Once weekly L-thyroxine treatment in non-compliance: A case report

• Published in: La revue de medecine interne Vol. 38; no. 11; pp. 766 - 768
• Main Authors: Oliver, C, Grino, M, Moatti Vacher-Coponat, P, Morange, I, Retornaz, F
• Format: Journal Article
• Language: English; French
• Published: France 01-11-2017
• Subjects: Administration, Oral; Adult; Drug Administration Schedule; Graves Disease - blood; Graves Disease - drug therapy; Graves Disease - surgery; Humans; Hypothyroidism - blood; Hypothyroidism - drug therapy; Hypothyroidism - etiology; Male; Patient Compliance; Postoperative Complications - drug therapy; Thyrotropin - blood; Thyroxine - administration & dosage; L-thyroxine; Non adherence; Hypothyroïdie; Hypothyroidism; Non-observance
• ISSN: 1768-3122
• DOI: 10.1016/j.revmed.2017.06.005

The non-adherence to substitutive treatment by L-thyroxine is the main cause of the discordance between high thyrotropin values and high doses of the drug.
In a 36-year-old patient with post-surgery hypothyroidism, thyrotropin values ranged between 100 and 400 mUI/L, although daily replacement therapy included 300 μg of L-thyroxine and 75 μg of L-triiodothyronine. The oral loading test with L-thyroxine was normal and thyrotropin serum level returned to normal values under weekly oral administration of 1000 μg L-thyroxine.
The strategy of non-adherence treatment in hypothyroidism is well defined with oral testing of L-thyroxine, followed by oral or parenteral weekly administration of the drug. The L-thyroxine oral test is the gold standard for diagnosis after eliminating of the other conventional causes: drug interactions or digestive malabsorption. L-thyroxine treatment should be discussed on a case-by-case basis, either daily under surveillance or once weekly oral or parenteral high dose.