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Levothyroxine administration — GPhC CRA MCQ

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HardEndocrine TherapeuticsLevothyroxine administrationGPhC CRA

A patient takes levothyroxine with breakfast, coffee, ferrous sulfate and a calcium supplement. TSH remains raised despite good reported adherence. Which change should the pharmacist recommend first?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: A — Take levothyroxine consistently 30–60 minutes before breakfast and separate calcium and iron

Food, coffee, iron and calcium can reduce or vary levothyroxine absorption. The first intervention is therefore to correct administration: take levothyroxine consistently on an empty stomach 30–60 minutes before breakfast or caffeine and keep it apart from interacting supplements, following product-specific advice. Dose escalation before correcting this pattern risks over-replacement if administration later changes. Alternate-day dosing, crushing into coffee and planned treatment interruptions are not appropriate.

Reference: NHS: Levothyroxine: https://www.nhs.uk/medicines/levothyroxine/