The Pharmaceutical Journal
Vol 273 No 7327 p785
27 November 2004

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· Registration exam (2)
· Pharmacist prescribing
· Agenda for change
· New contract (3)
· Retention fees (2)
· Statins
· Levothyroxine
· The Journal

Letters to the Editor

Levothyroxine

Levothyroxine suspension effective

From Mr R. A. Morgan, MRPharmS, and Dr Z. Huma

With reference to Kenneth Bird’s letter “Is levothyroxine suspension effective?” (PJ, 6 November, p680), we have recent experience of the successful use of extemporaneously prepared levothyroxine suspension in a 27-week gestation 800g infant.

This infant was underweight, septic, hypotensive and bradycardic as well as being artificially ventilated. The details are as follows:

· Free T4 on starting treatment was less than 3.0pmol/L (range 9.1–23.8pmol/L)
· Free T4 after 5 days was 16.6pmol/L
· Free T4 after 13 days was 22.5pmol/L
· Free T4 after 20 days was 20.3pmol/L

The levothyroxine was prepared as a 10µg per ml suspension (using xanthan gum 0.5 per cent). The dose was 5µg orally daily for two days followed by 10µg thereafter.

Further points to note from this patient are:

· Although it is routine practice at Wexham Park Hospital to give crushed levothyroxine tablets, in this instance, any approximation of dosing would have been unacceptable

· An exact dose of levothyroxine was required to avoid a too rapid correction of the thyroid status, which may have been detrimental to the other clinical problems

· The thyroid function tests demonstrate an almost ideal return to normal values and underline the efficacy of the suspension prepared

Royston Morgan
Paediatric Pharmacist

Zilla Huma
Consultant Paediatrician,
Wexham Park Hospital, Slough

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