Levothyroxine administration — GPhC CRA MCQ
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Correct answer: C — Arrange supervised dose reduction and assess cardiac symptom severity
Arrange supervised dose reduction and assess cardiac symptom severity: Symptoms plus suppressed TSH and raised free T4 establish over-replacement; authorised dose reduction is required, with urgent assessment if palpitations suggest significant arrhythmia. Continue treatment and repeat tests at the routine three-month review: Ongoing biochemical and symptomatic excess exposes the patient to arrhythmia and bone harm. Halve the dose immediately without contacting the prescriber: The dose needs prompt reduction, but the size and timing should be clinically authorised and individualised. Stop treatment until TSH normalises, then restart the same dose: Unmonitored cessation followed by the unchanged excessive dose produces unstable control. Add a beta blocker and leave the levothyroxine dose unchanged: Symptom control does not correct the underlying hormone excess and may not be suitable without assessment.
Reference: BNF: levothyroxine sodium: https://bnf.nice.org.uk/drugs/levothyroxine-sodium/; Levothyroxine tablets UK summary of product characteristics: https://www.medicines.org.uk/emc/product/5682/smpc