Thyroxine (T4), Free, Direct

CPT: 84439
Print Share

Test Details

Synonyms

  • Free T4, Direct, Serum
  • Free Thyroxine
  • T4, Free, Direct, Serum

Use

Free T4 may be indicated when binding globulin (TBG) problems are perceived, or when conventional test results seem inconsistent with clinical observations. It is normal in subjects with high thyroxine-binding globulin hormone binding who are euthyroid (ie, free thyroxine should be normal in nonthyroidal diseases). It should be normal in familial dysalbuminemic hyperthyroxinemia.

Limitations

FT4 may be increased with radiologic contrast agents, propranolol, amiodarone, and heparin. It may be decreased with carbamazepine (Tegretol®). Free T4 is a small part of total T4. Increased free T4 levels may occur in subjects with nonthyroid diseases. Such elevations are described as transient.2 Low values were reported in patients with nonthyroidal illness.3 Discrepancies in free T4 levels between methods are recognized.4 Reliability problems continue to be discussed with the direct (analog) methods.5 Results of kits intended to serve in place of equilibrium dialysis technique may differ from the reference method.

Methodology

Electrochemiluminescence immunoassay (ECLIA)

Reference Interval

See table.1

Age

Range (ng/dL)

0 to 3 d

0.66−2.71

4 to 30 d

0.83−3.09

31 d to 12 m

0.48−2.34

13 m to 5 y

0.85−1.75

6 to 10 y

0.90−1.67

11 to 19 y

0.93−1.60

>19 y

0.82−1.77

Specimen Requirements

Specimen

Serum

Volume

0.8 mL

Minimum Volume

0.3 mL (Note: This volume does not allow for repeat testing.)

Container

Red-top tube or gel-barrier tube

Patient Preparation

Heparin has been reported to have in vivo and in vitro effects on free T4 assay. Hence samples should not be collected during or soon after the administration of this anticoagulant.

Collection

If a red-top tube is used, transfer separated serum to a plastic transport tube.

Storage Instructions

Room temperature

Stability Requirements

Temperature

Period

Room temperature

14 days

Refrigerated

14 days

Frozen

14 days

Freeze/thaw cycles

Stable x3

Causes for Rejection

Citrate plasma specimen; improper labeling

Clinical Information

Special Instructions

This test may exhibit interference when sample is collected from a person who is consuming a supplement with a high dose of biotin (also termed as vitamin B7 or B8, vitamin H, or coenzyme R). It is recommended to ask all patients who may be indicated for this test about biotin supplementation. Patients should be cautioned to stop biotin consumption at least 72 hours prior to the collection of a sample.

Footnotes

  • 1. Reference intervals for children and adults. Elecsys Thyroid Test. Roche Diagnostics; May 2005. 8595709
  • 2. Borst GC, Eil C, Burman KD. Euthyroid hyperthyroxinemia. Ann Intern Med. 1983; 98(3):366-378. 6187257
  • 3. Cooke RR, Pratt R. Thyroid function tests in acutely ill patients. Comparison of analogue based free thyroid hormone assays with free thyroxine index. Pathology. 1986; 18(1):94-97. 3725439
  • 4. Gruhn JG, Barsano CP, Kumar Y. The development of tests of thyroid function. Arch Pathol Lab Med. 1987; 111(1):84-100. 3541847
  • 5. Bethune JE. Interpretation of thyroid function tests. Dis Mon. 1989; 35(8):541-595.2670494

References

Chattoraj SC, Watts NB. Endocrinology. In: Tietz NW, ed. Fundamentals of Clinical Chemistry. 3rd ed. Philadelphia, Pa: WB Saunders Co;1987: 533-613.
Gurnell M, Halsall DJ, Chatterjee VK. What should be done when thyroid function tests do not make sense? Clin Endocrinol (Oxf). 2011; 74(6):673-678.21521292
Ingbar SH. Diseases of the thyroid. In: Braunwald E, Isselbacher KJ, Petersdorf RG, et al, eds. Harrison's Principles of Internal Medicine. 11th ed. New York, NY: McGraw-Hill; 1987: 1732-1752.
Jansson R, Forberg R, Levin K. Free thyroxin index and direct measurements of free thyroxin compared for evaluating postpartum autoimmune thyroid dysfunction. Clin Chem. 1984; 30(6):903-905. 6723049
Pearce CJ, Himsworth RL. Total and free thyroid hormone concentrations in patients receiving maintenance replacement treatment with thyroxine. Br Med J [Clin Res Ed]. 1984; 288(6418):693-695. 6421436
Surks MI, Chopra IJ, Mariash CN, Nicoloff JT, Solomon DH. American Thyroid Association guidelines for use of laboratory tests in thyroid disorders. JAMA. 1990 Mar 16; 263(11):1529-1532. 2308185
Wilkins TA. Free thyroxine assays: Analogue methods. Lancet. 1985; 2(8460):884.2864591

LOINC® Map

Order Code Order Code Name Order Loinc Result Code Result Code Name UofM Result LOINC
001974 Thyroxine (T4) Free, Direct, S 3024-7 019745 T4,Free(Direct) ng/dL 3024-7

For Providers

Please login to order a test.

 

© 2019  Laboratory Corporation of America® Holdings and Lexi-Comp Inc. All Rights Reserved.

CPT Statement/Profile Statement

The LOINC® codes are copyright © 1994-2018, Regenstrief Institute, Inc. and the Logical Observation Identifiers Names and Codes (LOINC) Committee. Permission is granted in perpetuity, without payment of license fees or royalties, to use, copy, or distribute the LOINC® codes for any commercial or non-commercial purpose, subject to the terms under the license agreement found at https://loinc.org/license/. Additional information regarding LOINC® codes can be found at LOINC.org, including the LOINC Manual, which can be downloaded at LOINC.org/downloads/files/LOINCManual.pdf