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Thyroid Stimulating Immunoglobulin (TSI)

Thyroid Stimulating Immunoglobulin (TSI)

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LAB746
THSI

Category

Sendouts

Methodology

Chemiluminescent Immunoassay

Test Performance Schedule

Monday - Friday

Result Availability

2 – 4 days

Specimen Required

Container

Gold top (SST) or Red top (serum) tube

Volume

Pref. Vol.: 5 mL
Min. Vol.: 2 mL

Collection Instructions

• Routine venipuncture
• Immediately after collection, gently invert tube 5-10 times
• Clot 30 minutes
• Promptly centrifuge 15 minutes
• Separate serum to plastic tube
• Refrigerate

Transportation Instructions

Refrigerated

Stability

• Room temperature: 8 hours
• Refrigerated (preferred): 7 days
• Frozen: 180 days

Causes for Rejection

Grossly hemolyzed specimen

Remarks

 

CPT Codes

84445

Effective/Revised

5/1/2023

Clinical Significance

The TSH receptor (TSHR) harbors a large extracellular domain. Patients with Graves disease commonly develop autoantibodies to epitopes present on the extracellular domain of the TSH receptor. Such autoantibodies can be stimulatory or inhibitory in nature. Those that are stimulatory (i.e. TSI), mimic TSH stimulation. In contrast to TSH, thyroid stimulating immunoglobulins are not subject to a negative feedback mechanism, and thus potentiate autoimmune thyroid disease pathogenesis.

TSI should be used as a second-order test in autoimmune thyroid disease, including:

  1. To aid in the diagnosis of thyrotoxicosis if patient has ambiguous clinical presentation or thyroid scan is indeterminate/cannot be performed.
  2. To support the diagnosis of clinically suspected Graves disease in patients with normal thyroid function tests.
  3. As a prognostic marker for relapse of Graves disease.
  4. To predict the risk of thyroid dysfunction in a fetus of a pregnant female with active or treated Graves disease.

 

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