{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T14:19:54Z","timestamp":1787840394625,"version":"build-2784847793"},"reference-count":23,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"5","license":[{"start":{"date-parts":[[2025,9,1]],"date-time":"2025-09-01T00:00:00Z","timestamp":1756684800000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-sa\/4.0"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2025,9]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction:<\/jats:title>\n                    <jats:p>Levothyroxine has a narrow therapeutic index, with many factors affecting bioavailability. Overtreatment and undertreatment of hypothyroidism are common in clinical practice.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>In this study, we assessed the prevalence of incorrect levothyroxine administration technique (ILAT) in clinical practice and the impact of correction on follow-up. The study had two phases. The first phase was that all consecutive patients with primary hypothyroidism on treatment for at least 1 year with a minimal dose of 25 mcg were enrolled, and ILAT was assessed. Second phase: Participants with abnormal Serum TSH or ILAT were followed on the correct technique for euthyroidism.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      Among 444 participants (358 female and 86 male) at baseline, 46.2% had raised TSH, 41.3% were euthyroid, and 12.4% had iatrogenic thyrotoxicosis. The levothyroxine administration technique (LAT) was incorrect in 77.4% of participants. In participants with raised Serum TSH at baseline with incorrect LAT, on correction of the technique, the levothyroxine dose decreased in 26.3%, no dose change was required in 14.9%, and only 58.8% required dose escalation. Even among euthyroid at baseline with incorrect LAT, 64.4% needed dose reduction to remain euthyroid on correction of the technique. Among participants with suppressed TSH at baseline and ILAT, the levothyroxine dose at baseline was 97.5 \u00b1 28.7 mcg\/day, and with correction of the technique, the final dose was 71.1 \u00b1 23.9 mcg\/day. The decrease in dose was statistically significant (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.001).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>Ensuring the correct administration technique at each contact, especially before any dose adjustment, is essential to prevent suboptimal or overtreatment in primary hypothyroidism.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.4103\/ijem.ijem_525_24","type":"journal-article","created":{"date-parts":[[2025,10,27]],"date-time":"2025-10-27T08:00:47Z","timestamp":1761552047000},"page":"567-572","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":1,"title":["Levothyroxine Administration Techniques Audit and Utility of its Assessment at Each Visit: A Hospital-based Mixed Model Study"],"prefix":"10.4103","volume":"29","author":[{"given":"Rekha","family":"Singh","sequence":"first","affiliation":[{"name":"Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India"},{"name":"Nizam\u2019s Institute of Medical Sciences, Hyderabad, Telangana, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ashwani","family":"Tandon","sequence":"additional","affiliation":[{"name":"Nizam\u2019s Institute of Medical Sciences, Hyderabad, Telangana, India"},{"name":"Department of Pathology and Lab Medicine, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2025,10,25]]},"reference":[{"key":"R1-20251029","doi-asserted-by":"crossref","first-page":"1670","DOI":"10.1089\/thy.2014.0028","article-title":"Guidelines for the treatment of hypothyroidism: Prepared by the American Thyroid 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