Hypothyroidism and Removal of the Drug Liothyronine

Thank you for contacting me about hypothyroidism.

I understand that hypothyroidism describes the effects of an underactive thyroid gland, where not enough hormones are produced to keep the body functioning properly. I recognise that it is a lifelong condition which causes debilitating symptoms and it can be difficult to diagnose.

I agree that early diagnosis is key. I know that the Royal College of Physicians has published guidance regarding the diagnosis and treatment of hypothyroidism.

As you may know, this guidance states that overwhelming evidence supports the use of thyroxine T4 hormone replacement alone in the treatment of hypothyroidism. The guidance does not recommend prescribing additional T3 hormone in any presently available form, including Natural Desiccated Thyroid (NDT) treatments. I believe that this is because it has not been definitively proven to be of any benefit to patients.

NHS England announced in July 2017 that it will consider removing the T3 hormone - Liothyronine - from its list of regularly prescribed drugs, owing to the high cost of procuring this medicine, and the proven effectiveness of the T4 hormone as an alternative treatment, as noted by the British Thyroid Association in 2015. The prescription of Liothyronine will still be available in exceptional circumstances where there is a clinical need, on the recommendation of a multidisciplinary team.

I would like to stress that no final decision has been taken so far. This proposal is undergoing public consultation until October 2017, and can be viewed at the following webpage: https://www.engage.england.nhs.uk/consultation/items-routinely-prescribed/

However, clinicians are not prevented from considering other forms of thyroid hormone replacement, if appropriate. To clarify, NDT treatments remain unlicensed as its effectiveness is yet unproven. GPs may prescribe it on a named-patient basis and prescribing decisions are rightly a matter for the doctor in consultation with their patient.

I know that the Government is aware that this may produce some inconsistency in treatment. However, NHS England has produced its own plan for complex endocrinology to ensure that patients receive appropriate care and support. This has been developed in consultation with doctors, commissioners and patients.

Thank you again for taking the time to contact me.