Patient Education for Levothyroxine Therapy
Patients starting levothyroxine therapy should be instructed to take the medication as a single dose on an empty stomach, one-half to one hour before breakfast with a full glass of water to ensure optimal absorption. 1
Administration Instructions
- Take levothyroxine at the same time each day, preferably in the morning
- Wait at least 30 minutes (ideally 60 minutes) before eating breakfast 2
- Take with a full glass of water to avoid choking or gagging 1
- Do not take levothyroxine within 4 hours of:
- Iron supplements
- Calcium supplements
- Antacids
- Other medications that can decrease absorption 1
Expected Treatment Response
- Inform patients that symptom improvement may take several weeks 1
- Levothyroxine is typically a lifelong replacement therapy 1
- Initial follow-up testing will occur 6-12 weeks after starting therapy 3
- Once stable, monitoring will continue every 6-12 months 3
Potential Side Effects
Patients should be instructed to notify their healthcare provider if they experience any of the following symptoms, which may indicate overtreatment:
- Rapid or irregular heartbeat
- Chest pain
- Shortness of breath
- Nervousness or irritability
- Insomnia
- Tremors
- Excessive sweating
- Heat intolerance
- Weight loss 1
Special Considerations
Medication Storage
Important Disclosures
- Levothyroxine should not be used as a weight loss medication 1
- Partial hair loss may occur during the first few months of therapy but is usually temporary 1
Medical Alerts
Instruct patients to inform their healthcare provider about:
- All other medications they are taking (prescription and over-the-counter)
- Any medical conditions, particularly:
- Heart disease
- Diabetes (monitor blood/urine glucose levels closely)
- Clotting disorders (more frequent monitoring of clotting status needed)
- Adrenal or pituitary gland problems 1
- Pregnancy or breastfeeding status, or plans to become pregnant 1
- Upcoming surgeries or dental procedures 1
Alternative Administration Options
For patients with adherence difficulties:
- Bedtime administration may be considered as an alternative, though it may result in higher TSH levels compared to morning administration 4, 5
- Patients taking levothyroxine at bedtime should be monitored more closely for TSH variability 5
- For patients requiring precise TSH control, fasting morning administration remains recommended 5
Dosing Considerations
- Inform patients that their dose may need adjustment based on laboratory results
- Starting doses typically range from 25-50 mcg daily for most adults, with adjustments based on TSH levels 3, 6
- Elderly patients or those with cardiac conditions typically start at lower doses 3
By providing comprehensive education about levothyroxine administration, expected effects, monitoring, and potential complications, healthcare providers can help ensure optimal treatment outcomes and patient safety.