Anti-thyroid Ab Profile

Centralized Core Laboratory - Summa Akron City Hospital : Send Out

PATIENT INFO

Patient Name:

Medical Record #:

BD: / / Sex: F M

PHYSICIAN INFO

Physician Name :

Address:

Ph: ( ) - Fax: ( ) -

Additional Report to:

Ph: ( ) - Fax: ( ) -

TESTS REQUESTED
Test Name:	ICD9 Code: (required)
1. Anti-thyroid Ab Profile
2.
3.
4.
5.
6.

SPECIMEN INFO

Collection Date & Time:

Collected By:

Hospital:

Test ID :

ATAP

Test Workstation :

SUMMA

Specimen Type:

Blood

Tube Type:

Red top (no anticoagulant) tube

Collection Volume:

3.0 mL

Minimum Volume:

1.0 mL

Cause for Rejection:

Excessive hemolysis, anticoagulated specimen, bacterial contamination

Storage:

Refrigerated

Availability:

Sent to reference lab

Methodology:

Enzyme Immunoassay

Lab/Phone:

330-543-8418

TAT:

1-3 days

Additional Info:

Reference range:

Anti-Thyroglobulin Ab: 0.0-4.0 IU/mL

Anti-Thyroidperoxidase: 0.0-5.5 IU/mL

CPT Code:

86800, 86376

Panel Includes:

Anti-thyroglobulin Ab, Anti-thyroidperoxidase

Synonyms:

Antithyroglobulin Antibody; Antithyroid Antibody; Microsomal Antibody

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Anti-thyroid Ab Profile

Centralized Core Laboratory - Summa Akron City Hospital : Send Out

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