Comparison of the Profile and TSH Levels from Several Types of Blood Collection Tubes

Gunawan Eka Putra, Ninik Sukartini, Suzanna Immanuel, Fify Henrika, Nuri Dyah Indrasari


Thyroid-Stimulating Hormone (TSH) is an important parameter in diagnosing thyroid disease which uses serum
according to the World Health Organization's (WHO) recommendations. The use of plasma can help improve the Turn
Around Time (TAT); however, the discrepancy with serum is unknown. A cross-sectional study using 89 blood samples was
performed to compare TSH levels using serum tubes with clot activator (Tube I), plasma tubes with heparin (Tube II), and
plasma tubes with heparin-gel separator (Tube III); and to overview of TSH levels according to gender and age. The median
of TSH levels in Tubes I, II, and III were 1.380 (0.032-7.420) μIU/mL, 1.380 (0.030-7.480) μIU/mL, and 1.360 (0.030-7.460)
μIU/mL, respectively. There were no statistically significant differences in TSH levels of the three tubes. The median TSH
levels differences of Tubes II and III compared to the tube I were -0.9% (-7.2-2.2) and -1.7% (-8.0-1.6), respectively.
Measurement bias observed in this study was following the specified desirable bias according to Ricos. The median TSH
levels of the male and female groups were 1.500 (0.032-4.250) μIU/mL and 1.345 (0.058-7.420) μIU/mL, respectively. Median
TSH levels of 31-40 years old age group and >61 years old age group were 1.190 (0.609-3.240) μIU/mL and 1.730 (0.088-
5.760) μIU/mL, respectively. Specimens from three tubes could be used to examine TSH levels. Measurement of TSH levels
showed a higher median in the male and older group.


Thyroid-stimulating hormone, serum, plasma, clot activator, separator gel, clinical significance

Full Text:



Winter W, Schatz D, Bertholf R. Thyroid Disorders. In: Tietz Fundamental of Clinical Chemistry and Molecular Diagnostics. 7th ed. Missouri: Saunders; 2015. p. 806–23.

Vadiveloo T, Donnan PT, Murphy MJ, Leese GP. Age- and gender-specific TSH reference intervals in people with no obvious thyroid disease in Tayside, Scotland: the Thyroid Epidemiology, Audit, and Research Study (TEARS). J Clin Endocrinol Metab. 2013;98(3):1147–53.

Sarapura V, Samuel M. Thyroid-Stimulating Hormone. In: The Pituitary. 4th ed. London: Academic Press; 2017. p. 163–201.

Kleerekoper W. Hormones. In: Tietz Fundamental of Clinical Chemistry and Molecular Diagnostics. 7th ed. Missouri: Saunders; 2015. p. 430–41.

Banfi G, Bauer K, Brand W, Buchberger M. Use of anticoagulants in diagnostic laboratory investigations and stability of blood, plasma and serum samples [report no. WHO/DIL/LAB/99.1 rev. 2]. Geneva: World Health Organization; 2002.

Morovat A, James TS, Cox SD, Norris SG, Rees MC, Gales MA, et al. Comparison of Bayer Advia Centaur immunoassay results obtained on samples collected in four different Becton Dickinson Vacutainer tubes. Ann Clin Biochem. 2006;43(Pt 6):481–7.

Chance J, Berube J, Vandersmissen M, Blanckaert N. Evaluation of the BD Vacutainer PST II blood collection tube for special chemistry analytes. Clin Chem Lab Med CCLM FESCC. 2009;47:358–61.

TSH Thyrotropin. Roche. 2016;1–3.

Hollowell JG, Staehling NW, Flanders WD, Hannon WH, Gunter EW, Spencer CA, et al. Serum TSH, T(4), and thyroid antibodies in the United States population (1988 to 1994): National Health and Nutrition Examination Survey (NHANES III). J Clin Endocrinol Metab. 2002;87(2):489–99.

Ercan M, Fırat Oğuz E, Akbulut ED, Yilmaz M, Turhan T. Comparison of the effect of gel used in two different serum separator tubes for thyroid function tests. J Clin Lab Anal. 2018;1–4.

Ricos C, Alvarez V, Cava F, Garcio-Lario J, Hernandez A, Jimenez C. Desirable Specifications for Total Error, Imprecision, and Bias, derived from intra- and inter-individual biologic variation. Scand J Clin Lab Invest. 2014;(59):491–500.

Suzuki S, Nishio S, Takeda T, Komatsu M. Gender-specific regulation of response to thyroid hormone in aging. Thyroid Res. 2012;5(1):1.

Hadlow NC, Rothacker KM, Wardrop R, Brown SJ, Lim EM, Walsh JP. The relationship between TSH and free T₄ in a large population is complex and nonlinear and differs by age and sex. J Clin Endocrinol Metab. 2013;98(7):2936–43.

Ahmed Z, Khan MA, Haq A ul, Attaullah S, Rehman J ur. Effect of race, gender and age on thyroid and thyroid stimulating hormone level in North West Frontier Province, Pakistan. J Ayub Med Coll. 2009;21(3):21–4.

Gordon DF, Ridgway EC. Thyroid-Stimulating Hormone: physiology and secretion. In: Endocrinology: adult and pediatric. 7th ed. Massachusetts: WB Saunders; 2016. p. 1278–96.

Kwon H, Kim WG, Jeon MJ, Han M, Kim M, Park S, et al. Age-specific reference interval of serum TSH levels is high in adolescence in an iodine excess area: Korea national health and nutrition examination survey data. Endocrine. 2017;57(3):445–54.

Pirahanchi Y, Jialal I. Physiology, Thyroid Stimulating Hormone (TSH). In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2018 [cited 2019 Jan 14]. Available from:

Gesing A, Lewinski A, Karbownik-Lewinska M. The thyroid gland and the process of aging: what is new? Thyroid Research. 2012;5(16):1–5.

Aggarwal N, Razvi S. Thyroid and Aging or the Aging Thyroid? An Evidence-Based Analysis of the Literature [Internet]. Journal of Thyroid Research. 2013 [cited 2019 Jan 14]. Available from:



  • There are currently no refbacks.

Creative Commons License
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.