Intravenous levothyroxine stewardship program at a tertiary academic medical center.

Marino, Kaylee K; Crowley, Kaitlin E; Tran, Lena K; Sylvia, Daniel; Dell'Orfano, Heather; DeGrado, Jeremy R; Szumita, Paul M

DISCLAIMER In an effort to expedite the publication of articles related to the COVID-19 pandemic, AJHP is posting these manuscripts online as soon as possible after acceptance. Accepted manuscripts have been peer-reviewed and copyedited, but are posted online before technical formatting and author proofing. These manuscripts are not the final version of record and will be replaced with the final article (formatted per AJHP style and proofed by the authors) at a later time. PURPOSE Based on the pharmacokinetic profile of levothyroxine, a 3-day hold guideline for adult patients ordered for intravenous (IV) levothyroxine was implemented at a tertiary academic medical center. The purpose of this study was to evaluate the impact of the implementation of an IV levothyroxine hold guideline. METHODS This single-center, retrospective analysis identified patients ordered for IV levothyroxine during a thirteen-week period before and after implementation of the guideline. The primary outcome was guideline adherence, defined as full implementation of the three-day hold. Secondary outcomes included the number of IV levothyroxine administrations avoided in the post-guideline group, extrapolated yearly cost avoidance (EYCA) post-guideline implementation, reasons for guideline non-adherence, and number of safety reports involving IV levothyroxine. RESULTS A total of 166 and 134 patients met inclusion criteria for the pre and post-guideline groups, respectively. Guideline adherence was observed in 94 (70.1%) patients, resulting in 276 vials saved in the thirteen-week post-guideline period which translated to an EYCA of $139,877. Forty orders (29.9%) were non-adherent to the guideline with the most common reason stated as nil per os (NPO). No difference in safety outcomes was seen between the pre- and post-guideline groups as evidenced by one safety report in each group. CONCLUSION We observed a high rate of adherence to an IV levothyroxine hold guideline. This was associated with a substantial cost savings over the study period with no increase in reported safety events. To our knowledge, this is the first published report of an inpatient IV levothyroxine three-day hold guideline.