CAN WEEKLY L-THYROXINE CAN REPLACE DAILY DOSE OF DRUGTO TREAT HYPOTHYROIDISM ?

Prof Dr,DRAM,HIV /AIDS,HEPATITIS ,SEX DISEASES & WEAKNESS expert,New Delhi,India, +917838059592

L-THYROXINE is being prescribed for lazy or hypothyroidism patients mostly as sinle dose taken daily in empty stomach but new research says it combined seven days dose taken once a week is as good as once daily dose and it also treats many refractile or unresponsive patients.

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

      In the new research, the doctors evaluated 40 women, ages 25 to 55, who had been diagnosed with hypothyroidism for at least five years and were on a daily dose of levothyroxine. They assigned them to two groups. One group had thyroid-stimulating hormone (TSH) levels viewed as in the normal range at the start; the other group had levels that were above the normal range. Higher TSH levels indicate a failing thyroid, according to the American Thyroid Association.Both groups of women took a weekly dose of levothyroxine seven times their daily dose, following the regimen for six months. Those in group 1, with TSH levels closer to ideal to start with, all maintained normal thyroid functioning by 12 weeks into the study and maintained it at the six-month mark. In group 2, 16 of 20 had normal functioning at 12 weeks and 18 did by the six-month mark. Two did not achieve normal thyroid function, probably due to underlying diabetes and obesity, the researchers say.

              The researchers say the weekly regimen is effective and safe, ''making it a possible alternative to customary daily therapy." They also concluded that the once-a-week regimen ''can be considered as first-line therapy in working young and middle-aged women facing impaired absorption due to early breakfast." They would need to take the weekly dose on an empty stomach, but could skip that waiting period the other six days.             

           But not everyone is on board with that idea. "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. 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. "However, if you give a larger dose on a weekly basis there are big peaks and troughs. This means that a patient may have symptoms of too much thyroid hormone right after the dose is given and symptoms of too little right before the next dose is due to be given. This is not at all ideal. The high levels could potentially be associated with risks such as a fast or irregular heart beat."

           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."