Thyroid deficiency refractory to treatment: is this a case for DOT?

Directly Observed Therapy (DOT) that is used for tuberculosis treatment, where a trained health worker watches the patient swallow every dose can be used for patients receiving doses of Levothyroxine of more than 2micrograms/kg with persistently increased TSH levels who are considered as having thyroid deficiency that is refractory to treatment. Poor adherence is the most common cause of failure of therapy and if this is suspected, a supervised test may be helpful.