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Levothyroxine administration — GPhC CRA MCQ

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HardEndocrine TherapeuticsLevothyroxine administrationGPhC CRA

A patient was stable on one levothyroxine tablet product but has twice developed palpitations and fatigue after dispensing changed to another manufacturer. Thyroid function is currently within range and administration is consistent. What is the most appropriate next step?

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Correct answer: D — Arrange clinical review and request consistent prescribing of the previously tolerated product

Generic levothyroxine prescribing remains appropriate for most people, but the MHRA recognises a small group with persistent symptoms after product switching, even when biochemically euthyroid. Thyroid function should be assessed and a specific previously tolerated product may be prescribed consistently. If symptoms or poor control persist despite that, oral solution can be considered. Combining products, unsupervised dose changes or permanent cessation are unsafe.

Reference: MHRA: Levothyroxine product-switching advice: https://www.gov.uk/drug-safety-update/levothyroxine-new-prescribing-advice-for-patients-who-experience-symptoms-on-switching-between-different-levothyroxine-products