Levothyroxine for Sluggish Thyroids: Weekly or Daily?

[Clutter]

The drug levothyroxine (Synthroid, Levoxyl, others) has long been the treatment for sluggish thyroids or hypothyroidism. The pill needs time to be absorbed properly, so patients are often instructed to take it daily a half hour to an hour before breakfast. But that can make the regimen inconvenient for some, and compliance declines.

Now, a new study suggests that weekly doses appear to work as well. Indian researchers presented the findings at the 2016 annual meeting of the American Association of Clinical Endocrinologists in Orlando. "Once weekly L-thyroxine replacement was well tolerated and there was no indication of acute toxicity or hypothyroidism symptoms compared with daily therapy," according to researchers Satish Wasoori, MD, and Manoj Naik, MD, of Park Hospital in Guragaon, India. The new study echoes some findings from previous research.

U.S. endocrinologists who reviewed the findings say, in general, they still prefer daily dosing.

continues in endocrineweb.com/news/parat...

[humanbean]

U.S. endocrinologists who reviewed the findings say, in general, they still prefer daily dosing.

I'm very glad to hear it!

Diogenes has posted on the subject of once weekly dosing a couple of times and he thinks it is a dreadful idea. He posted with his thoughts in this thread posted by helvella :

healthunlocked.com/thyroidu...

[Clutter in reply to humanbean]

HB,

The idea wasn't well received by all endos who read it for similar reasons to Diogenes. This study is by the same researcher and Indian hospital as in the link Helvella posted.

[humanbean in reply to Clutter]

Ah - he obviously thinks the idea is good for his career.

[Jazzw]

I haven't read the study and maybe it details the doses the research group were on. But the cynic in me says, is that because so many doctors think that 50mcg or 75mcg dose are acceptable, and therefore, a once-weekly dosage only amounts to 350-525mcg dose in one go anyway?

If the patients were on 200mcg daily, does taking 1400mcg in one go cause an issue?

[Jazzw in reply to Jazzw]

Hmm. This is as much about the study as I can find with a quick search. healio.com/endocrinology/th...

But already - and having had a quick skim through the thread humanbean kindly reposted - I'm not exactly rating this as a fine piece of research...

[Jazzw in reply to Jazzw]

Ah, found it. (It's on p.294 of this rather lengthy PDF of thyroid stuff). journals.aace.com/doi/pdf/1...

Minimum weekly dose 175mcg (so these were unfortunate patients on 25mcg levo a day who were being accused of not taking their little white pills...) to 1050mcg a week (folk on 150mcg a day). And all 40 study subjects had been hypothyroid for more than 5 years...

[humanbean in reply to Jazzw]

Interesting link, Jazzw, thanks for posting.

[Jazzw]

Good to know though Clutter that when people are worried they've taken their levo dose twice by accident that it really is extremely unlikely to do any harm.

[Clutter in reply to Jazzw]

Jazzw,

And that there's no problem in taking double dose today if you forgot to take it yesterday.

[helvella in reply to Clutter]

There most certainly is if you are on weekly dosing!

(Sorry - that is rather facetious. But amused me at the thought of catching up on a missed weekly dose. Can't imagine the A&E staff would be very impressed.)

[Clutter in reply to helvella]

I kinda thought the point was for a weekly dose to be supervised by a carer or medic

[helvella in reply to Clutter]

Can those who need supervision actually rely on finding a suitable supervisor every seven days? Regardless of Christmas/Boxing Day, Passover or Eid al Fitr? Regardless of hurricane, earthquake, or storm? Regardless of epidemic, industrial action or fire?

We have over the years read all sorts of horror stories of those who should be carers/supervisors actually encouraging poor practice with many medicines. Often either for their own benefit or because they know the alternative would be for the person to have to do without. Sure as anything, someone will see someone who should have had a dose on 25th December give a double dose on 29th December assuming it to be fairly safe - and no-one will be around until well into the new year...

The ONLY reason that anyone anywhere thought weekly dosing might be OK is that the history of levothyroxine is full of massive overdoses which have been survived. Just because you might live through a large dose doesn't for one moment mean it is a good, nor even an acceptable, approach.

[Clutter in reply to helvella]

Given the way NHS and social care is breaking down if anyone can rely on 365 day care supervision today to make sure meds are taken I'm not confidant that will happen for any but the most vulnerable patients in the future. Missed doses of Levothyroxine aren't likely to be seen as a priority until enough missed doses become life threatening.

[helvella]

But that can make the regimen inconvenient for some, and compliance declines.

Yes, well. Just how many people here had anything explained to them about when to take (including bed-time option), separation from food, drink, supplements and other medicines, and sheer importance of the medicine?

If people are told, clearly, the issues, I think they are more likely to take the necessary care about taking their medicine. If you just get a prescription pushed across the desk, it is quite likely you won't appreciate all the factors that are important.

Back to the same thing we see in post after post after post: Blame the patient.

Weekly dosing? Never.

Yesterday I posted an abstract to a paper which referred to the pituitary and T3 (and TSH and GH) using the phrase "minute by minute". For a good reason. Absolutely NOT seven days by seven days. OK - that was the detailed effect of T3, but we have to understand that in a heathy person with optimally functioning hypothalamus-pituitary-thyroid axis, the release of hormones really is incredibly finely controlled. Day at a time is already a massively non-physiological approach.

(Perhaps we should refer to that when medics talk about T3, especially in desiccated thyroid, being non-physiological just due to the ratio.)

[dolphin5]

I'm pretty sure that I would swing every week between hyper and hypo on a weekly dosing regime. I know this because I have, for many years, varied my dose of T4 depending on how active I expect to be (because I do long distance cycling, but not usually daily).

I only vary the dose by 25mcg, but if I get it wrong, I can feel the consequences. Taking a massive dose one day, and nothing on others would wreck me!!!!!!

[Mauds]

God that's scary clutter I'd hate to take it in one go especially with hashis. I'd rather stay as I am when my husband gets up each morning at 5 am if I'm not awake he will wake me so I can be sure I've taken my eltroxin well before my breakfast.