Thank you for your emails of 8 and 20 June to David Cameron about thyroid testing and treatment. As the matter you raise concerns the NHS, your emails have been forwarded to the Department of Health and I have been asked to reply.
I was sorry to read about your ill health.
The Royal College of General Practitioners (RCGP) curriculum sets out the skills, attitudes and knowledge required to practise as a GP for a career of continuing professional development. GP trainees are systematically assessed against this curriculum and, to be licensed as an independently practising GP, must successfully complete their training placements and pass the assessment for Membership of the RCGP, which consists of an applied knowledge test examination, a clinical skills assessment – a mock-surgery examination – and a series of assessments carried out in the workplace by trained supervisors. Hypothyroidism is a common condition encountered in the community and, therefore, its diagnosis and management is incorporated in all of these assessments.
GPs are required to demonstrate knowledge and skills in the diagnosis and management of hypothyroidism relevant to their role as generalist, community-based doctors. However, the diagnosis of hypothyroidism is often challenging and the RCGP is continually looking at ways of improving the training and education of GPs.
The vast majority of patients, once diagnosed with hypothyroidism, can achieve successful management of their condition with a synthetic hormone replacement treatment.
Best practice on the identification and management of hypothyroidism has been provided in the Royal College of Physicians’ (RCP’s) guidance ‘The diagnosis and management of primary hypothyroidism’. This document was developed on behalf of organisations such as the British Thyroid Association, British Thyroid Foundation and Society for Endocrinology, and is endorsed by the RCGP.
The guidance states that overwhelming evidence supports the use of thyroxine T4 hormone replacement alone in the treatment of hypothyroidism. This is usually prescribed as levothyroxine (Thyroxine) tablets. The guidance does not recommend prescribing additional T3 hormone in any presently available form. However, this does not prevent clinicians considering other forms of thyroid hormone replacement if appropriate.
The RCP’s ‘The diagnosis and management of primary hypothyroidism’ also makes clear that the only validated method of testing thyroid function is on blood, which must include a measurement of the thyroid stimulating hormone and free thyroxine in serum. The guidance does recognise that different methods used for testing blood can give differing results, and the RCP highlights its support for an international initiative for greater harmonisation of reference ranges, and of the units used in expressing the results of thyroid function tests.
I hope this reply is helpful.
Ministerial Correspondence and Public Enquiries
Department of Health