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Rounding Levothyroxine dose

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by Drake2400 Drake2400 (New) New

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Example 26 year old woman with hypothyroidism. Replacement dose is calculated at 108mcg daily. How much should she be given initially? 

tab sizes-25, 50, 75, 88, 100, 112, 125, 137, 150, 175,200, 300 mcg 

would you round down to 100mcg or round up to 112 mcg tab?

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llg has 43 years experience as a PhD, RN and specializes in Nursing Professional Development.

6 Followers; 13,247 Posts; 59,365 Profile Views

I would follow institutional policy on that.  If the institution has no policy on that ... then I would call the person who wrote the order and ask which way they wanted to go.

But I don't understand the situation behind the question.   Levothyroxine is not a does that realistically can be "calculated" based on any other parameters such as age, weight, etc.   Dosages are titrated based on symptoms -- with some input from lab values to make sure the patient's levels are within a reasonable range.  Treatment with levothyroxine is all about "approximates" and "acceptable ranges" and not about specific numbers.

Under what circumstances would a nurse be encountering that unclear order to give levo based on a mathematical calculation?   A reasonable doc or NP would write the order based on the strengths of the available pills.  Anyone who doesn't write a better order deserves a phone call and a request for clarification.

Finally, why is it being "replaced?"   Why isn't she being covered by her regular dose?   Her regular dose should be written to correspond with the strengths of the pills available.   

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