Atypical thyroxine replacement in hypothyroidism: A clinical audit

Abstract

Background: Change in dosage timing and frequency of L-thyroxine administration may decrease the severity of hypothyroid symptoms and contribute to patient satisfaction. This clinical audit was planned to assess the patterns of L-thyroxine replacement in hypothyroid patients. Materials and Methods: A pretested, structured questionnaire collecting information about age, gender, duration of disease, concomitant morbidity and therapy, patient concerns, and thyroid control was administered to 100 consecutive hypothyroid patients attending an endocrine clinic in Karnal, Haryana, North India. Analysis was carried out using the SPSS version 19.0. Results: The mean age of patients was 42.14 ± 13.14 yr, with an average duration of hypothyroidism of 5.12 ± 6.87 yr. Thirty-two subjects were euthyroid (thyroid stimulating hormone (TSH) 0.35-5.00 mIU/l).Eleven subjects reported a TSH < 0.35 and 57 reported TSH ≥5.00 mIU/l. The commonest dose of L-thyroxine used was 100 mcg/day (n = 35), followed by 125 mcg/day (n = 20). The mean total daily dose was 101.17 ± 24.91 (range 50-150) mcg/day. The daily dose per body weight was 1.452 ± 0.38 (range 0.67-2.56) mcg/kg). Nine patients were on atypical regimes: five took their medication in divided daily doses, two took it at night, and two preferred a time two hours after breakfast and two hours before lunch. They shifted from early morning administration of L-thyroxine because of uneasiness (n = 5/9), palpitation (n = 2/9), and increased hunger (n = 1/9) post-tablet ingestion. The symptoms subsided after the timing or frequency of L-thyroxine intake was changed. Conclusions: Changing the time and/or frequency of L-thyroxine dosage helps in alleviating some of the distressful symptoms among the hypothyroid subjects.