Twice-Weekly Dosing for Thyroxine Replacement in Elderly Patients with Primary Hypothyroidism

Taylor, Jo A.; Williams, B. O.; Frater, John L.; Stott, David J.; Connell, John

doi:10.1177/030006059402200504

Cited by 28 publications

(15 citation statements)

References 10 publications

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“…(16). In another study, treatment with LT4 twice a week showed no statistically significant differences in thyroid hormones and in systolic time intervals, when compa red to daily treatment (22), as observed in our study.…”

Section: Discussionsupporting

confidence: 74%

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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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Section: Discussionsupporting

confidence: 74%

“…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%

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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“…Taylor et al compared once daily versus twice weekly thyroxine treatment in seven female patients. 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.…”

Section: Discussionmentioning

confidence: 89%

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

Rangan

Tahrani

Macleod

et al. 2007

Postgraduate Medical Journal

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Hypothyroidism is a common disorder, which is mainly treated in primary rather than secondary care. Once daily thyroxine replacement restores euthyroidism in most patients; some patients, however, remain hypothyroid despite adequate thyroxine replacement. Non-compliance is the most common cause of lack of response to thyroxine treatment. We describe two cases of primary hypothyroidism in which daily thyroxine treatment did not restore biochemical euthyroidism but once weekly thyroxine treatment was successful. In addition we review the evidence and discuss the differential diagnosis of lack of response to thyroxine treatment. Once weekly thyroxine treatment can be a safe, well-tolerated, and effective therapy for patients with non-compliance.

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“…This is also seen in other studies incorporating weekly and alternate day strategies to combat non compliance and to reduce costs in the treatment of sub clinical hypothyroidism. [9][10][11][12]…”

Section: Effects On Thyroid Profilementioning

confidence: 99%

A study of subclinical hypothyroidism treated with alternate day fixed dose thyroxine therapy

Jhavar

Naredi

2018

Int J Adv Med

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Background: Subclinical hypothyroidism (SCH) is a biochemical diagnosis wherein free T4 is within normal range while serum TSH value >5mIU/L. We aimed to study effects of alternate day fixed dose thyroxine therapy on this subset of patients with a 3month follow up of various clinical and biochemical parameters.Methods: It was an interventional trial. Fifty consecutive consenting participants with SCH aged 18-45 years were started on alternate day 50µg thyroxine and were observed for 3 months for changes in body mass index, blood pressure, serum cholesterol, serum triglyceride, serum TSH, T3 and T4 levels.Results: Forty four out of fifty participants had initial TSH levels between 5-10 µU/mL and at the end of 3 months, 58% of these (n=29/44) shown improved thyroid profile as their TSH fell to the target 2-4 µU/mL. Seven participants’ (n=7,14%) turned into iatrogenic hyperthyroidism as their T3 and T4 levels rose above normal and TSH levels fell to below 1 µU/mL. Another 7 participants (n=7,14%) showed increased T3 and T4 levels (n=3, n=4 respectively) above normal range with TSH still within normal range. One patient (n=1,2%) had persistently raised TSH levels. Out of 6 participants (n=6,12%) who had initial TSH>10 µU/mL, 3 participants achieved normal TSH with alternate day therapy (n=3,6%) while 3 participants did not achieve euthyroid status (n=3,6%). Authors observed decrease in cholesterol levels (initial=183.18±52.96 mg/dL, final=170.04±42.13 mg/dL, p<0.05). It lead to reduction in weight (initial BMI=24.11±5.69, final=23.33±5.30, p<0.05).Conclusions: Authors found that treatment of SCH with alternative day thyroxine therapy is effective in normalizing TSH values. Its dose needs to be titrated according to TSH levels to avoid side effects. It decreased cost of therapy resulting in good compliance in noncompliant patients and reduced pill burden helped the patients in adhering to the therapy.

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Twice-Weekly Dosing for Thyroxine Replacement in Elderly Patients with Primary Hypothyroidism

Cited by 28 publications

References 10 publications

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

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

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

A study of subclinical hypothyroidism treated with alternate day fixed dose thyroxine therapy

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