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          The flagship journal of the Society for Endocrinology. Learn more

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      Effect of once weekly oral levothyroxine therapy

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          Abstract

          Summary

          Primary hypothyroidism is one of the most common endocrine disorders with widely available treatment. A minority of patients remain with uncontrolled hypothyroidism despite therapy. The objective of this case series was to demonstrate that medication non-adherence, rather than malabsorption, should be sought as the most common cause of unsuppressed TSH levels in patients receiving treatment for this condition. Non-adherence is often considered as a diagnosis of exclusion. Nonetheless, a diagnosis of malabsorption requires a more extensive workup, including imaging and invasive procedures, which increase healthcare costs and burden to the patient. The findings of this study allow for a cost-effective approach to uncontrolled hypothyroidism.

          Learning points

          • Medication non-adherence is a common cause of insuppressible TSH levels.

          • Once weekly levothyroxine is an alternative approach to non-compliant patients.

          • Assessing compliance is more cost-effective and less burdensome than testing for malabsorption.

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          Guidelines for the treatment of hypothyroidism: prepared by the american thyroid association task force on thyroid hormone replacement.

          Jacqueline Jonklaas, Antonio Bianco, Andrew Bauer … (2014)
          A number of recent advances in our understanding of thyroid physiology may shed light on why some patients feel unwell while taking levothyroxine monotherapy. The purpose of this task force was to review the goals of levothyroxine therapy, the optimal prescription of conventional levothyroxine therapy, the sources of dissatisfaction with levothyroxine therapy, the evidence on treatment alternatives, and the relevant knowledge gaps. We wished to determine whether there are sufficient new data generated by well-designed studies to provide reason to pursue such therapies and change the current standard of care. This document is intended to inform clinical decision-making on thyroid hormone replacement therapy; it is not a replacement for individualized clinical judgment.
          Article 0 comments Cited 388 times – based on 0 reviews     Review now
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            The Unmet Challenge of Medication Nonadherence

            Fred Kleinsinger (2018)
            Medication nonadherence for patients with chronic diseases is extremely common, affecting as many as 40% to 50% of patients who are prescribed medications for management of chronic conditions such as diabetes or hypertension. This nonadherence to prescribed treatment is thought to cause at least 100,000 preventable deaths and $100 billion in preventable medical costs per year. Despite this, the medical profession largely ignores medication nonadherence or sees it as a patient problem and not a physician or health system problem. Much of the literature on nonadherence focuses on barriers to adherence, with the assumption that appropriate adherence is the normal course of events and nonadherence is an aberration. This approach minimizes and oversimplifies the problem. It is not easy for humans to change their behavior, even for what many physicians see as a minor change such as taking prescription medications. Improving medication adherence has not been well studied, but a Cochrane review shows that multifactorial interventions are more effective. In at least one integrated health care system, Kaiser Permanente Northern California, a combination of approaches centered on the electronic health record has improved medication adherence rates to above 80%. Using similar elements would be feasible in other health care systems but would require motivation and planning. Effective change will not happen until key players decide to take on this challenge and reimbursement systems are changed to reward health systems that improve medication adherence and chronic disease control.
            Article 0 comments Cited 76 times – based on 0 reviews     Review now
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              A thyroxine absorption test followed by weekly thyroxine administration: a method to assess non-adherence to treatment.

              Charles A Vincent, A Allahabadia, N Karavitaki … (2013)
              For patients who remain hypothyroid despite the administration of what would seem adequate doses of levothyroxine (L-T4), the underlying cause can be difficult to determine. The possibility of a biological cause should first be explored; however, in the majority of cases, poor adherence to medication is likely to be the main cause of treatment failure. When non-adherence is suspected but not volunteered, options to confirm the suspicion are limited. In this study, we identified patients for whom known drugs and pathological causes of L-T4 malabsorption were excluded, and despite often high doses of L-T4, the patients remained hypothyroid. Using a weight-determined oral L-T4 bolus administration, absorption was initially assessed in 23 patients. In nearly all patients, this was shown to be maximal at 120 min post-ingestion. This was then followed by the continued administration of a weekly T4 bolus for a 4-week period after which TSH and free T4 (fT4) levels were recorded. All patients showed a rise in fT4 at 120 min following the administration of the L-T4 bolus, with a mean increase of 54±3% from baseline. Following the treatment period, using an equivalent weekly L-T4 dose, which was significantly less than that of the daily dose taken by the patients before the test, TSH reduced from baseline in ~75% of cases. Using this combination of tests allows significant malabsorptive problems to be identified first and then potential non-adherence to be demonstrated. A management plan can then be implemented to increase adherence, aiming to improve treatment outcomes.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Endocrinol Diabetes Metab Case Rep
                Journal ID (iso-abbrev): Endocrinol Diabetes Metab Case Rep
                Journal ID (hwp): EDM
                Title: Endocrinology, Diabetes & Metabolism Case Reports
                Publisher: Bioscientifica Ltd (Bristol )
                ISSN (Electronic): 2052-0573
                Publication date (Electronic): 07 June 2021
                Publication date Collection: 2021
                Volume: 2021
                Electronic Location Identifier: 21-0045
                Affiliations
                [1 ]Endocrinology Department , San Juan City Hospital, San Juan, Puerto Rico
                Author notes
                Correspondence should be addressed to A del Toro-Diez; Email: andrea.deltoro@ 123456upr.edu
                Article
                Publisher ID: EDM210045
                DOI: 10.1530/EDM-21-0045
                PMC ID: 8284960
                PubMed ID: 34196276
                SO-VID: b9d5b6c6-7a34-4d44-b475-8baafaeb5519
                Copyright © © The authors
                License:

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

                History
                Date received : 20 May 2021
                Date accepted : 07 June 2021
                Categories
                Subject: Adult
                Subject: Male
                Subject: Female
                Subject: Hispanic or Latino - Puerto Rican
                Subject: Puerto Rico
                Subject: Thyroid
                Subject: Thyroid
                Subject: Gastroenterology
                Subject: Error in Diagnosis/Pitfalls and Caveats
                Subject: Error in Diagnosis/Pitfalls and Caveats

                Keywords: adult,male,female,hispanic or latino - puerto rican,puerto rico,thyroid,gastroenterology,error in diagnosis/pitfalls and caveats,july,2021
                Data availability:
                Keywords: adult, male, female, hispanic or latino - puerto rican, puerto rico, thyroid, gastroenterology, error in diagnosis/pitfalls and caveats, july, 2021

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