There has been some confusion online about whether GPs and endos can continue to prescribe dessicated thyroid products such as Armour on the NHS; some doctors have refused.
1. Any GP *can* prescribe dessicated thyroid tablets on the NHS, provided that they are willing to take personal responsibility for the treatment. All dessicated thyroid products are unlicensed in the UK; this results in the prescriber being personally responsible for the safety of the treatment. Doctors can prescribe unlicensed medicines if they believe that no licensed product can meet requirements for an individual patient. Licensed products should always be tried first, unless there are exceptional circumstances which make this impossible.
2. British Thyroid Association (BTA) guidelines for the management of hypothyroidism recommend first-line use of levothyroxine. Levothyroxine treatment is safe and effective for many patients. Because dessicated thyroid tablets are not recommended by UK guidelines, your doctor may not wish to prescribe. On the other hand, guidelines are just that, guidelines, and not legal documents - there is flexibility with respect to whether your doctor chooses to follow BTA guidelines or not. Some GPs adhere to these guidelines rigidly whereas others are much more flexible. I do recognise that BTA guidelines are unpopular with the online community, but I felt it was appropriate to mention them here since they form the basis of most UK GPs prescribing decisions. As a result, if you feel that dessicated thyroid is the next medication which you would like to try, you may need to see several different doctors before you find one who is willing to prescribe.
3. Many doctors will not have heard of Armour thyroid, or other brands of NDT. Because it is not a licensed product in the UK, it cannot be found in the British National Formulary, or MIMS. In addition, students are not taught about dessicated thyroid at medical school. This may lead your doctor to believe that it cannot be prescribed. Although this is not the case, doctors need to be familiar with a product before they can prescribe it safely. Your GP may need to do some reading.
4. Some patients may have been told by pharmacy staff that they cannot obtain these medicines. In many cases, this was probably because they are not on the pharmacy computer system - most unlicensed imports are not. The pharmacist may therefore need to add Armour (or whichever brand is prescribed) as a new product. This is easy to do on most pharmacy systems. The pharmacy can then order via their wholesaler's special orders office or direct from an importer such as IDIS. The wholesaler's special orders office simply place an order with IDIS or another importer on behalf of the pharmacy. IDIS are one of the largest importers of specialist medicines into the UK. Direct ordering from IDIS is useful because IDIS can usually inform the pharmacy exactly when they will deliver the item. IDIS import common items in bulk, which are then stocked in their warehouse. If IDIS are out of stock, it may take much longer to obtain the product, but the pharmacy can try another supply if they have an account. If you are finding it hard to obtain a product, try an independent pharmacy. Independents can order from whichever company they choose, whereas the large pharmacy chains are restricted to a small number of head office approved suppliers.
5. *Some* importers require the words 'for hypothyroidism' to be written on the prescription. Your doctor can simply type this into the dosage instructions box when writing the prescription eg. Take ONE tablet in the morning, for hypothyroidism. It's probably easiest if you ask your doctor to do this when writing your first prescription. Similarly, other importers require a letter from your doctor. This sounds worse than it is. Your doctor does not need to explain why you need dessicated thyroid tablets specifically. The letter simply needs to have: something to identify you (eg. your name/DOB/address), similar information to identify the doctor (including their GMC number), a statement that the dessicated thyroid is necessary to treat your hypothyroidism, and the doctor's signature. The pharmacy will fax the letter to the supplier and should then file it away so that they can fax it again when you next get your prescription - this has always worked for me. It might be worth asking your doctor for the letter before you leave the consultation. It could be a bit more awkward to get one at a later date.