eCRF template · LaboratoryUpdated September 29, 2026

Thyroid function panel eCRF template

TSH, free T4, free T3 and thyroid antibodies, each with a unit, a result and a reference range, plus the sampling details that make the numbers interpretable. Use it for thyroid disease trials or for thyroid safety monitoring in any study.

  • Units and reference ranges per analyte
  • Sampling conditions recorded
  • Range checks with auto-queries

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Thyroid function · Cycle 4
Subject 008-0013 · Local labSubmitted

Sample date and time

LBDTC
12-Mar-2027 08:40

TSH

TSH
6.8mIU/L

Above reference range 0.4 to 4.0: auto-query raised

Free T4

FT4
10.2pmol/L

Free T3

FT3
3.9pmol/L
Reference ranges from the performing lab

At a glance

  • A standard panel records TSH, free T4 and often free T3, with thyroid antibodies (anti-TPO, anti-thyroglobulin, TSH receptor antibodies) where the protocol needs them.
  • Units differ between labs: free T4 is reported in pmol/L or ng/dL (1 ng/dL is about 12.87 pmol/L). Record the unit with every result.
  • Reference ranges are assay- and lab-specific, and pregnancy uses trimester-specific ranges. Store the performing lab's range with each result.
  • Biotin supplements can interfere with some immunoassays and produce misleading thyroid results. Ask about biotin use before sampling.
  • Thyroid dysfunction is a known effect of several drug classes, including immune checkpoint inhibitors and some tyrosine kinase inhibitors, so thyroid panels often appear as safety labs.

In trials

Efficacy lab or safety lab

In thyroid disease trials, such as Graves' disease, hypothyroidism or thyroid eye disease, thyroid function tests are efficacy or eligibility data: the protocol defines target ranges, and dose adjustments follow the results. In other trials they are safety labs, collected at baseline and at intervals to detect drug-induced thyroiditis, hypothyroidism or hyperthyroidism.

Either way, the result is only meaningful with its context. TSH varies through the day, free T4 in people taking levothyroxine depends on the time since the last dose, and assays differ between laboratories. Record the sampling time and, where relevant, the time of the last thyroid medication dose.

Immune checkpoint inhibitors

Thyroiditis is among the most common immune-related adverse events with checkpoint inhibitors, often with a brief hyperthyroid phase followed by hypothyroidism. Oncology protocols typically check TSH and free T4 at baseline and regularly during treatment. See EDC for oncology trials.

Site 02 · City Hospital Lab

Haemoglobin HGB · g/dL

3 strata
  • General13.0 to 17.0
  • Female 18-6412.0 to 15.5
  • Female 65+11.5 to 15.0
+ Add stratumNo Male 65+ stratum: general range applies

Template

Thyroid panel fields

FieldUnitNotes
Sample date and timeDate-timeFor diurnal variation and dose timing
TSHmIU/LFirst-line test in most protocols
Free T4pmol/L or ng/dLRecord the unit reported
Free T3pmol/L or pg/mLWhere the protocol requires it
Anti-TPO antibodiesIU/mLAutoimmune thyroid disease
TSH receptor antibodiesIU/LGraves' disease and thyroid eye disease
Biotin use in last daysYes / NoAssay interference check
Reference range low and highPer analyteFrom the performing lab

Adapt analytes and units to your lab manual.

In Capture

A lab table drafted from your lab manual

Upload the lab manual and the AI drafts a lab table with analytes as rows and unit, result and reference range columns, split by sex and age where the source has them. Nothing is saved without review. Range edit checks raise an auto-query when a result falls outside the limits you set, and each repeating row keeps its own audit trail.

  • AI-drafted lab table for review.
  • Range checks with auto-queries.
  • Per-row audit trail.
Lab results eCRF template
Build this form with AI · Lab table
central_lab_ranges.xlsx48 KB
2 tables24 rows1 unrecognised analyte

Haematology

RowCodeUnitRangeStratum
HaemoglobinHGBg/dL13.0-17.0Male 18-65 y
HaemoglobinHGBg/dL12.0-15.5Female 18-65 y
PlateletsPLAT10^9/L150-400All
ALTALTU/L7-56All
Site QC flagSITEQC--All

Draft a thyroid panel from your lab manual

Upload it to the free sandbox and review the lab table.

Use the thyroid panel template free

Units and ranges

Multi-site studies and mixed labs

When sites use local laboratories, the same analyte arrives in different units with different reference ranges. Recording the result exactly as reported, with the unit and the lab's own range, keeps the source traceable; conversion to standard units and normalisation happen in analysis. A central lab removes most of this variability and is common where thyroid results drive efficacy endpoints.

For grading abnormal results as adverse events, oncology trials usually use CTCAE definitions, which refer to the lab's upper and lower limits of normal. That is another reason to store each result's range. See reference interval.

Before go-live

Thyroid panel checklist

Analytes chosen

TSH, free T4, free T3 and antibodies as needed.

Units recorded

Unit field with every result.

Ranges stored

Performing lab's range per result.

Sampling conditions

Time, last thyroid medication dose, biotin use.

Range checks

Queries for values outside expected limits.

Schedule

Baseline and interval monitoring per protocol.

FAQ

Questions about this template

Something not covered here? Ask us directly.

What should a thyroid panel eCRF include?

TSH, free T4 and often free T3, with thyroid antibodies where needed, plus sample time, units and reference ranges.

Why record the unit with every result?

Labs report free T4 and free T3 in different units, so the unit is needed to interpret and convert results.

Why ask about biotin?

Biotin supplements can interfere with some immunoassays and give misleading thyroid results.

Why monitor thyroid function in oncology trials?

Immune checkpoint inhibitors and some other cancer drugs can cause thyroiditis, hypothyroidism or hyperthyroidism.

Can AI draft the lab table?

Yes. AI drafts lab tables from a lab manual or file for your review. Nothing is saved without review.

Is the template free?

Yes. Copy it into your study in the free sandbox.

Thyroid results with their context

Units, ranges and sampling details on one form. Free sandbox.

Use the thyroid panel template free