NDT on the NHS?? CCG response to my question.

Question to NHS CCG:

Can you please advise me as to whether GPs can prescribe Armour on the NHS if requested to by an endocrinologist?

Both synthetic T4 and T4/T3 combo did not work for me and I have seen an endocrinologist who cured me on Armour.

The endocrinologist has asked my GP to prescribe it me but my GP has said he cannot as it is not licenced in the UK and he would be struck off if he did prescribe it. However it is on his list of medications to prescribe.

I have done some research and found some GPs do prescribe it on the NHS, also the thyroid uk website says GPs can prescribe on a named patient basis if the synthetic forms do not work.

Can you tell me whether it is up to the individual GP as to whether he/she prescribes it or not? Would my GP be struck off if he did prescribe it?

Are you able to tell me which GPs can prescribe it on the NHS in the Worcester/Malvern area?

Response:

Thank you for your email enquiring about the prescribing of Natural Desiccated Thyroid (NDT) extract also known as ‘Armour Thyroid’ which was forwarded to me.

As I’m sure you are aware, NDT is derived from porcine thyroid gland and contains a combination of levothyroxine (T4) and liothyronine (T3), used to treat hypothyroidism. It is not a licensed medicine in the United Kingdom (UK).

The prescribing of products that do not have a UK product license is not supported locally, even though they may have a license in another country. These products are not licensed under the Medicines Act, and so do not have any official clinical information for the prescriber to check when prescribing these products. Some unlicensed products have been reviewed by the Worcestershire Area Prescribing Committee (APC) but have been considered not suitable for prescribing in Worcestershire. 1 There is also no standardisation of quality, efficacy or safety.

Whilst doctors are not totally prohibited from prescribing unlicensed medicines, the General Medical Council (GMC) guidance on prescribing unlicensed medicines states that when prescribing an unlicensed medicine prescribers must be satisfied that there is sufficient evidence or experience of using the medicine to demonstrate its safety and efficacy. 2

A statement made by the Royal College of Physicians on ‘The diagnosis and management of primary hypothyroidism’states: 3

“Overwhelming evidence supports the use of thyroxine (T4 or tetra-iodothyronine) alone in the treatment of hypothyroidism, with this usually being prescribed as levothyroxine. We do not recommend the prescribing of additional tri-iodothyronine (T3) in any presently available formulation, including Armour Thyroid, as it is inconsistent with normal physiology, has not been unequivocally proven to be of any benefit to patients, and may be harmful. There are potential risks from T3 therapy, using current preparations, on bone (eg osteoporosis) and the heart (eg arrhythmia). We note that the extract marketed as Armour Thyroid contains an excessive amount of T3 in relation to T4. Over-treatment with T4, when given alone, has similar risks.”

Additionally the British Thyroid Association (BTA) issued a statement in 2007 regarding the use of armour thyroid in thyroid replacement. 4 This stated:

“There is no evidence to favour the prescription of Armour Thyroid in the treatment of hypothyroidism over the prescription of thyroxine sodium, as supplied in the United Kingdom. There has never been a direct comparison of these two treatments. The BTA committee cannot recommend a treatment with possible side-effects, when a safe and equally well-established treatment exists.”

These statements emphasise the lack of evidence to demonstrate the safety and efficacy of NDT.

Given this information, I hope you understand why the prescribing of NDT is not supported locally. The same advice will be given to all GP's in the Malvern and Worcester area.

Unbelievable they haven't really answered the question and so many untruths, but as they mention advice in the last sentence I assume it is up to individual GPs rather than mandatory.

It would be interesting to know how many people actually do get it on the NHS. Someone did a survey about the taking of NDT a few weeks ago, was it the administrators? Is it possible to do a survey of this, do you take NDT, do you get it on the NHS?

Please PM me if you know any doctors in this area who do prescribe on NHS. Thank you.

[shaws Administrator]

Doctors are able to prescribe NDT on a 'named patient basis'. Even though NDTs aren't licenced (due to it being a 'natural'product the pharmaceutical companies cannot get their 'cut' of any products). Ignorance is bliss, particularly in regard to treating thyroid gland dysfunctions.

Do doctors really believe that a product which has been in use since 1892 in different forms, with no adverse effects (except if you overdose) and which is more synergystic to the human body that synthetic levothyroxine that they will be hauled before the GMC (they might well be). False statements have also been made by the British Thyroid Association/RCoP and they turned a blind eye to the following:

thyroidscience.com/Criticis...

The fact that they do NOT 'care' for the wellbeing of their patients and think we are hypochondriacs because we complain of symptoms (they don't recognise/know them). Give you 'extra' prescripts for the symptoms instead of a decent dose of thyroid hormones.

thyroiduk.org.uk/tuk/treatm...

thyroiduk.org.uk/tuk/treatm...

web.archive.org/web/2010073...

It's strange, isn't it - they ignore scientific evidence but believe the 'hype' given by 'big pharma' who make enormous amounts of money and even more because we are given even more for the problems which arise if we aren't properly medicated. It also costs the NHS so much more because when hypo patients develop other serious conditions due to the reliance on the TSH lives are ruined.

[Hidden in reply to shaws]

Yes I was so ill on levo and T3/T4 and have endo confirmation they wouldn't work for me, but NHS say it works for everyone. Even my GP was amazed how ill I was and the improvement now. It's like we don't exist. Thanks shaws this forum is a lifeline for me and many others.

[shaws Administrator in reply to Hidden]

I would speak to my MP if GP is still unwilling. Considering thyroid hormones are 'life or death'. We must be able to source which suits 'us' not the guidelines.

If we don't get sufficient hormones of anything, levo etc we can develop heart problems as well as other more serious diseases. I don't know how they can be so lax.

web.archive.org/web/2010103...

[Hidden in reply to shaws]

Shaws yes maybe you a right I should. It is just so frustrating and I am sure I will get some wishy washy response and they won't do anything. We spend most of our time trying to get better and the NHS just want us to get worse again.

[RedApple Administrator]

There is Poll here on the group - this may be the survey you are referring to.

If you are on Natural desiccated thyroid i.e. armour erfa nature-throid who prescribes it for you:

healthunlocked.com/thyroidu...?

[RedApple Administrator]

A few people are fortunate enough to get desiccated prescribed by their GP/endo, but many do not. Hence many are forced unwillingly down the route of self-medication

[helvella Administrator]

The RCP document refers to:

UK guidelines for the use of thyroid function tests. London, BTA/ACB/BTF: 2006.

acb.org.uk/docs/TFTguidelin...

That document is years past its due for revision date and there is NO means by which it can be maintained. I have personally attempted to get corrected a glaring error in it but even its principle author couldn't get it changed. (And he is now retired.)

Therefore, it simply cannot be accepted as a source/reference.

DailyMed is a rather odd site, but it is an FDA offical source:

DailyMed provides trustworthy information about marketed drugs. DailyMed is the official provider of FDA label information (package inserts). This Web site provides a standard, comprehensive, up-to-date, look-up and download resource of medication content and labeling found in medication package inserts.

They clearly list Armour Thryoid:

dailymed.nlm.nih.gov/dailym...

Rod

[Hidden]

Thank you Red Apple and helvella. It was a more recent survey about whether you swallow NDT or chew it and other things. But thank you that survey shows some did get it on the NHS although it is 2 years ago. I wonder if it is still the same or if those who did get it on NHS have now been stopped? I have read recent posts where some have it on NHS so I assume some people are lucky. Just down to individual GPs I think.

[helvella Administrator in reply to Hidden]

This might be of use:

healthunlocked.com/thyroidu...

[Hidden]

Very useful thank you Helvella. Seems quite a few people except in South Worcestershire!