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Test Catalog

Test ID: T4FT4    
T4 (Thyroxine), Total and Free, Serum

Useful For Suggests clinical disorders or settings where the test may be helpful

Thyroxine (T4) and free T4 are measured together with thyroid-stimulating hormone when thyroid function disorders are suspected.

Clinical Information Discusses physiology, pathophysiology, and general clinical aspects, as they relate to a laboratory test

THYROXINE (T4), TOTAL:

T4 is synthesized in the thyroid gland. T4 is metabolized to 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 or unbound portion. The remainder is bound to thyroxine-binding globulin (TBG), prealbumin, and albumin.

 

The hypothalamus secretes thyrotropin-releasing hormone (TRH), which stimulates the pituitary to release thyroid-stimulating hormone (TSH). TSH stimulates the thyroid to secrete T4. T4 is partially converted peripherally to triidothyronine (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. However, changes in binding proteins can occur which affect the level of total T4 but leave the level of unbound hormone unchanged.

 

THYROXINE (T4), FREE:

Free thyroxine comprises a small fraction of total thyroxine. The free T4 (FT4) is available to the tissues and is, therefore, the metabolically active fraction.

 

Elevations in FT4 cause hyperthyroidism, while decreases cause hypothyroidism.

Reference Values Describes reference intervals and additional information for interpretation of test results. May include intervals based on age and sex when appropriate. Intervals are Mayo-derived, unless otherwise designated. If an interpretive report is provided, the reference value field will state this.

T4 (THYROXINE), TOTAL ONLY

Adult (> or =20 years): 4.5-11.7 mcg/dL

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

 

T4 (THYROXINE), FREE

Adult (> or =20 years of age): 0.9-1.7 ng/dL

0-5 days: 0.9-2.5 ng/dL

6 days-2 months: 0.9-2.2 ng/dL

3-11 months: 0.9-2.0 ng/dL

1-5 years: 1.0-1.8 ng/dL

6-10 years: 1.0-1.7 ng/dL

11-19 years: 1.0-1.6 ng/dL

Clinical Reference Recommendations for in-depth reading of a clinical nature

Melmed S, Polonsky KS, Larsen PR, et al: Williams textbook of Endocrinology. 12th edition. Elsevier Saunders Company, 2011, pp 348-414