type

Serum


Ordering Guidance


This test cannot be used in patients receiving treatment with lipid-lowering agents containing dextrothyroxine unless therapy is discontinued for 4 to 6 weeks to allow the physiological state to become reestablished prior to testing.



Specimen Required


Collection Container/Tube:

Preferred: Serum gel

Acceptable: Red top

Submission Container/Tube: Plastic vial

Specimen Volume: 1 mL

Collection Instructions: Centrifuge and aliquot serum into a plastic vial.


Specimen Minimum Volume

0.75 mL

Specimen Stability Information

Specimen Type Temperature Time Special Container
Serum Refrigerated (preferred) 7 days
  Frozen  30 days

Reference Values

Pediatric

0-5 days: 5.0-18.5 mcg/dL

6 days-2 months: 5.4-17.0 mcg/dL

3-11 months: 5.7-16.0 mcg/dL

1-5 years: 6.0-14.7 mcg/dL

6-10 years: 6.0-13.8 mcg/dL

11-19 years: 5.9-13.2 mcg/dL

 

Adult (≥20 years): 4.5-11.7 mcg/dL

 

For SI unit Reference Values, see www.mayocliniclabs.com/order-tests/si-unit-conversion.html

Test Classification

This test has been cleared, approved, or is exempt by the US Food and Drug Administration and is used per manufacturer's instructions. Performance characteristics were verified by Mayo Clinic in a manner consistent with CLIA requirements.

CPT Code Information

84436

LOINC Code Information

Test ID Test Order Name Order LOINC Value
T4 T4 (Thyroxine), Total Only, S 83119-8

 

Result ID Test Result Name Result LOINC Value
T4 T4 (Thyroxine), Total Only, S 83119-8
Mayo Clinic Laboratories | Endocrinology Catalog Additional Information:

mml-endo-thyroid