Info

Tri-iodothyronine

T3: 110-230 ng/dL;

Hyperthyroid: increased;

Results depend on underlying

(T3) and thyroxine (T4)

T4: 4.6-11 ^g/dL

hyperthyroid: decreased

disease process

Other Tests: Supporting tests include thyroid scan, plasma T4 index, thyroid antibody tests, and urinary iodine excretion; ultrasounds, computed tomography (CT), magnetic resonance imaging (MRI).

^ PLANNING AND IMPLEMENTATION Collaborative

MEDICAL. The goal of medical management for the patient with a simple goiter is to reduce the size of the goiter by correcting the underlying cause. If the patient has decreased iodine stores,

380 Goiter small doses of iodide (such as Lugol's solution) may correct the problem. If the patient is ingesting a known substance that leads to goiter, avoidance of the food or drug is necessary. Commonly, no specific cause of the goiter is found, and the patient is placed on thyroid-replacement therapy.

If the patient is elderly or has a long-standing goiter with many nodules, further testing is needed because levothyroxine may lead to thyrotoxic crisis; the patient may need radioiodine ablation therapy to destroy areas of hypersecretion. Surgical treatment is rarely indicated and is used only when symptoms of obstruction occur after a trial of medications. Patients with goiter and thyroid nodules may also need surgical exploration to determine if they have cancer.

Pharmacologic

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