Levothyroxine is one of the most common medications that I see used in my everyday practice. I’ve definitely seen a fair share of mistakes with levothyroxine. Here’s a few common ones that come to mind.
- Dosing levothyroxine based upon TSH is counter-intuitive. When you think of most medications, a low level will lead you to increase the dose (warfarin, phenytoin, etc.). With levothyroxine, when TSH is low, it indicates (with a few exceptions) that the body has too much thyroid hormone and levothyroxine should be reduced.
- Identifying medications that may cause changes in thyroid function. Lithium and amiodarone are two classic examples of medications that you need to monitor thyroid function. I have definitely seen this get missed.
- Drug interactions. Getting the correct dose of levothyroxine can sometimes be challenging and drug interactions can complicate this. The classic example that comes to mind is calcium.
- Simplify. Patients can get overwhelmed and confused about complex medication regimens. We need to do our best to try to avoid every other day, half tab orders, two times per week, and other orders that aren’t consistent. This will hopefully prevent some headaches and help ensure that our patients are actually taking the medications as we intend.
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