Once weekly thyroxine treatment as a strategy to treat non-compliance

Rangan, Srinivasa; Tahrani, Abd A; Macleod, Andrew; Moulik, Probal

doi:10.1136/pgmj.2007.060244

Cited by 37 publications

(28 citation statements)

References 11 publications

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“…A study done on Asian hypothyroid patients by Doraiswamy and Zainudin [11] demonstrated that after 3 months, there were no significant differences in thyroid profile between the weekly and daily groups. In a case series of 2 patients, Rangan et al [12] showed that once-weekly T4 is an alternative treatment strategy to treat noncompliant patients and commented that once-weekly T4 is a safe treatment regimen. However, Grebe et al [4] showed that weekly therapy was well tolerated, but TFT showed mild hypothyroidism with an increase in TSH and a decrease in T3 and T4 before the next weekly dose.…”

Section: Discussionmentioning

confidence: 99%

The Effect of Daily versus Weekly Levothyroxine Replacement on Thyroid Function Test in Hypothyroid Patients at a Tertiary Care Centre in Haryana

Rajput¹,

Pathak²

2017

Eur Thyroid J

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Objective: We compare the effect of daily versus weekly levothyroxine (LT4) replacement on thyroid function test (TFT) in hypothyroid patients at a tertiary care centre in Haryana. Materials and Methods: This was a randomised crossover study in which 100 hypothyroid patients on a stable LT4 dose were divided into 2 groups of 50 each. In group I, patients were given daily therapy for 6 weeks and then shifted to weekly therapy for the next 6 weeks. In group II, patients were given LT4 once a week for 6 weeks and then switched to daily therapy for the next 6 weeks. TFT, quality of life (QOL), and hyperthyroidism symptom scale (HSS) score of patients were compared in each group at 0, 6, and 12 weeks. Results: TFT remained within the normal range, but TSH increased (group I, daily 2.8 ± 1.4 mIU/L, weekly 3.9 ± 1.1 mIU/L, p = 0.001; group II, weekly 4.6 ± 1.1 mIU/L, daily 2.7 ± 1.2 mIU/L, p = <0.001) and T3/T4 decreased with weekly therapy as compared to daily therapy. No significant difference in HSS score was found between daily and weekly administration of LT4. With weekly therapy, QOL showed improvement in bodily pain, vitality, mental health, and social functioning. Conclusion: Once-weekly LT4 administration is a reasonable alternative for patients, especially for those who have issues with compliance.

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Section: Discussionmentioning

confidence: 99%

The Effect of Daily versus Weekly Levothyroxine Replacement on Thyroid Function Test in Hypothyroid Patients at a Tertiary Care Centre in Haryana

Rajput¹,

Pathak²

2017

Eur Thyroid J

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“…Some recent series evaluating hypothyroid patients with poor control have shown that adequate thyroid hormone levels were obtained after introducing weekly LT4 (17,19,20,22). However, cardiovascular side effects were not thoroughly investigated in these reports.…”

Section: Introductionmentioning

confidence: 99%

“…(25) used a small LT4 dose in an 11month old child, without initial ade quate effects on thyroid hormones levels, but reaching satisfactory thyroid hormones levels after correcting the dose by weight. In another study (19), it was also necessa ry to increase the dose for adequate control. It seems that the most adequate weekly dose is 7fold higher than the daily one.…”

Section: Introductionmentioning

confidence: 99%

Treating primary hypothyroidism with weekly doses of levothyroxine: a randomized, single-blind, crossover study

Bornschein

Paz-Filho

Graf

et al. 2012

Arq Bras Endocrinol Metab

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Objective: Compliance to levothyroxine treatment in hypothyroidism is compromised by daily schedule, and a weekly dose may be an alternative. Subjects and methods: This was a randomized, crossover study. Fourteen females were assigned to daily or weekly doses of LT4. After six weeks, they switched regimens. Thyroid parameters were measured at baseline, and after 42 and 84 days. Echocardiogram and hyperthyroidism symptoms were evaluated before and four hours after LT4 intake. Results: In the weekly dose treatment, fT4 levels were higher after taking LT4, and lower seven days after the last dose; by the 6 th week there was a small decrease in T3 levels. TSH remained unchanged and there were no hyperthyroidism symptoms or echocardiographic manifestations. Conclusion: Weekly dose leads to transient increases in fT4, without hyperthyroidism or cardiac symptoms. That approach seems to be a safe alternative for the treatment of hypothyroidism. Arq Bras Endocrinol Metab. 2012;56(4):250-8 Keywords Adhesion; dosing; thyroid; treatment ReSUMO Objetivo: Aderência ao tratamento do hipotiroidismo é comprometido pelo uso diário de levotiroxina, e doses semanais poderiam ser uma alternativa. Sujeitos e métodos: Este é um estudo randomizado, crossover. Quatorze mulheres foram selecionadas para receber LT4 diariamente ou semanalmente. Após seis semanas, houve inversão do regime de tratamento. Avaliações tireoideanas foram realizadas antes, após 42 e 84 dias. Avaliação de sintomas de hipertireoidismo e ecocardiograma foi realizada antes e após quatro horas de LT4. Resultados: Com dose semanal, os níveis de fT4 foram mais elevados logo após a dose de LT4, e menores após sete dias; após seis semanas, houve diminuição de T3. TSH permaneceu inalterado e não houve manifestações ecocardiográficas ou de hipertireodismo. Conclusão: Dose semanal de LT4 leva à elevação de fT4, sem manifestações de hipertireoidismo, e parece ser uma alternativa segura para o tratamento do hipotireoidismo. Arq Bras Endocrinol Metab. 2012;56(4):250-8

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“…Case reports have suggested using a T 4 absorption test, which involves administering a bolus of 1 mg oral L-T 4 , as a strategy to identify pseudomalabsorption (12). Other reports have suggested using a bolus of weekly T 4 as a way to identify and reduce non-adherence (13). One of the earliest studies to use weekly T 4 showed that when compared with daily administration, the mean peak fT 4 following weekly administration of T 4 was significantly higher.…”

Section: Introductionmentioning

confidence: 99%

A thyroxine absorption test followed by weekly thyroxine administration: a method to assess non-adherence to treatment

Walker

Shillo

Ibbotson

et al. 2013

European Journal of Endocrinology

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Objective: For patients who remain hypothyroid despite the administration of what would seem adequate doses of levothyroxine (L-T 4 ), 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-T 4 malabsorption were excluded, and despite often high doses of L-T 4 , the patients remained hypothyroid. Design: Using a weight-determined oral L-T 4 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 T 4 bolus for a 4-week period after which TSH and free T 4 (fT 4 ) levels were recorded. Results: All patients showed a rise in fT 4 at 120 min following the administration of the L-T 4 bolus, with a mean increase of 54G3% from baseline. Following the treatment period, using an equivalent weekly L-T 4 dose, which was significantly less than that of the daily dose taken by the patients before the test, TSH reduced from baseline in w75% of cases. Conclusion: 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.European Journal of Endocrinology 168 913-917

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Once weekly thyroxine treatment as a strategy to treat non-compliance

Cited by 37 publications

References 11 publications

The Effect of Daily versus Weekly Levothyroxine Replacement on Thyroid Function Test in Hypothyroid Patients at a Tertiary Care Centre in Haryana

The Effect of Daily versus Weekly Levothyroxine Replacement on Thyroid Function Test in Hypothyroid Patients at a Tertiary Care Centre in Haryana

Treating primary hypothyroidism with weekly doses of levothyroxine: a randomized, single-blind, crossover study

A thyroxine absorption test followed by weekly thyroxine administration: a method to assess non-adherence to treatment

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