Thyroid, Vitamin D and B12 Panel

Details

Thyroid stimulating hormone with free T3 and free T4, 25 hydroxy vitamin D, and vitamin B12. Five reported values, one venous draw, no fasting. The thing that belongs on this page and is almost never on one is biotin. Biotin at supplement doses, the 5 mg and 10 mg capsules sold for hair, skin and nails, interferes with the biotin and streptavidin chemistry that most immunoassay analysers use. It typically pushes TSH DOWN and free T4 and free T3 UP, which is the shape of an overactive thyroid produced entirely by a vitamin capsule. Stop high dose biotin for at least three days before this draw, longer if the dose is large, and tell us if you did not. People have been treated for a thyroid problem they never had because nobody asked. Second thing: TSH follows a daily rhythm. It runs highest around midnight to four in the morning and lowest in the middle of the afternoon, and the swing across a day is large enough to move a borderline value. So a borderline TSH partly reflects the hour you were bled, and a repeat is worth drawing at a similar time of day rather than whenever is convenient. Third: 25 hydroxy vitamin D is the storage form and is the correct test for vitamin D status. The 1,25 dihydroxy form is a different test, it is frequently ordered by mistake, it costs several times more and it does not answer the question people think it answers. If someone has ordered that one for a routine check, ask why. Nobody here is paid for ordering a test or for sending you anywhere. No commission on a referral, no target on a panel, no revenue share with any laboratory, imaging centre or hospital. That matters more than an accreditation, because an accreditation says the machine was right and says nothing about why the test was asked for. This panel is run when there is a reason to run it. If an earlier report already answers the question, the honest answer is to skip it, and that answer costs us Rs. 1,150 every time it is given. Vitals Clinic at A.P. Colony is not open. There is no practitioner in post, no premises registration and no appointment book, and this page does not pretend otherwise. What is written here is the specification: the qualification the role requires, the register the person must appear on, and the licence the premises must hold. Booking opens when those exist, and not before.

• Five values: TSH, free T3, free T4, 25 hydroxy vitamin D total, and vitamin B12
• Chemiluminescent immunoassay, one venous draw, serum. No fasting required
• Stop high dose biotin at least 3 days before, or the numbers are not yours
• Repeat intervals stated below, because a thyroid or vitamin D value repeated too soon means nothing
• No commission on ordering it, and no thyroid antibody test added unless a specific reason is written down