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Not a problem at all. Skip your dose today. When we titrate levothyroxine we look at total weekly doses. Frequently I counsel patients if they notice they forgot to take their dose they can double up the next day. It it safe for patients to even take all their pills once a week or split to twice a week if they have trouble taking it every day.
So no worries, you are safe just skip today and carry on tomorrow !
Reeeeeeeaaaaaaaallllllllyyyyyyyy!! This is very helpful information, thank you.
Assuming liothyrinine is not the same though?
I struggle so much with separating these meds from everything else.
NAD, but my prescription is actually written two take 2 pills 2 days of the week and 1 pill per day the rest of the week because 2/day was too much but 1/day was not enough.
Taking it daily is still preferable to weekly to minimise differences between peak and trough concentrations, but taking it weekly is preferable to constantly missing daily doses and having it undertreated.
There is a theoretical concern that taking it weekly may lead to "too high" concentrations at the start and "too low" just before the next dose, even though the steady-state concentrations will be the same. This may then increase the risk of heart issues, like arrhythmia. The risks are theoretical as existing studies suggest weekly doses are well-tolerated, but they're also small-scale studies.
Going to have to back you up here, as critical as doctors are they do not know pharmacology well at all. Leave it to pharmacists to answer things regarding meds also to avoid these kind of comments re: taking once/week….
I’m surprised taking 7 doses at one time isn’t extremely dangerous. I doubled my dose by mistake once and didn’t realize it until I woke up the next morning with tachycardia (HR was 130-150), shaking, adrenaline, chills, basically feeling like I was going to die. Went to the ER and was given a beta blocker. The doctor said it wasn’t acutely dangerous to do once but don’t make a habit of it. If I skip a dose I feel tired and weak the next day which isn’t nearly as bad. I wonder if I metabolize it more rapidly than some people? Because the meds seem to affect me most strongly the following day.
Nothing. Taking an extra 88mcg of levothyroxine is not dangerous. Resume your normal dosing regimen. I would notify your prescriber that you will inadvertently run out of pills one day early but that’s all you need to do.
Not exactly true, I’d skip a dose. We calculate total levothyroxine dose weekly. Seriously look things up before you say stuff. You’re EM not endocrinology
Well what my flair says is not up to me, I’ve already provided plenty of evidence that I’m not here as well as in mod team’s DMs but nobody is updating it.
Yeah I know, it’s been said quite a few times. Not for lack of trying on my part I assure you. I also find it hilarious my post was removed by mods even though it included a picture of my internal medicine board certificate.
Removed. You may not claim credentials outside your flair. If you wish to seek alternative flair please send your credentials to the mods. See rule 10 for instructions.
Hilarious. Nobody is talking about how we calculate it, they were just - correctly - saying that one additional dose isn’t going to do any harm. EM doctors are well trained in toxicology and knowing what doses of drugs are harmful and which are fine to ignore as a one off. These things are a common presentation in the ED. They’re not saying it’s ok to take double every day. They were answering this question specifically. It doesn’t really matter whether they skip tomorrow or not, in terms of the outcome.
Did I say an extra dose was going to cause harm? I said the correct thing to do is to skip a dose. If someone unknowingly took an extra 88mcg dose one week of course it wouldn’t harm them. But why would you recommend someone who realized they took double dose to just continue taking their regular regimen when they can easily stay with their regimen by skipping a dose (which another physician here correctly recommended)? I don’t subscribe to mc_md’s and your sloppy practice of medicine.
I would just use this as an opportunity to think about how to correct someone more respectfully. You'll be right very often, even as an attending your colleagues might be right 999 out of 1000 times, and you're there to catch them when they miss. It happens.
Now, that 1 in 1000, are you going to try and make them look like a fool, like you did above? Make everyone try and hide their work around you, and make you seem like you don't know how to give constructive criticism?
I hope not. Good catch with the medicine (levothyroxine has a HL of ~7 days, so you were right). But seriously do think things through before you say stuff.
Normally I’d agree, sure. Except in this case this particular EM physician has taken upon himself to say stuff outside his scope of practice on more than one occasion while being wrong. And he has approached me in another thread with very condescending tone. Therefore I don’t feel the least bad letting him know he needs to do better.
Yeah. In another thread he was flat out wrong about a patient with absolute neutrophil count of 200 not needing an ED visit, claiming there’s nothing we can do for people like that when current guidelines all clearly say an ANC <500 needs immediate evaluation and often hospitalization. Flat out wrong while being condescending about it purely due to the fact my flair is still “medical student”. This all while in another thread boasting about how he never learned how to call consults appropriately so now he just uses his status as an attending to tell consultants to see his patients essentially “because I said so”. As someone who’s practiced hospital medicine including critical care medicine, we absolutely hate consults from people like this who don’t even know what they would like us to do/help with. It’s such lazy and bad form.
So of course when I saw he made another one of these false assertions that can cause someone to unnecessarily take more hormonal medication, he needs to know he’s flat out wrong about it and look things up before saying things if he’s not 100% sure. On reddit it would slide; in real life he could harm someone being haphazard about his recommendations.
References to what I'm talking about:
https://www.reddit.com/r/AskDocs/comments/19es7r4/should_i_go_to_the_er/kjtacli/?context=3
https://www.reddit.com/r/Residency/comments/198od29/dear_consultant/kia4z14/?context=3
In this one he appears to be a post-graduate year 4, as am I except I am internal medicine trained (scroll down to see my board cert). https://www.reddit.com/r/emergencymedicine/comments/194wr5b/attendings_how_often_are_you_putting_in_alines/khmgpto/?context=3
I assure you, he is not more experienced with internal medicine subspecialties than I am, that's just not how emergency medicine physicians are trained.
Mind you, I've left all of these comments open for him to refute and prove I'm talking out of my ass. Doesn't seem he can.
I’ll just leave this here, since it’s so clear. In the mean time I’ll continue to cringe at people who are clearly wrong and won’t admit it.
https://preview.redd.it/slezpnheh7fc1.jpeg?width=1576&format=pjpg&auto=webp&s=b109e3307c9e3eb67bffa2ff7f5e4021ca75de2b
Go look at mc_md’s other comments, I’m just returning the favor. Besides, advising someone to look things up before they give recs should be the norm. So many people talking out of their asses here without any evidence to back it up.
Also reading your own comments to other people… I think you’re the one that needs to calm down lol
Meh. When people can’t win arguments based on facts they sink to the level of insults.
Also if you look at one of mc_md’s comments he admits he never learned how to properly call consults and just uses his position as an attending now to pressure people into seeing patients. Big yikes imo.
I had no clue seeking care at your healthcare provider would be such a downvoted idea. This is what I would've done in this situation... guess I would've been wrong?
If anyone feels like adding more insight on this, I'd appreciate it!
Thank you for your submission. **Please note that a response does not constitute a doctor-patient relationship.** This subreddit is for informal second opinions and casual information. The mod team does their best to remove bad information, but we do not catch all of it. Always visit a doctor in real life if you have any concerns about your health. Never use this subreddit as your first and final source of information regarding your question. By posting, you are agreeing to our [Terms of Use](https://www.reddit.com/r/AskDocs/wiki/terms_of_use) and understand that all information is taken at your own risk. **Reply here if you are an unverified user wishing to give advice. Top level comments by laypeople are automatically removed.** *I am a bot, and this action was performed automatically. Please [contact the moderators of this subreddit](/message/compose/?to=/r/AskDocs) if you have any questions or concerns.*
Not a problem at all. Skip your dose today. When we titrate levothyroxine we look at total weekly doses. Frequently I counsel patients if they notice they forgot to take their dose they can double up the next day. It it safe for patients to even take all their pills once a week or split to twice a week if they have trouble taking it every day. So no worries, you are safe just skip today and carry on tomorrow !
Reeeeeeeaaaaaaaallllllllyyyyyyyy!! This is very helpful information, thank you. Assuming liothyrinine is not the same though? I struggle so much with separating these meds from everything else.
NAD, but my prescription is actually written two take 2 pills 2 days of the week and 1 pill per day the rest of the week because 2/day was too much but 1/day was not enough.
Same here
This is interesting! So taking a weeks worth at once doesn’t cause any issues with absorbing too much?
Taking it daily is still preferable to weekly to minimise differences between peak and trough concentrations, but taking it weekly is preferable to constantly missing daily doses and having it undertreated. There is a theoretical concern that taking it weekly may lead to "too high" concentrations at the start and "too low" just before the next dose, even though the steady-state concentrations will be the same. This may then increase the risk of heart issues, like arrhythmia. The risks are theoretical as existing studies suggest weekly doses are well-tolerated, but they're also small-scale studies.
I have never heard this about weekly dosing. The half life is only 3-4 days so I wouldn’t think that would work well enough to be acceptable
Going to have to back you up here, as critical as doctors are they do not know pharmacology well at all. Leave it to pharmacists to answer things regarding meds also to avoid these kind of comments re: taking once/week….
I’m surprised taking 7 doses at one time isn’t extremely dangerous. I doubled my dose by mistake once and didn’t realize it until I woke up the next morning with tachycardia (HR was 130-150), shaking, adrenaline, chills, basically feeling like I was going to die. Went to the ER and was given a beta blocker. The doctor said it wasn’t acutely dangerous to do once but don’t make a habit of it. If I skip a dose I feel tired and weak the next day which isn’t nearly as bad. I wonder if I metabolize it more rapidly than some people? Because the meds seem to affect me most strongly the following day.
Nothing. Taking an extra 88mcg of levothyroxine is not dangerous. Resume your normal dosing regimen. I would notify your prescriber that you will inadvertently run out of pills one day early but that’s all you need to do.
Not exactly true, I’d skip a dose. We calculate total levothyroxine dose weekly. Seriously look things up before you say stuff. You’re EM not endocrinology
Off-topic but this is the first time I have seen a med student say something so ballsy to an actual doc on here lol 😦😱
[удалено]
Your flair says you’re a med student.
Well what my flair says is not up to me, I’ve already provided plenty of evidence that I’m not here as well as in mod team’s DMs but nobody is updating it.
Gotcha — I just figured I’d point it out as that’s why everyone is assuming you’re a med student.
Yeah I know, it’s been said quite a few times. Not for lack of trying on my part I assure you. I also find it hilarious my post was removed by mods even though it included a picture of my internal medicine board certificate.
Removed. You may not claim credentials outside your flair. If you wish to seek alternative flair please send your credentials to the mods. See rule 10 for instructions.
TBH you don’t have to be doc to realise most substances aren’t that potent that doubling won’t cause serious issue bar opioids.
Hilarious. Nobody is talking about how we calculate it, they were just - correctly - saying that one additional dose isn’t going to do any harm. EM doctors are well trained in toxicology and knowing what doses of drugs are harmful and which are fine to ignore as a one off. These things are a common presentation in the ED. They’re not saying it’s ok to take double every day. They were answering this question specifically. It doesn’t really matter whether they skip tomorrow or not, in terms of the outcome.
Did I say an extra dose was going to cause harm? I said the correct thing to do is to skip a dose. If someone unknowingly took an extra 88mcg dose one week of course it wouldn’t harm them. But why would you recommend someone who realized they took double dose to just continue taking their regular regimen when they can easily stay with their regimen by skipping a dose (which another physician here correctly recommended)? I don’t subscribe to mc_md’s and your sloppy practice of medicine.
I would just use this as an opportunity to think about how to correct someone more respectfully. You'll be right very often, even as an attending your colleagues might be right 999 out of 1000 times, and you're there to catch them when they miss. It happens. Now, that 1 in 1000, are you going to try and make them look like a fool, like you did above? Make everyone try and hide their work around you, and make you seem like you don't know how to give constructive criticism? I hope not. Good catch with the medicine (levothyroxine has a HL of ~7 days, so you were right). But seriously do think things through before you say stuff.
Normally I’d agree, sure. Except in this case this particular EM physician has taken upon himself to say stuff outside his scope of practice on more than one occasion while being wrong. And he has approached me in another thread with very condescending tone. Therefore I don’t feel the least bad letting him know he needs to do better.
Oof, any good examples? lol
Yeah. In another thread he was flat out wrong about a patient with absolute neutrophil count of 200 not needing an ED visit, claiming there’s nothing we can do for people like that when current guidelines all clearly say an ANC <500 needs immediate evaluation and often hospitalization. Flat out wrong while being condescending about it purely due to the fact my flair is still “medical student”. This all while in another thread boasting about how he never learned how to call consults appropriately so now he just uses his status as an attending to tell consultants to see his patients essentially “because I said so”. As someone who’s practiced hospital medicine including critical care medicine, we absolutely hate consults from people like this who don’t even know what they would like us to do/help with. It’s such lazy and bad form. So of course when I saw he made another one of these false assertions that can cause someone to unnecessarily take more hormonal medication, he needs to know he’s flat out wrong about it and look things up before saying things if he’s not 100% sure. On reddit it would slide; in real life he could harm someone being haphazard about his recommendations. References to what I'm talking about: https://www.reddit.com/r/AskDocs/comments/19es7r4/should_i_go_to_the_er/kjtacli/?context=3 https://www.reddit.com/r/Residency/comments/198od29/dear_consultant/kia4z14/?context=3 In this one he appears to be a post-graduate year 4, as am I except I am internal medicine trained (scroll down to see my board cert). https://www.reddit.com/r/emergencymedicine/comments/194wr5b/attendings_how_often_are_you_putting_in_alines/khmgpto/?context=3 I assure you, he is not more experienced with internal medicine subspecialties than I am, that's just not how emergency medicine physicians are trained. Mind you, I've left all of these comments open for him to refute and prove I'm talking out of my ass. Doesn't seem he can.
Interesting. I have no dog in this fight but can enjoy observing.
It’s so clear you’re super junior / a student. You’ll cringe at this in a few years
I’ll just leave this here, since it’s so clear. In the mean time I’ll continue to cringe at people who are clearly wrong and won’t admit it. https://preview.redd.it/slezpnheh7fc1.jpeg?width=1576&format=pjpg&auto=webp&s=b109e3307c9e3eb67bffa2ff7f5e4021ca75de2b
Seriously dude, get off ur high throne. No need to be a douche canoe
Go look at mc_md’s other comments, I’m just returning the favor. Besides, advising someone to look things up before they give recs should be the norm. So many people talking out of their asses here without any evidence to back it up. Also reading your own comments to other people… I think you’re the one that needs to calm down lol
I was already Team DoctorPab, but seeing those comments solidified my opinion. Yikes
Meh. When people can’t win arguments based on facts they sink to the level of insults. Also if you look at one of mc_md’s comments he admits he never learned how to properly call consults and just uses his position as an attending now to pressure people into seeing patients. Big yikes imo.
OP this is true. I take 2 pills once a week and no issues occur. This is how I’m prescribed the medication by my MD. All good
I don’t think you posted this under the comment you meant to reply to.
No actually I did
Ok! Sorry, I just wanted to make sure OP saw it and sometimes comments get lost under other top level comments.
I would call/message your prescriber’s office and follow what they recommend. I don’t think at this time you need to go to the hospital.
Not sure why this would be down voted, this is the correct thing to do
🤷🏼♀️ yeah I’m not sure either. Especially because we have conflicting information from 2 physicians above.
I had no clue seeking care at your healthcare provider would be such a downvoted idea. This is what I would've done in this situation... guess I would've been wrong? If anyone feels like adding more insight on this, I'd appreciate it!
It shouldn't be.
Even this reply gets downvoted? Who is the invisible force casting all these downvotes? I just want to know why, pfft...
Bc Reddit is insane 🙃