Efficacy of Daily vs Weekly Levothyroxine for Hypothyroidism

At the 26th American Association of Clinical Endocrinologists (AACE) Annual Scientific Sessions & Clinical Congress, once-weekly levothyroxine vs. daily levothyroxine proved safe and effective for the treatment of hypothyroidism in non-adherent young and middle-aged adults. 

Satish Wasoori, MD, FACE, and colleagues from the Park Hospital and Sunjeevan Hospital, aimed to evaluate the efficacy and compliance to levothyroxine therapy as a weekly dose (7 times the normal daily dose) as an alternative to treat hypothyroidism in adults in a randomized prospective observational study (n=180). 

Patients were aged 18-55 years with a clinical diagnosis of hypothyroidism. They were divided into 3 groups: Group 1: patients with thyroid-stimulating hormone (TSH) levels ≤4.2 assigned weekly levothyroxine at a dose 7-fold of the normal dose; Group 2: patients with TSH >4.2 assigned weekly levothyroxine at a dose 7-fold of normal dose that was individualized as per body weight and TSH value; and Group 3: patients with TSH >4.2 assigned an initial weekly dose individualized as per the body weight and TSH value. The study doses ranged from 175 mcg–1050 mcg.

“All subjects in all the groups were screened for malabsorption and were not receiving any drugs which interfere with the absorption of L-thyroxine,” explained Dr Wasoori. 

In Group 1, 59 of 60 patients achieved euthryoidism at 12 weeks and continued to 24 weeks. Treatment was withdrawn in the 1 patient due to symptoms of hyperthyroidism. 

In Group 2, 52 of 60 patients achieved euthryoidism at 12 weeks and later achieved in 55 patients after dose adjustment at 24 weeks. The 5 patients who did not achieve euthyroidism may be explained by other comorbidities such as diabetes and obesity.

In Group 3, 54 of 60 patients achieved euthyroidism at 12 weeks and later achieved in 59 patients after dose adjustment at 24 weeks. One patient did not complete the study. 

The weekly levothyroxine therapy was shown to be safe and effective and the findings support its use in newly diagnosed patients with hypothyroidism. For patients who are non-compliant to a rigorous treatment regimen, “it is a valid therapeutic option and can also be considered as a first-line therapy in young and middle aged working adults facing impaired absorption due to early breakfast,” added Dr Wasoori.

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Reference

Wasoori S, Naik M, Pande D, Bhardwaj C. Hypothyroidism – once a week treatment option in young and middle aged adults. Abstract 1076. Presented at: 26th American Association of Clinical Endocrinologists Annual Scientific Sessions & Clinical Congress; May 3-7, 2017; Austin, TX.

This article originally appeared on MPR