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11/13/24, 8\:18 PM Guide | Levothyroxine counselling

Levothyroxine counselling

Table of contents

Opening the consultation

Wash your hands and don PPE if required.
Introduce yourself including your name and role.
Con
Explain the reason for the consultation\:
t h a t b e o k ?”
.
“ T o d a y I' d l i k e t o t a l k t o y o u a b o u t t h e n e w m e d i c a t i o n y o u' v e b e e n p r e s c r i b e d , w o u l d
Establish rapport and an open line of communication\:
“ F e e l f r e e t o i n t e r r u p t m e i f y o u h a v e a n y q u e s t i o n s a t a n y p o i n t”
.
Make sure to check the patient's understanding at regular intervals throughout the consultation and provide opportunities to
ask questions (this is often referred to as 'chunking and checking').

Ideas, concerns & expectations

A key component of counselling involves exploring a patient’s ideas, concerns and expectations (often referred to as ICE).
Asking about a patient’s ideas, concerns and expectations can provide insight into how a patient currently perceives their
situation, what they are worried about and what they expect from the consultation. It can sometimes be challenging to use the
ICE structure in a way that sounds natural in your consultation, but we have provided some examples for each of the three
areas below.
Ideas
" D o y o u k n o w w h a t h y p o t h y r o i d i s m i s ?"
“ H a v e y o u h e a r d o f l e v o t h y r o x i n e ?”
“ W h a t d o y o u k n o w a b o u t l e v o t h y r o x i n e ?”
“ D o y o u k n o w w h a t l e v o t h y r o x i n e i s u s e d f o r ?”
Concerns
“ I s t h e r e a n y t h i n g , i n p a r t i c u l a r , t h a t’ s w o r r y i n g y o u a b o u t t a k i n g l e v o t h y r o x i n e ?”
Expectations
“ W h a t w e r e y o u h o p i n g t o g e t f r o m o u r d i s c u s s i o n t o d a y ?”
“ I s t h e r e a n y t h i n g , i n p a r t i c u l a r , y o u w o u l d l i k e t o d i s c u s s t o d a y ?”

History taking

Although the purpose of this station is to counsel the patient, it is a good idea to gather a quick, focused history early in the
consultation.
It would be appropriate to ask about speci
weight gain, cold intolerance, dry skin and constipation.
It is also important to clarify what medications the patient takes, to identify possible interactions with levothyroxine.

What is hypothyroidism?

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You should begin your explanation by discussing hypothyroidism, as this will form a foundation of understanding to then build
upon with your description of levothyroxine.
Example
“ Y o u r t h y r o i d s i t s a t t h e b a s e o f y o u r n e c k a n d p r o d u c e s a h o r m o n e c a l l e d t h y r o x i n e t h a t r e gu l a t e s m a n y a s p e c t s o f y o u r
m e t a b o l i s m , s u c h a s h e a t c o n t r o l , w e i g h t a n d e n e r gy l e v e l s . W h e n y o u r t h y r o i d d o e s n’ t p r o d u c e e n o u g h t h y r o x i n e , w e
c a l l t h i s h y p o t h y r o i d i s m .
"
If the patient has already mentioned some symptoms of hypothyroidism, try to integrate these into your tailored
explanation.
“ Y o u m e n t i o n e d y o u h a v e b e e n f e e l i n g t i r e d r e c e n t l y w h i c h i s a c o m m o n s y m p t o m o f h y p o t h y r o i d i s m . h y p o t h y r o i d i s m c a n i n c l u d e w e i g h t ga i n , d r y s k i n , c o n s t i p a t i o n a n d f e e l i n g c o l d e r t h a n u s u a l .
”
O t h e r s y m p t o m s o f

What is levothyroxine & how does it work?

Move on to explaining that levothyroxine is a synthetic form of thyroxine that can be used to increase the level of thyroid
hormones in people with hypothyroidism.
Example
" L e v o t h y r o x i n e i s a m e d i c a t i o n t h a t c a n b e u s e d t o t o p u p t h e l e v e l o f t h y r o x i n e i n p e o p l e w h o s e b o d i e s a r e u n a b l e t o
m a k e e n o u g h t h y r o i d h o r m o n e s o n t h e i r o w n . B y u s i n g t h i s m e d i c a t i o n , w e c a n r e s t o r e n o r m a l l e v e l s o f t h y r o i d h o r m o n e s
a n d p r e v e n t y o u f r o m e x p e r i e n c i n g t h e s y m p t o m s a s s o c i a t e d w i t h h y p o t h y r o i d i s m .
"

How to take levothyroxine

Explain that levothyroxine is prescribed as a once a day tablet.
The medication should be taken at least 30 minutes before breakfast. This is because food and co
absorption of levothyroxine.
1
Explain that the treatment is lifelong and make it clear that they shouldn’t suddenly stop taking levothyroxine or change their
dose without speaking to a doctor
If they forget to take a dose, advise them to take it as soon as they remember but to avoid double dosing.
Example
“ Y o u s h o u l d t a k e l e v o t h y r o x i n e e v e r y m o r n i n g b e f o r e b r e a k f a s t b e c a u s e f o o d a n d c o
m e d i c a t i o n y o u a b s o r b . U n f o r t u n a t e l y , y o u' l l m o s t l i k e l y n e e d t o c o n t i n u e t h i s t r e a t m e n t f o r t h e r e s t o f y o u r l i f e , a s y o u r
t h y r o i d i s v e r y u n l i k e l y t o r e c o v e r a n d b e a b l e t o p r o d u c e e n o u gh o f i t s o w n h o r m o n e s .
"
“ I t’ s i m p o r t a n t t h a t y o u d o n’ t s t o p t a k i n g t h e m e d i c a t i o n s u d d e n l y o r c h a n ge t h e n u m b e r o f t a b l e t s y o u’ r e t a k i n g w i t h o u t
t a l k i n g t o a d o c t o r . Y o u c a n a l w a y s ge t i n t o u c h i f y o u h a v e a n y q u e s t i o n s o r c o n c e r n s .
”
" I f y o u m i s s a t a b l e t , t r y t o t a k e i t a s s o o n a s y o u r e m e m b e r , b u t a v o i d t a k i n g t w o d o s e s i n t h e s a m e d a y .
"

Monitoring

Monitoring thyroid function tests, especially thyroid stimulating hormone (TSH), is essential for patients taking levothyroxine.
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The following intervals are recommended\:
4-6 weeks after initiation of treatment, adjusting levothyroxine dose as required (follow local guidelines)
3 monthly intervals after a dose change
Annually once thyroid hormone levels are within the normal range and stable
Example
" W h e n y o u
s l i g h t l y d i
s e e i f w e n e e d t o a d j u s t t h e d o s e . W e' l l t h e n r e-c h e c k y o u r t h y r o i d h o r m o n e l e v e l s e v e r y 3 m o n t h s u n t i l y o u r l e v e l s a r e
s t a b l e a f t e r w h i c h y o u' l l n e e d y o u r l e v e l s c h e c k i n g o n c e a y e a r .
"

Side e

Levothyroxine’s side e
hyperthyroidism respectively).
An excessive dose of levothyroxine can result in symptoms of hyperthyroidism such as\:
Heat intolerance
Weight loss
Insomnia
Fine tremor
An inadequate dose of levothyroxine can result in symptoms of hypothyroidism such as\:
Cold intolerance
Weight gain
Low mood
Constipation
Dry skin
Example
" T h e r e a r e v e r y f e w s i d e e
c o m m e n c i n g t r e a t m e n t , t h e d o s e m a y b e e i t h e r t o o l o w r e s u l t i n g i n y o u r h y p o t h y r o i d i s m s y m p t o m s c o n t i n u i n g o r t o o
h i g h c a u s i n g s y m p t o m s o f h y p e r t h y r o i d i s m s u c h a s w e i gh t l o s s , t r e m o r a n d h e a t i n t o l e r a n c e . T h i s i s w h y w e' l l b e
c h e c k i n g y o u r t h y r o i d h o r m o n e s m o r e f r e q u e n t l y a t
"

Closing the consultation

Check the patient’s understanding of the information given and ask if they have any questions.
Summarise what you have discussed to emphasise the key points to the patient.
Advise the patient that because they have hypothyroidism, they are now eligible to claim free prescriptions for all of their
medications moving forward. Signpost them towards the appropriate resources to apply for free prescriptions.
Thank the patient and o
Remind the patient to get in touch with their doctor if they have any further questions.
Dispose of PPE and wash your hands.
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Example
“ T h a t’ s a l l t h e i n f o r m a t i o n I h a v e f o r y o u t o d a y . C o u l d I j u s t a s k i f y o u f e e l l i k e y o u h a v e u n d e r s t o o d e v e r y t h i n g w e’ v e t a l k e d
a b o u t t o d a y a n d i f y o u h a v e a n y q u e s t i o n s f o r m e ?”
“ J u s t b e f o r e w e
h y p o t h y r o i d i s m a n d t h e r a t i o n a l e b e h i n d t a k i n g l i f e l o n g l e v o t h y r o x i n e t o r e p l a c e y o u r t h y r o i d h o r m o n e s . W e a l s o
d i s c u s s e d h o w t o t a k e l e v o t h y r o x i n e a n d t h e i m p o r t a n c e o f n o t m i s s i n g d o s e s . F i n a l l y , w e d i s c u s s e d t h e p o t e n t i a l s i d e
e
"
“ T h a n k y o u f o r t a k i n g t h e t i m e t o t a l k t o d a y , I u n d e r s t a n d t h i s i s a l o t o f i n f o r m a t i o n t o t a k e i n , l e a
"
s o p l e a s e r e a d t h r o u gh t h e

Reviewer

Dr Emily Clothier
Consultant GP at Brooks Bar Medical Centre

References

1. Patient.info. L e v o t h y r o x i n e . Published 2020. Available from\: [LINK]
2. NHS.uk. L e v o t h y r o x i n e . Published 2018. Available from\: [LINK]
3. NICE Guidelines. L e v o t h y r o x i n e . Published 2021. Available from\: [LINK]
Source\: geekymedics.com
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