Thyroglobulin

Centralized Core Laboratory : Chemistry

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. Thyroglobulin
2.
3.
4.
5.
6.

SPECIMEN INFO

Collection Date & Time:

Collected By:

Test ID/Workstation :

THYGL MAYO

Specimen Type:

Blood

Tube Type:

Red top (no anticoagulant) tube

Collection Volume:

2.5 mL (minimum 1.5 mL)

Cause for Rejection:

Gross hemolysis

Storage:

Refrigerated

Availability:

Sent to reference lab

Methodology:

Immunoenzymatic Assay

Special Instructions:

Red top tubes should be centrifuged and serum removed within 2 hours of collection. For Outpatients, test should only be drawn in outpatient locations within a Hospital (Akron or Beeghly).

Lab/Phone:

330-543-8418

TAT:

1-3 days

Additional Info:

Reference Values are available on patient report

CPT Code:

84432, 86800

Panel Includes:

Thyroglobulin Antibody Screen Thyroglobulin, Tumor Marker

Synonyms:

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Thyroglobulin

Centralized Core Laboratory : Chemistry

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