A few weeks later, R.M. calls the clinic stating she cannot remember whether she took her
thyroid medication. What additional data should you obtain, and how would you advise her?
What will be an ideal response?
• Ask her about the time and day of the last pill she can remember taking, how many doses she
thinks she missed, and her current pulse rate.
• If R.M. proves to have cognitive dysfunction or is a poor historian, have her come to the clinic to
count pills and contact her pharmacy to determine when her last prescription was filled.
• Advising R.M. would be based on knowledge that levothyroxine has a half-life of 6 to 7 days; thus
missing a dose would not place her at risk for complications such as might be experienced in
patients missing a dose of, for example, glucocorticoids. If R.M. has missed one dose only and it is
still early in the day, advise her to take the prescribed dose.
• Suggest that R.M. obtain a daily pill dispenser. Instruct her to fill the container at the beginning of
each week so that she will know if she accidentally omits a dose.
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