QuestionPrescription
QuestionComment
Do NICE count anyone above age 65 to receive the 'elderly dose'? 
60831
QuestionComment
i want to know this too

60944
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Schistosomiasis
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Claire
QuestionComment
According to NICE, a person is considered elderly if they are 65 or older. This definition applies to people in residential care homes as well.
61123
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Samantha
QuestionComment
How do we know the duration for this Rx?
61171
QuestionComment
You have a look at medicinal forms of the drug on BNF and they're available in packets of 28 pills (ie. 4 weeks)
61605
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Taa The Best
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DJnR
Concept
Chapter
2693
3765
Hypothyroidism
Topic
133
Endocrinology
# Drug choice feedback

This is a patient presenting with symptoms and signs of hypothyroidism (dry skin, cold intolerance, alopecia), and the blood tests confirm the likely cause is Hashimoto's thyroiditis (commonest cause of hypothyroidism in the UK). As such, she should be commenced on thyroxine replacement therapy with levothyroxine.

# Dose/Route/Frequency/Duration feedback

NICE recommend considering starting levothyroxine at a dosage of 25–50 *micrograms* per day with titration for adults aged 65 years and over, and adults with a history of cardiovascular disease. It should be taken in the morning on an empty stomach and before any other medication has been taken. The dose can be uptitrated every 4 weeks by 25-50mcg. The patient should be reviewed and have TSH levels every 3 months after initiation of levothyroxine therapy and adjust the dose according to symptoms and TFT results.
18095
PrescriptionAnswer
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25 micrograms
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levothyroxine sodium 25 microgram tablets
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4 weeks
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daily (OD)
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oral (PO)
PrescriptionAnswer
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50 micrograms
PrescribeAnswerData
levothyroxine sodium 50 microgram tablets
PrescribeAnswerData
4 weeks
PrescribeAnswerData
daily (OD)
PrescribeAnswerData
oral (PO)
PrescriptionAnswer
PrescribeAnswerData
50 micrograms
PrescribeAnswerData
levothyroxine sodium 50 microgram tablets
PrescribeAnswerData
4 weeks
PrescribeAnswerData
daily (OD)
PrescribeAnswerData
oral (PO)
PrescriptionAnswer
PrescribeAnswerData
25 micrograms
PrescribeAnswerData
levothyroxine sodium 25 microgram tablets
PrescribeAnswerData
4 weeks
PrescribeAnswerData
daily (OD)
PrescribeAnswerData
oral (PO)
Case Presentation: A 67-year-old lady attends her GP for a follow up appointment after her recent blood tests. She had previously presented with feeling cold all the time despite the weather being warm, drier skin than usual and she has also noticed small amounts of hair loss. Her blood test results are below.




## PH


Vitiligo


## DH


NKDA


## On examination


No cyanosis. Alert and orientated. Two patches of hair loss noted on the scalp.


Temperature 37.0°C, HR 60, RR 14, BP 130/73, O<sub>2</sub> saturation 96% RA, GCS 15, Weight 94kg


## Investigations


||||
|---------------------------|:-------:|------------------------------|
|Thyroid Stimulating Hormone|10 mU/L|0.3 - 4.2|
|Free T4|8 pmol/L|9 - 25|
|Free T3|0.8 pmol/L|3.1 - 6.8|

Anti-TPO (thyroid peroxidase) assay: positive


# Prescribing Request


Write a prescription for one drug that is most appropriate for managing this patient's condition.

