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HelpTest Code T4BPE Thyroxine-Binding Protein Electrophoresis, Serum
Reporting Name
Thyroxine-Binding Protein ElectroUseful For
Explaining unusual thyroxine (T4), free T4, and thyroxine-binding globulin test results that do not correlate with the patient's clinical presentation
Detecting the presence of aberrant thyroxine-binding proteins, such as abnormal forms of albumin and prealbumin
Detecting selective deficiency of one of the thyroxine-binding proteins
Detecting antibodies to T4
An adjunct to the diagnosis of patients with high T4 concentration due to peripheral hormone resistance by ruling out thyroxine-binding abnormalities
Profile Information
| Test ID | Reporting Name | Available Separately | Always Performed |
|---|---|---|---|
| TBPE | Thyroxine-Binding Protein Electro | No | Yes |
| T4 | T4 (Thyroxine), Total Only, S | Yes | Yes |
Method Name
TBPE: Electrophoresis
T4: Electrochemiluminescence Immunoassay (ECLIA)
Performing Laboratory
Mayo Clinic Laboratories in Rochester
Specimen Type
SerumOrdering Guidance
This assay measures thyroxine binding to various proteins.
For analysis of thyroxine-binding globulin, see TBGI / Thyroxine-Binding Globulin (TBG), Serum.
For immunologic assay of prealbumin, see PALB / Prealbumin, Serum.
This test should not be requested in patients who have recently received radioisotopes, therapeutically or diagnostically, because of potential assay interference. A recommended time period before collection cannot be made because it will depend on the isotope administered, the dose given, and the clearance rate in the individual patient.
The total thyroxine (T4) test should not be used in patients receiving treatment with lipid-lowering agents containing dextrothyroxine unless therapy is discontinued for 4 to 6 weeks to allow the T4 physiological state to become re-established prior to testing.
Specimen Required
Patient Preparation: For 12 hours before specimen collection, patient should not take multivitamins or dietary supplements (eg, hair, skin, and nail supplements) containing biotin (vitamin B7).
Supplies: Sarstedt Aliquot Tube, 5 mL (T914)
Collection Container/Tube:
Preferred: Serum gel
Acceptable: Red top
Submission Container/Tube: Plastic vial
Specimen Volume: 1.6 mL
Collection Instructions: Centrifuge and aliquot serum into a plastic vial.
Specimen Minimum Volume
0.8 mL
Specimen Stability Information
| Specimen Type | Temperature | Time | Special Container |
|---|---|---|---|
| Serum | Refrigerated (preferred) | 7 days | |
| Frozen | 30 days | ||
| Ambient | 24 hours |
Reject Due To
| Gross hemolysis | Reject |
| Gross lipemia | Reject |
| Gross icterus | Reject |
Reference Values
THYROXINE-BINDING PROTEIN ELECTROPHORESIS:
10.3-24.9 mcg T4/dL bound to thyroxine-binding globulin
11.5-34.1 mcg T4/dL bound to albumin
48.8-70.4 mcg T4/dL bound to prealbumin
T4 (THYROXINE), TOTAL ONLY:
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
Adult (≥20 years): 4.5-11.7 mcg/dL
For SI unit Reference Values, see www.mayocliniclabs.com/order-tests/si-unit-conversion.html
Day(s) Performed
Fourth Friday of the month
CPT Code Information
84436
82664
LOINC Code Information
| Test ID | Test Order Name | Order LOINC Value |
|---|---|---|
| T4BPE | Thyroxine-Binding Protein Electro | 48073-1 |
| Result ID | Test Result Name | Result LOINC Value |
|---|---|---|
| 2860 | TBG | 14016-0 |
| 2861 | Albumin | 11062-7 |
| T4 | T4 (Thyroxine), Total Only, S | 83119-8 |
| 2862 | Pre-Albumin | 14014-5 |
| 2863 | Abnormal Binding Protein | 48767-8 |
| 3345 | Comment | 50681-6 |
Clinical Information
Normally, almost all thyroxine (99.5%) is bound to thyroxine-binding globulin, prealbumin, and albumin. Deficiencies and aberrant forms of these binding proteins can occur, causing difficulties interpreting thyroid function test results. Such abnormalities may be identified by thyroxine-binding protein electrophoresis.
Interpretation
An interpretive comment will be provided based on the total thyroxine concentration and the thyroxine-binding protein profile observed in the electrophoresis.
Cautions
Thyroxine-binding globulin values may be elevated in women taking estrogens and during pregnancy.
In rare cases, some individuals can develop antibodies to mouse or other animal antibodies (often referred to as human anti-mouse antibodies [HAMA] or heterophile antibodies), which may cause interference in some immunoassays. Caution should be used in interpretation of results and the laboratory should be alerted if the result does not correlate with the clinical presentation.
Clinical Reference
1. Hay ID, Klee GG. Thyroid dysfunction. Endocrinol Metab Clin North Am. 1988;17(3):473-509
2. Bartalena L, Robbins J. Thyroid hormone transport proteins. Clin Lab Med. 1993;13(3):583-598
3. Mimoto MS, Refetoff S. Clinical recognition and evaluation of patients with inherited serum thyroid hormone-binding protein mutations. J Endocrinol Invest. 2020;43(1):31-41. doi:10.1007/s40618-019-01084-9
4. Pappa T, Ferrara AM, Refetoff S. Inherited defects of thyroxine-binding proteins. Best Pract Res Clin Endocrinol Metab. 2015;29(5):735-747
Method Description
Thyroxine-binding protein electrophoresis:
Radioactive (125)I-thyroxine (T4) is incubated with patient serum, the mixture is electrophoresed on polyacrylamide gel, and the profile of binding proteins is quantitated by counting the radioactivity in slices of the gel. The binding proteins are separated by both charge and size with prealbumin on the anode side followed by albumin and thyroxine-binding globulin (TBG). Gamma globulin remains at the origin, and free T4 migrates between albumin and prealbumin. The concentration of (125)I-T4 added will saturate TBG but not the other T4-binders. The binding is expressed as thyroxine-binding capacity at 100 mcg T4/dL serum.(Unpublished Mayo method).
Thyroxine:
The Roche T4 (thyroxine) assay is a competitive assay using electrochemiluminescence detection. Bound T4 is released from binding proteins by 8-anilino-1-naphthalene sulfonic acid. Patient specimen is incubated with sheep polyclonal anti-T4 antibody labeled with ruthenium. Streptavidin-coated microparticles and biotinylated T4 are added for a second incubation during which the still free binding sites of the labeled antibody become occupied. The resulting immunocomplex becomes bound to the solid phase by interaction of biotin and streptavidin. The reaction mixture is aspirated into the measuring cell where the microparticles are magnetically captured onto the surface of the electrode. Unbound substances are then removed and application of a voltage to the electrode induces the electrochemiluminescent emission. This signal is measured against a calibration curve to determine patient results.(Package insert: Elecsys T4. Roche Diagnostics; V 2.0 English, 03/2020)