Patient Resource Guide: Thyroid Medication Management
Thyroid replacement therapy with levothyroxine (Synthroid®) or a similar medication is often required for treatment of thyroid hormone deficiency. Low thyroid hormone can negatively affect multiple body systems, including the skin, blood, cardiovascular, respiratory, gastrointestinal, reproductive, neurologic, and musculoskeletal. With an emphasis on deprescribing as patients near the end of life, the appropriateness of tapering thyroid replacement therapy to discontinuation has been posed.
Considerations for Stopping Thyroid Medication in Hospice
Unmanaged hypothyroidism affects several body systems and metabolic processes with symptoms severe enough to warrant palliation with thyroid hormone replacement therapy. Many of these symptoms are similar to those manifested by other conditions common to patients at end of life and may not be recognized as thyroid-related and overlooked by clinicians. Examples include:
- Cognitive dysfunction in dementia
- Fatigue and poor concentration in major depression
- Dyspnea on exertion in respiratory disease
- Edema in cardiovascular disease
- Constipation unexplained by other factors
Thyroid replacement hormones have drug-drug and drug-food interactions that should be factored in when making therapy decisions
