Once a Week Dose of T4? A bad idea for most patients

Once a Week Dose of T4? A bad idea for most patients

Once a Week Dose of T4? A bad idea for most patients

The drug levothyroxine (Synthroid, Levoxyl, others) has long been the treatment for sluggish thyroids or hypothyroidism. The pill needs time to be absorbed properly, so patients are often instructed to take it daily a half hour to an hour before breakfast. But that can make the regimen inconvenient for some, and compliance declines.

Now, a new study suggests that weekly doses appear to work as well. Indian researchers presented the findings at the 2016 annual meeting of the American Association of Clinical Endocrinologists in Orlando. “Once weekly L-thyroxine replacement was well tolerated and there was no indication of acute toxicity or hypothyroidism symptoms compared with daily therapy,” according to researchers Satish Wasoori, MD, and Manoj Naik, MD, of Park Hospital in Guragaon, India. The new study echoes some findings from previous research.

U.S. endocrinologists who reviewed the findings say, in general, they still prefer daily dosing

The researchers say the weekly regimen is effective and safe, ”making it a possible alternative to customary daily therapy.”

Second Opinions

“There is no question that daily therapy is preferable to weekly therapy,” says Jacqueline Jonklaas, MD, associate professor of endocrinology at Georgetown University Medical Center, Washington, D.C. She reviewed the new data.

Why? “The ‘half life’ of  thyroid hormone (how long it stays in your system) means that if you give it daily there are minimal peaks and troughs (ups and downs) in its blood level,” she says.

In her view, “the only patient who might be considered for weekly therapy is someone who could not be kept with normal thyroid levels on daily therapy.” That’s usually due to failing to take the medicine daily, she says. “Therefore, weekly therapy would only be a compromise when normal levels just cannot be achieved with daily therapy.”

Most do not have an issue remembering the daily dose, says Dr. Jonklaas says, adding that medicine can be taken morning or evening. “Patients can put their thyroid hormone on their night stand, next to their tooth brush, use a weekly pill container, set an i-phone alarm and so on,” she says. “I think working on finding a schedule that someone can keep to would be far preferable to pursuing weekly therapy. I also worry that this is not ideal for women of child-bearing potential. I do not think the up and downs in thyroid hormone would be optimum during pregnancy.”

Comment: I agree with others that daily is a better method.I use weekly for only a very few who can’t remember daily dosing regimen.

Richard Guttler MD,FACE,ECNU

thyroid.com

 

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