TSH-ICMA

Laboratory assay overview

This panel combines tests used in the diagnosis and management of cardiometabolic disease elements, including metabolic syndrome, prediabetes, diabetes, thyroid conditions, kidney, fatty liver, and cardiovascular disease risk. The benefits of GLP-1 therapies extend far beyond glycemic control and weight reduction.[1] These agents provide cardiovascular benefits, showing promise in improving kidney and liver health while on GLP-1 treatment.[1] This panel can establish a baseline prior to initiating GLP-1 therapy, if clinically indicated and a periodic comprehensive view of a patient’s cardiometabolic health thereafter. Note this panel does not measure Glucagon-like peptide-1 hormone levels in blood. Up to 45% of Americans have a chronic disease; more than half of older adults have multiple chronic conditions.[2] The related chronic cardiometabolic conditions are characterized by initial stages that may remain clinically silent for years. Medical societies, like the American Heart Association, recognize the interrelated impacts of metabolic risk factors (e.g., obesity and diabetes), chronic kidney disease (CKD), and cardiovascular disease, and the gap in early screening, prevention, and management of these chronic conditions.[3,4] Rising rates of metabolic dysfunction, obesity, and type 2 diabetes mellitus (T2DM) also contribute to increased prevalence of nonalcoholic fatty liver disease (NAFLD), also known as metabolic dysfunction-associated steatotic liver disease (MASLD).[5] Thyroid health may either be impacted by or exacerbate cardiometabolic conditions, such as coronary heart disease (CHD), MASLD, and CKD.[6-9] The Cardiometabolic Disease Assessment Panel includes guideline-recommended testing that spans interrelated areas of cardiometabolic disease to determine the extent of metabolic dysfunction (glycemic control and advanced lipid assessment), identify whether thyroid health contributes to or is altered by metabolic dysfunction, and adverse impacts to heart, liver, and kidney function.[10-14] Identification of cardiometabolic disease presence can help guide personalized treatment strategies to prevent or delay disease progression and related complications. This panel should be requested when all elements are medically necessary, and components have not recently been reported. The results of this panel should be interpreted in the context of pertinent clinical and family history and physical examination findings. References 1. Rosen C, et al. N Engl J Med. 2026;394:1313-1324. doi: 10.1056/NEJMra2500106. 2. Raghupathi W, et al. Int J Environ Res Public Health. 2018;15(3):431. doi:10.3390/ijerph15030431. 3. Ndumele CE, et al. Circulation. 2023;148(20):1636-1664. doi.org/10.1161/CIR.0000000000001186. 4. Khan SS, et al. Circulation. 2024;149(6):430-449. doi: 10.1161/CIRCULATIONAHA.123.067626. 5. Bril F, et al. J Clin Endocrinol Metab. 2021;106(11):e4360-e4371. doi:10.1210/clinem/dgab417. 6. Cappola AR, et al. Circulation. 2019;139(25):2892- 2909. doi.org/10.1161/circulationaha.118.036859. 7. Kalra S, et al. Diabetes Ther. 2019;10(6):2035-2044. doi:10.1007/s13300-019-00700-4. 8. Mantovani A, et al. Thyroid. 2018;28(10):1270-1284. doi:10.1089/ thy.2018.0257. 9. Iglesias P, et al. Rev Endocr Metab Disord. 2017;18(1):131-144. doi:10.1007/s11154-016-9395-7. 10. Classification and Diagnosis of Diabetes: Standards of Medical Care in Diabetes-2020. Diabetes Care. 2020;43(Suppl 1):S14-S31. doi: 10.2337/dc23-S002. 11. Arnett DK, et al. J Am Coll Cardiol. 2019. doi: 10.1161/CIR.0000000000000677. 12. Cusi K, et al. Clinical Practice Guidelines. 2022;28(5):P528-562. doi:10.1016/j.eprac.2022.03.010. 13. Rinella NE, et al. Hepatology. 2023;77(5):1797-1835. doi:10.1097/HEP.0000000000000323. 14. Kidney Disease: Improving Global Outcomes (KDIGO) CKD Work Group. Kidney Int. 2024;105(4S):S117-S314. doi:10.1016/j.kint.2023.10.018.

Laboratory assay overview

Chronic urticaria is a common skin disorder affecting 1% to 6% of the general population. It is characterized by repeated occurrence of short-lived cutaneous wheals accompanied by redness and itching. Autoimmune urticaria is defined by the presence of a functional IgG antibody to high-affinity IgE receptor (Fc epsilon RI alpha) or to IgE. These antibodies trigger mast cell and basophile degranulation by the engagement of Fc epsilon receptor. Functional IgG antibody to the receptor has been identified in approximately 30-40% of patients with chronic urticaria, and anti IgE antibody has been identified in another 5-10%.

Laboratory assay overview

Patients with a chronic form of urticaria who are positive with the functional Histamine Release (Chronic Urticaria) test have an autoimmune basis for their disease. A positive result does not indicate which autoantibody (anti-IgE or anti-Fc epsilon RI alpha chain) is present. A positive anti-IgE antibody does not exclude the presence of anti-Fc epsilon RI alpha chain antibody. Autoimmune thyroid disease coexists in approximately 25% of autoimmune chronic urticaria patients.

Laboratory assay overview

This panel is designed to evaluate a patient for the presence of potentially reversible (i.e., secondary) causes of dementia such as Vitamin B12 deficiency, hypothyroidism, hypoparathyroidism, anemia, hypoxia or hypercapnia, hepatic and renal encephalopathies, diabetes and dehydration. The panel includes a Complete Blood Count, TSH, Vitamin B12, Folate and a Comprehensive Metabolic Panel. It is modeled after the recommendations of the American Academy of Neurology (AAN), a National Institutes of Health Consensus Panel, the European Federation of Neurological Societies (EFNS), and others [1-4]. References 1. Knopman DS, DeKosky ST, Cummings JL, et al. Practice parameter: diagnosis of dementia (an evidence-based review). Report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology. 2001;56:1143-1153. 2. Consensus conference. Differential diagnosis of dementing diseases. JAMA. 1987;258:3411-3416. 3. Sorbi S, Hort J, Erkinjuntti T, et al. EFNS-ENS Guidelines on the diagnosis and management of disorders associated with dementia. Eur J Neurol. 2012;19:1159-1179. 4. Simmons BB, Hartmann B, DeJoseph D. Evaluation of suspected dementia. Am Fam Physician. 2011;84:895-902.

Laboratory assay overview

This panel is intended to aid physicians in diagnosing polycystic ovary syndrome (PCOS) by assessing biochemical hyperandrogenism and ruling out other disorders that mimic the clinical features of PCOS. This assay provides the sensitivity and specificity required for the assessment of the low testosterone levels found in women, children, adolescents, and hypogonadal men.1

Laboratory assay overview

The Thyroid Cascading Reflex order code that will act as an aid to physicians in the diagnosis of common adult thyroid disorders. The initial results of a TSH will determine further reflex orders of T4, Free, TPO Antibodies and T3, Free orders and provided an interpretation based upon the results of the reflexed tests.

Quest Diagnostics population reference ranges

Quest Diagnostics calculates these statistical intervals for this specific assay and demographic group, not as universal optimal targets.

Laboratory assay overview

This panel provides an assessment of thyroid function and includes tests for thyroid stimulating hormone (TSH), total thyroxine (T4), triiodothyronine (T3) uptake (T3 resin uptake), and free T4 index. This panel may be useful for evaluating thyroid function when pituitary disease is not suspected. The results of the panel may help in the diagnosis of hyperthyroidism and hypothyroidism [1]. T3 and T4 are hormones derived from the thyroid and released into the blood to regulate metabolism. Both T3 and T4 are produced in response to TSH from the pituitary gland. T4 circulates mostly bound to plasma proteins, with a small amount unbound and available for biological activity. To estimate free T4 concentration, a total T4 test and T3 uptake test are used to calculate the free T4 index [1]. A normal TSH result excludes most cases of primary overt thyroid disease. Therefore, a cascaded testing approach (test code 15102) may be preferable for evaluating and monitoring thyroid function. This panel does not identify T3 thyrotoxicosis, which requires measurement of free T3 [2,3]. Note: Interference due to heterophile antibodies has been known to occur [1]. The results of this panel should be interpreted in the context of pertinent clinical and family history and physical examination findings. References 1. Demers LM, et al. The thyroid: pathophysiology and thyroid function testing. In: Burtis CA, et al. eds. Tietz Textbook of Clinical Chemistry and Molecular Diagnostics. 4th ed. Elsevier; 2006:2053-2095. 2. Ross DS, et al. Thyroid. 2016;26(10):1343-1421. 3. Vasileiou M, et al; Guideline Committee. BMJ. 2020;368:m41.

Laboratory assay overview

For differential diagnosis of primary, secondary, and tertiary hypothyroidism. Also useful in screening for hyperthyroidism. This assay allows adjustment of exogenous thyroxine dosage in hypothyroid patients and in patients on suppressive thyroxine therapy for thyroid neoplasia.

Quest Diagnostics population reference ranges

Quest Diagnostics calculates these statistical intervals for this specific assay and demographic group, not as universal optimal targets.

Laboratory assay overview

Precision in the estimation of TSH is crucial to the follow-up of subjects with thyroid disorders. The preincubation of samples to remove HAMA immunoglobulins provides a way to ensure that an otherwise unsuspected rise or drop in TSH concentration will not be interpreted as either a false positive or false negative.

Quest Diagnostics population reference ranges

Quest Diagnostics calculates these statistical intervals for this specific assay and demographic group, not as universal optimal targets.

Laboratory assay overview

This test may be useful in assessing thyroid dysfunction when pituitary disease is not suspected. In patients with clinical suspicion of hyperthyroidism or hypothyroidism, testing thyroid stimulating hormone (TSH) is the initial step [1]. An abnormal TSH result will reflex to a free thyroxine (T4) test to aid in diagnosis and guide further testing if needed. TSH stimulates the thyroid gland to synthesize and secrete triiodothyronine (T3) and T4. TSH production is reduced in response to high T3/T4 levels and increased in response to low T3/T4 levels. When pituitary disease is not suspected, TSH serves as a sensitive marker for screening for thyroid dysfunction [1,2]. A normal TSH result excludes most cases of primary overt thyroid disease. When the TSH level is elevated, measurement of free T4 level may help diagnose subclinical or overt hypothyroidism. Thyroid peroxidase antibody testing may be needed to aid in the diagnosis of Hashimoto thyroiditis. When the TSH level is decreased, measurement of free T4 and free T3 may help identify hyperthyroidism or T3 thyrotoxicosis. In patients with thyrotoxicosis, TSH receptor antibodies testing helps confirm Graves disease [1-3]. Note: Interference due to heterophile antibodies has been known to occur [1]. The results of this test should be interpreted in the context of pertinent clinical and family history and physical examination findings. References 1. Demers LM, et al. The thyroid: pathophysiology and thyroid function testing. In: Burtis CA, et al. eds. Tietz Textbook of Clinical Chemistry and Molecular Diagnostics. 4th ed. Elsevier; 2006:2053-2095. 2. Ross DS, et al. Thyroid. 2016;26(10):1343-1421. 3. Vasileiou M, et al; Guideline Committee. BMJ. 2020;368:m41.

Quest Diagnostics population reference ranges

Quest Diagnostics calculates these statistical intervals for this specific assay and demographic group, not as universal optimal targets.

Laboratory assay overview

TSH levels are lower during pregnancy, especially during the 1st trimester. Based on recent clinical studies which have shown that even mildly elevated TSH during pregnancy is associated with adverse pregnancy outcomes, the American Thyroid Association has released clinical guidelines which recommend the use of assay-specific and trimester-specific reference intervals.

Quest Diagnostics population reference ranges

Quest Diagnostics calculates these statistical intervals for this specific assay and demographic group, not as universal optimal targets.