Chellama Jayakumari, Abilash Nair, Jabbar Puthiyaveettil Khadar, Darvin V Das, Nandini Prasad, S J Jessy, Anjana Gopi, Padmanabhan Guruprasad
The most common reason for poor control of hypothyroidism is noncompliance to thyroxine, attributed to the inconvenience of taking the medication in a fasting state, waiting for 60 minutes for the next meal or beverage, and avoiding other medications that may interfere with absorption of thyroxine. Directly observed treatment for 5 to 6 weeks is one method to ensure compliance and rule out malabsorption as the cause of poor control of hypothyroidism. Once-weekly thyroxine (OWT) with doses <3 mg/d have been shown to be a safe treatment alternative to standard daily thyroxine (SDT) therapy for treating hypothyroid patients.
OWT has been recommended by the American Thyroid Association for older adults and patients dependent on caregivers for thyroxine therapy.
Still, there are few data regarding performance of OWT for patients who are not able to maintain normal TSH levels with daily therapy. Moreover, very few studies have evaluated the long-term treatment with OWT outside an institution. The current study intended to evaluate the effectiveness of OWT for patients with thyroxine-resistant hypothyroidism and its outcome for patients taking it over the long term at home.
Noncompliance with thyroxine therapy is the most common cause of poor control of hypothyroidism. An open-label prospective study to compare once-weekly thyroxine (OWT) with standard daily thyroxine (SDT) was undertaken.
Patients taking thyroxine doses of >3 μg/kg/d, with or without normalization of TSH, were included and administered directly observed OWT or nonobserved SDT according to patient preference based on their weight for 6 weeks. Furthermore, patients on OWT were advised to continue the same at home without supervision.
Twenty six of 34 patients on OWT and 7 of 18 patients on SDT achieved a TSH <10 μIU/mL (P < 0.05), and 2 patients from the SDT arm were lost to follow-up. During home treatment, 15 of 25 at 12 weeks and 19 of 23 contactable patients at a median follow-up of 25 months maintained TSH below target. Thyroxine absorption test was unable to predict normalization of TSH at 6 weeks of OWT therapy. No adverse events were seen with OWT-treated patients over the 12-week follow-up period. OWT has significantly higher efficacy (OR = 5.1) than SDT for patients with thyroxine-resistant hypothyroidism and is not associated with side effects.
OWT benefits a majority of patients in the long-term treatment of thyroxine-resistant hypothyroidism, in the real-world setting.
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