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Free T4

Principle

Thyroxine (T4) is the principal hormone secreted by the thyroid gland and serves as a precursor to the more biologically active triiodothyronine (T3). The free fraction of circulating thyroxine (FT4) represents the hormonally active component available to tissues and is considered the most direct indicator of an individual’s thyroid functional status.

FT4 concentrations are typically decreased in hypothyroidism and increased in hyperthyroidism. Measurement of FT4 therefore provides valuable information for the differential diagnosis of thyroid disease. Because FT4 concentrations are independent of thyroid hormone–binding protein levels, accurate assessment is possible in patients with increased or decreased binding protein concentrations without the need for additional tests of binding capacity.

Specimen Requirements

Specimen

Serum (red-top tube with no additive or serum separator tube, SST).

Collection

Separate serum from clot as soon as possible to prevent hemolysis.

Processing

Separate serum from clot as soon as possible to prevent hemolysis.

Storage and Transport

Store/transport at 15–30°C for ≤8 hours; 2–8°C for ≤48 hours; freeze at ≤ –20°C if delayed. Avoid repeated freeze–thaw cycles.

Unacceptable Specimens

Hemolyzed or unseparated specimens.

Method

Enhanced Chemiluminescence.

Normal Range

0.61–1.12 ng/dl

Turnaround Time

3 days

References

  • Robbins J, Rall JE. Interaction of thyroid hormones and proteins in biological fluids. Recent Prog Horm Res. 1957;13:161–202.
  • Robbins J, Rall JE. The iodine-containing hormones. In: Grady CH, Bacharach AL, eds. Hormones in Blood. Vol 1. London: Academic Press; 1967:383–490.
  • Avruskin TW, et al. Measurements of free and total serum T3 and T4 in pregnant subjects and neonates. Am J Med Sci. 1976;271:309–315.
  • Lewis M. Measurement of free thyroid hormones in health and disease. In: Ekins R, et al., eds. International Symposium on Free Thyroid Hormones. Venice: Excerpta Medica; 1979:167–180.

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