Practical Considerations of Levothyroxine Administration for Hypothyroidism

EP: 1.Prevalence of Primary Hypothyroidism

EP: 2.Prevalence of Subclinical vs Overt Hypothyroidism

EP: 3.Importance of TSH Target Ranges in Hypothyroidism Management

EP: 4.Key Data on Off Target TSH Levels in Patients with Hypothyroidism

EP: 5.Treatment Adherence and Compliance in Maintaining TSH Levels for Hypothyroidism

EP: 6.Impact of Age and Concomitant Drug Interactions on TSH Levels in Hypothyroidism

EP: 7.Key Takeaways for Optimizing TSH Levels in Elderly Patients With Hypothyroidism

EP: 8.Impact of Diet and Calorie Restriction on TSH Levels in Hypothyroidism

EP: 9.Levothyroxine Formulation Considerations in Hypothyroidism Management

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EP: 10.Practical Considerations of Levothyroxine Administration for Hypothyroidism

EP: 11.Expert Perspectives on TSH Monitoring and Treatment Follow-up to Manage Hypothyroidism

EP: 12.Clinical Implications of Off Target TSH Levels and Importance of Patient Education in Managing Hypothyroidism

Antonio Bianco, MD, PhD: In practical terms, I have patients where I’ll look at their TSH [thyrotropin levels], let’s say TSH is 3.5, and I’ll tell them that once per week, they should take a half tablet more. If on Sunday, they decide to take a half tablet more, it’s only a minor change in the total dose that the patient is taking. It will bring their TSH down slightly, and some patients will feel better, and some will not. But I know there’s a possible placebo effect, even though I also know there are studies showing that minor changes in the dose of levothyroxine should not affect clinical outcomes, but anecdotally, that’s what we see in the office; minor adjustments in the dose sometimes do make a difference with the patients. I believe that we should be aware of this minor change, and if this is something we can control, it’s something we should do for our patients.

James Hennessey, MD, FACP: Also in the study [conducted by Juan Pablo Brito Campana, MBBS], they had a subgroup of study participants that was taking more than 100 mcg a day—about364 mcg—and interestingly, they were able to maintain a normal TSH on the same insistent brand about 71% of the time. That indicates that there’s some variability in TSH outcomes that we’ll see at baseline throughout our practice. The interesting thing here was, if the patients were switched to another generic, they would maintain a normal TSH 76.6% of the time. Why would switching be an improvement? We can move on from there. What you were saying before about switching from brand names to generics is completely valid, because Juan Pablo was very clear in stating that the study did not address any changes from brand names to generics. It referred specifically to the 3 generics that had been referenced to that particular thyroxine product.

Transcript edited for clarity