Summary: In a single-centre open-label randomised controlled trial of 43 adults with hypothyroidism on levothyroxine, clinical pharmacist review reduced drug-related problems within the intervention arm (66 to 24) and eliminated potential drug-drug interactions (21 to 0) across two months. Overall medication adherence did not differ significantly between groups (p>0.05); only adherence to dosing time improved within the intervention arm (55.5% to 94.4%, p=0.008). TSH normalisation and adverse-event outcomes were not reported.
PICO Summary
| Element | Detail |
|---|---|
| Population | 43 adults with hypothyroidism on levothyroxine attending a single university-hospital endocrinology outpatient clinic in Türkiye; open-label randomised controlled trial, two-month follow-up (two visits). |
| Intervention | Clinical pharmacist review with identification and management of drug-related problems (PCNE v9.1), patient education and medication therapy management to support levothyroxine therapy (n=18). |
| Comparison | Usual care without clinical pharmacist involvement (n=25). |
| Outcome | No significant between-group difference in overall adherence at either visit (p>0.05). Within the intervention arm: total drug-related problems fell 66 to 24 and potential drug-drug interactions 21 to 0 across visits (p<0.001); adherence to dosing time rose 55.5% to 94.4% (p=0.008). No effect estimate, 95% CI, ARR or NNT was reported, and TSH/treatment-goal achievement and adverse events were not analysed. Findings are exploratory and associational rather than confirmatory. |
Expert Commentary
This trial is best read as a feasibility-scale, hypothesis-generating study rather than evidence that pharmacist input improves hypothyroidism control. The headline claim of “achieving treatment goals” is not supported by the data presented: no biochemical endpoint such as TSH normalisation was reported, and the pre-specified between-group comparison of overall adherence was null (p>0.05). What was demonstrated is a within-arm reduction in drug-related problems and potential drug-drug interactions, plus improved adherence to dosing time, all of which are plausible but are uncontrolled before-and-after changes susceptible to regression to the mean and attention effects. The trial is small (n=43, with unequal and modest arms of 25 and 18), single-centre, and necessarily open-label, since a counselling intervention cannot be blinded; outcome ascertainment by self-report adds further bias risk, and no funding or sponsorship detail is available to assess. The dropout-free two-month horizon is too short to judge durable thyroid control. Can I use this with my patients? Not yet as a reason to mandate pharmacist-led thyroid clinics, though it reasonably supports referring patients with polypharmacy or suspected interactions for medication review. A larger, multi-centre trial powered for biochemical control and reporting between-group effect sizes with confidence intervals is needed before practice should change.
References
Ayhan YE, Bektay MY, Gogas Yavuz D, Sancar M. Evaluation of the clinical pharmacist’s effect on achieving treatment goals in patients with hypothyroidism: a randomized controlled trial. BMC Endocr Disord. 2025;25(1):94. doi:10.1186/s12902-025-01914-3
