Levothyroxine given with breakfast after the client ate. What is the most appropriate action?

• A. Document that timing was as ordered.
• B. Notify the provider and adjust the timing for future doses.
• C. Continue with the same schedule.
• D. Discontinue levothyroxine.

Answer: (B)

Levothyroxine needs to be absorbed best on an empty stomach. Food, especially breakfast, can significantly decrease its absorption, which can lead to under-treated hypothyroidism. Because the timing affects how much medication actually gets into the bloodstream, the appropriate action is to notify the provider so the dosing schedule can be adjusted for future doses. The provider may instruct taking levothyroxine first thing in the morning with water at least 30–60 minutes before breakfast or at another empty-stomach time, and may re-evaluate the dose if needed. Simply continuing the same schedule or documenting it as ordered won’t correct the absorption issue, and discontinuing the medication isn’t warranted.