Thyroid Stimulating Hormone (TSH)
Medical Test

Diseases (200)
Screening/Initial Testing (37)
Diagnostic Testing (115)
Parkinson's disease
9
Note:

Rule out thyroid disorders.

Seizure
8
Note:
Alcoholic fatty liver
7
Note:

Evaluate for thyroid disorders

Alopecia
7
Note:
Amenorrhea
7
Note:

Rule out thyroid disease.

Chronic fatigue syndrome
7
Note:

Rule out thyroid disease.

Coma
7
Note:
Diabetes mellitus type 1
7
Note:

Rule out thyroid disease.

Epilepsy
7
Note:
Familial hypercholesterolemia
7
Note:

Rule out secondary cause of hypercholesterolemia.

Familial hypobetalipoproteinemia
7
Note:

Evaluate for hypothyroidism

Gestational trophoblastic disease
7
Note:

Evaluate for possible hyperthyroidism.

Hypercholesterolemia
7
Note:

Rule out secondary cause of hypercholesterolemia.

Hypogammaglobulinemia
7
Note:

Rule out autoimmune thyroid disease.

Idiopathic thrombocytopenic purpura
7
Note:

If symptoms of hypo-or hyperthyroidism are present.

Jaundice
7
Note:
Multiple endocrine neoplasia, type II
7
Note:

Rule out thyroid disorders.

Myasthenia gravis
7
Note:

Rule out thyroid disease.

Obstructive sleep apnea
7
Note:

Rule out hypothyroidism.

Osteoporosis
7
Note:

Rule out thyroid disease as etiology of osteoporosis.

Polycystic ovary syndrome
7
Note:

Rule out hypothyroidism.

Polymyalgia rheumatica
7
Note:

Rule out Hypothyroidism.

Pregnancy without complications
7
Note:

Rule out thyroid disease.

Primary fibromyalgia syndrome
7
Note:

Rule out thyroid disease if symptoms of thyroid diseases are present.

Whipple's disease
7
Note:

R/O hyperthyroidism

Adrenal hypofunction
6
Note:

Rule out thyroid disease.

Anemia, NOS
6
Note:

Rule out anemia due to hypothyroidism.

Atrophic gastritis
6
Note:

Rule out thyroid related diseases.

Bloom syndrome
6
Note:

Rule out hypothyroidism.

Chronic gastritis
6
Note:

Rule out thyroid related diseases.

Essential (primary) hypertension
6
Note:

R/O hypothyroidism as a cause of secondary hypertension

Huntington disease
6
Note:

If genetic testing for HD is negative test to rule out thyroid disorders.

Insomnia
6
Note:
Malabsorption
6
Note:

Rule out thyroid disease.

Multifactorial encephalopathy
6
Note:

Rule out thyroid diseases.

Protein losing enteropathy
6
Note:

Rule out thyroid diseases.

Raynaud's disease
6
Note:

R/O Hypothyroidism

Secondary hyperaldosteronism
6
Note:

Rule out thyroid disease.

Autoimmune hemolytic anemia
5
Note:

Rule out thyroid disease.

Myelodysplastic syndrome
5
Note:

Rule out hypothyroidism.

Disease Management Testing (28)
Other Supportive/Alternative Tests (20)

Overview

Thyroid stimulating hormone (TSH) is a glycoprotein hormone produced by the anterior pituitary gland, which stimulates the thyroid gland to produce thyroid hormones. Secretion is stimulated by thyroid-releasing hormone from the hypothalamus. Free thyroid hormones (FT4 and FT3) work in a negative feedback loop to regulate the amount of TSH that is released from the pituitary gland. Dysregulation of TSH may either be a primary or secondary condition causing either hypo- or hyperthyroidism. Although thyroid issues are seen at all ages, onset is usually seen in the late 40s or early 50s, and affects females almost four times more often than males. An elevated TSH result usually means an underactive thyroid (hypothyroidism), whereas a decreased result means an overactive thyroid gland (hyperthyroidism) or excessive amounts of thyroid medication in an individual being treated for hypothyroidism. Measurement of serum TSH is the best initial laboratory test of thyroid function. If TSH levels are abnormal, free thyroxine (FT3) should then be measured. Also, measurement of anti-thyroperoxidase antibody should be done if the TSH level is high.

Clinical Utility
  • Screening for Thyroid Dysfunction
  • Diagnosis of Hyperthyroidism (Decreased TSH)
  • Diagnosis of Hypothyroidism (Elevated TSH)
  • Monitoring thyroid hormone replacement therapy
  • Monitoring anti-thyroid therapy (in hyperthyroidism)
  • Monitoring thyroid cancer patients taking thyroxine

Interpretation

Increased in:

  • Primary Hypothyroidism
  • Mild increase in subclinical hypothyroidism, which is defined as a mild increase in serum TSH and normal free thyroxine and triiodothyronine levels
  • Hashimoto's thyroiditis patients who are euthyroid
  • Ectopic TSH secretion in certain cancers (lung, breast).
  • Recovery phase of subacute thyroiditis
  • Recovery phase of a non-thyroidal illness
  • Thyroid hormone resistance

Decreased in:

  • Primary Hyperthyroidism
  • Secondary (pituitary) hypothyroidism
  • Tertiary hypothyroidism
  • Graves disease
  • Thyroiditis
  • Toxic adenomas
  • Acute medical or surgical illness
  • Some drugs such as dopamine
  • High-dose corticosteroids
  • Mild decrease in subclinical hyperthyroidism (mild decrease in serum TSH and normal free thyroxine and triiodothyronine levels, as in treated Graves disease, toxic multinodular goiter, autonomous thyroid hormone secretion, exogenous thyroid hormone therapy)
  • Euthyroid sick syndrome

Reference Ranges
  uU/mL mU/L
Premature infants    
(28-36 wk gestation): 0.7-27 0.7-27
1-4 days: 1.0-39 1.0-39
2-20 wk: 1.7-9.1 1.7-9.1
5 mo-20 yr: 0.7-6.4 0.7-6.4
Adults    
21-54 yr: 0.4-4.2 0.4-4.2
55-87 yr: 0.5-8.9 0.5-8.9
Pregnancy    
First trimester: 0.3-4.5 0.3-4.5
Second trimester: 0.5-4.6 0.5-4.6
Third trimester: 0.8-5.2 0.8-5.2


 

 

 

Methodology

Immunoassay.

Specimen Collection

Serum (SST)

Stability:

  • Ambient: 5 days
  • Refrigerated: 7 days
  • Frozen: 2 months

Additional Testing

Free Thyroxine (Free T4), Total Thyroxine (T4 total), Thyroid stimulating immunoglobulin, Thyroid peroxidase antibody (TPO antibody), Thyroid Stimulating Hormone Receptor Antibody, Thyroglobulin Antibody.

CPT
84436$6.87
84439$9.02
84443$16.8$16.8
84479$6.47

ICD10
ICD CODE AND DESCRIPTIONLCD CODENCD CODE
A23 - Brucellosis—190.22
A35 - Other tetanus—190.22
A37 - Whooping cough—190.22
A37.0 - Whooping cough due to Bordetella pertussis—190.22
A51.32 - Syphilitic alopecia—190.22
B02 - Zoster [herpes zoster]—190.22
B02.23 - Postherpetic polyneuropathy—190.22
B17 - Other acute viral hepatitis—190.22
B17.1 - Acute hepatitis C—190.22
B18 - Chronic viral hepatitis—190.22
B18.2 - Chronic viral hepatitis C—190.22
B19 - Unspecified viral hepatitis—190.22
B19.2 - Unspecified viral hepatitis C—190.22
B19.20 - Unspecified viral hepatitis C without hepatic coma—190.22
B19.21 - Unspecified viral hepatitis C with hepatic coma—190.22
B82 - Unspecified intestinal parasitism—190.22
B89 - Unspecified parasitic disease—190.22
C15 - Malignant neoplasm of esophagus—190.22
C16 - Malignant neoplasm of stomach—190.22
C17 - Malignant neoplasm of small intestine—190.22
C17.0 - Malignant neoplasm of duodenum—190.22
C17.1 - Malignant neoplasm of jejunum—190.22
C17.2 - Malignant neoplasm of ileum—190.22
C18 - Malignant neoplasm of colon—190.22
C19 - Malignant neoplasm of rectosigmoid junction—190.22
C20 - Malignant neoplasm of rectum—190.22
C21 - Malignant neoplasm of anus and anal canal—190.22
C21.0 - Malignant neoplasm of anus, unspecified—190.22
C25 - Malignant neoplasm of pancreas—190.22
C25.4 - Malignant neoplasm of endocrine pancreas—190.22
C25.9 - Malignant neoplasm of pancreas, unspecified—190.22
C26.0 - Malignant neoplasm of intestinal tract, part unspecified—190.22
C26.9 - Malignant neoplasm of ill-defined sites within the digestive system—190.22
C44 - Other and unspecified malignant neoplasm of skin—190.22
C48 - Malignant neoplasm of retroperitoneum and peritoneum—190.22
C48.0 - Malignant neoplasm of retroperitoneum—190.22
C48.1 - Malignant neoplasm of specified parts of peritoneum—190.22
C48.2 - Malignant neoplasm of peritoneum, unspecified—190.22
C48.8 - Malignant neoplasm of overlapping sites of retroperitoneum and peritoneum—190.22
C49 - Malignant neoplasm of other connective and soft tissue—190.22
C49.A - Gastrointestinal stromal tumor—190.22
C56 - Malignant neoplasm of ovary—190.22
C56.1 - Malignant neoplasm of right ovary—190.22
C56.2 - Malignant neoplasm of left ovary—190.22
C56.3 - —190.22
C56.9 - Malignant neoplasm of unspecified ovary—190.22
C58 - Malignant neoplasm of placenta—190.22
C64 - Malignant neoplasm of kidney, except renal pelvis—190.22
C64.1 - Malignant neoplasm of right kidney, except renal pelvis—190.22
C64.2 - Malignant neoplasm of left kidney, except renal pelvis—190.22

Additional ICD10
ICD CODE AND DESCRIPTIONLCD CODENCD CODE
A23.0 - Brucellosis due to Brucella melitensis—190.22
A23.1 - Brucellosis due to Brucella abortus—190.22
A23.2 - Brucellosis due to Brucella suis—190.22
A23.3 - Brucellosis due to Brucella canis—190.22
A23.8 - Other brucellosis—190.22
A23.9 - Brucellosis, unspecified—190.22
A36.81 - Diphtheritic cardiomyopathy—190.22
A37.0 - Whooping cough due to Bordetella pertussis—190.22
A37.00 - Whooping cough due to Bordetella pertussis without pneumonia—190.22
A37.01 - Whooping cough due to Bordetella pertussis with pneumonia—190.22
A37.1 - Whooping cough due to Bordetella parapertussis—190.22
A37.10 - Whooping cough due to Bordetella parapertussis without pneumonia—190.22
A37.11 - Whooping cough due to Bordetella parapertussis with pneumonia—190.22
A37.8 - Whooping cough due to other Bordetella species—190.22
A37.80 - Whooping cough due to other Bordetella species without pneumonia—190.22
A37.81 - Whooping cough due to other Bordetella species with pneumonia—190.22
A37.9 - Whooping cough, unspecified species—190.22
A37.90 - Whooping cough, unspecified species without pneumonia—190.22
A37.91 - Whooping cough, unspecified species with pneumonia—190.22
A51.45 - Secondary syphilitic hepatitis—190.22
B00.81 - Herpesviral hepatitis—190.22
B02.0 - Zoster encephalitis—190.22
B02.1 - Zoster meningitis—190.22
B02.2 - Zoster with other nervous system involvement—190.22
B02.21 - Postherpetic geniculate ganglionitis—190.22
B02.22 - Postherpetic trigeminal neuralgia—190.22
B02.23 - Postherpetic polyneuropathy—190.22
B02.24 - Postherpetic myelitis—190.22
B02.29 - Other postherpetic nervous system involvement—190.22
B02.3 - Zoster ocular disease—190.22
B02.30 - Zoster ocular disease, unspecified—190.22
B02.31 - Zoster conjunctivitis—190.22
B02.32 - Zoster iridocyclitis—190.22
B02.33 - Zoster keratitis—190.22
B02.34 - Zoster scleritis—190.22
B02.39 - Other herpes zoster eye disease—190.22
B02.7 - Disseminated zoster—190.22
B02.8 - Zoster with other complications—190.22
B02.9 - Zoster without complications—190.22
B17.0 - Acute delta-(super) infection of hepatitis B carrier—190.22
B17.1 - Acute hepatitis C—190.22
B17.10 - Acute hepatitis C without hepatic coma—190.22
B17.11 - Acute hepatitis C with hepatic coma—190.22
B17.2 - Acute hepatitis E—190.22
B17.8 - Other specified acute viral hepatitis—190.22
B17.9 - Acute viral hepatitis, unspecified—190.22
B18.0 - Chronic viral hepatitis B with delta-agent—190.22
B18.1 - Chronic viral hepatitis B without delta-agent—190.22
B18.2 - Chronic viral hepatitis C—190.22
B18.8 - Other chronic viral hepatitis—190.22

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