Clinical examination was unremarkable apart from a weight of 42 kg. Initial investigations, including full blood count, and renal and liver function tests, were within normal limits. Coeliac disease was ruled out by a normal gastroduodenoscopy and undetectable antigliadin and antitissue transglutaminase (antiTTG) antibodies.According to the researchers, weekly levothyroxine administration was demonstrated to be well tolerated and safe; hence, it represents a valid therapeutic option for patients who find adherence to a rigorous treatment regimen difficult.
Thyroid hormone in health and disease. J Endocrinol.15 PubMed 2. Evans T C. Thyroid disease. Prim Care.640 PubMed 3. Vermeire E, Hearnshaw H, Van Royen P. et al Patient adherence to treatment: three decades of research.One week after testing (day 50) they then began taking 7 times their daily dose once each week for 5 weeks. Those subjects previously on the weekly dose.
CLINICAL THYROIDOLOGY FOR PATIENTS A publication of the American Thyroid Association. Summaries for Patients from Clinical Thyroidology (from recent articles in Clinical Thyroidology) Table of Contents PDF File for Saving and Printing.The known physical causes should be excluded before noncompliance is considered most likely, and a trial of weekly supervised thyroxine at the local GP surgery (or pharmacy) may confirm the clinical suspicion.
By Mary Shomon Updated October 31, 2014. In some cases, doctors have recommended alternative ways of taking levothyroxine (i.e., taking all your levothyroxine once a week, rather than daily) to help ensure that patients are actually taking their medication at the prescribed dosage.4 When larger doses of thyroxine are needed, the treating physician needs to investigate the underlying cause. There are many different causes for nonresponse to thyroxine treatment ranging from drugrelated interference with thyroxine absorption to small bowel disease that could also affect thyroxine absorption (table 1).
1. These patients are commonly treated in primary rather than secondary care. 2 Once daily thyroxine replacement restores euthyroidism in most patients; some patients, however, remain hypothyroid despite adequate thyroxine replacement.The TSH concentrations were never well controlled since the diagnosis, with values ranging from mu/l. As a result the patient was referred to our endocrine clinic. The patient denied poor compliance and was not taking any medications that could interfere with thyroxine absorption.
What does this mean for you? If you have difficulty remembering to take your thyroid medication - and remember, this applies to levothyroxine, but not to the shorter-acting medications with T3, like Thyrolar, Armour, or Cytomel - taking it all once a week may be an option to discuss with your doctor.J Clin Endocrinol Metab.875 PubMed 9. Taylor J, Williams B O, Frater J. et al Twiceweekly dosing for thyroxine replacement in elderly patients with primary hypothyroidism. J Int Med Res.277 PubMed 10.
The diagnosis of noncompliance is by exclusion, and all other causes must be sought and excluded before making such a diagnosis. Particular attention should be paid to concurrent medications as many commonly used medications can either impair thyroxine absorption or increase its clearance (table 1).HYPOTHYROIDISM Use of a weekly dose of levothyroxine may be effective in patients that have difficulty taking daily medications. ABBREVIATIONS DEFINITIONS Hypothyroidism: a condition where the thyroid gland is underactive and doesnt produce enough thyroid hormone.
Case histories Patient 1 A 47yearold woman was diagnosed with primary hypothyroidism in 2001 by her general practitioner (GP). At diagnosis, the thyroid stimulating hormone (TSH) concentration was 22.90 mu/l ( mu/l). Despite titrating the dose of thyroxine to 375 g once daily, the patient remained hypothyroid with a free T4 (FT4) of 10.9 pmol/l (1025 pmol/l) and a TSH.Therefore, a subtle approach is essential. Though hypothyroidism is common and managed well in primary care, a small number of patients who have persistently raised TSH in spite of adequate replacement doses of thyroxine need specialist assessment.
Adequate precautions need to be taken in patients with ischaemic heart disease. Close liaison between primary and secondary care is essential at the initiation of treatment, but once stabilised, supervision of the patient can be undertaken in the primary care setting in the majority of cases.In conclusion, poor compliance with oral thyroxine is one of the most common causes of nonresponse to thyroxine treatment. Other causes must be excluded before making the diagnosis of noncompliance. Supervised once weekly oral thyroxine may be a safe, successful and well tolerated treatment regimen, and should be considered as an option in treating these.
Org/thyroid-hormone-treatment Table of Contents PDF File for Saving and Printing.The trough and peak serum concentrations of FT4, T3 and TSH were similar. 9 Grebe et al compared daily T4 treatment with once weekly dosing in 12 hypothyroid patients in a randomised crossover trial.
7 Studies have shown that a single dose of T4 up to 3 mg is well tolerated. 8 Taylor et al compared once daily versus twice weekly thyroxine treatment in seven female patients.3 The daily lifelong administration of thyroxine can lead to patient noncompliance. The mean treatment dose of oral thyroxine is 1.6 g/kg/day. The results achieved with this dose are adequate and reproducible.
Copyright 2007 The Fellowship of Postgraduate Medicine. This article has been cited by other articles in PMC. Abstract Hypothyroidism is a common disorder, which is mainly treated in primary rather than secondary care.Mar 26, 2009. In some cases, doctors have recommended alternative ways of taking levothyroxine (i.e., taking all your levothyroxine once a week, rather than ).
Levothyroxine therapy in patients with thyroid disease. Ann Intern Med.502 PubMed 6. Stock J M, Surks M I, Oppenheimer J H. Replacement dosage of Lthyroxine in hypothyroidism. A reevaluation. N Engl J Med.533 PubMed 7.Once daily thyroxine replacement restores euthyroidism in most patients; some. was not taking any medications that could interfere with thyroxine absorption.
Facebook Photo: m.For example, an elevated can be seen even after they have a normal serum TSH while taking the same dose of L-T4 previously. This may be due to taking L-T4 at the same time as food, calcium, iron or certain drugs that decrease the absorption of the thyroid hormone or due to GI problems that.
However, varying dose requirements may also be due to missing doses on an intermittent or regular basis. The current study had patients in whom this was a possibility take a weekly dose of L-T4 under observation to determine if this was an effective alternative to daily doses.Discussion. Noncompliance with prescribed medical interventions is an old and well recognised problem in patients with chronic disorders. 3 The frequency of dosing, duration of treatment and number of medications are all implicated in the development of noncompliance, in addition to other factors such as the doctorpatient relationship and the patient's psychiatric history.