Just as any other health professional GP's have to keep up with continued professional development. Modules are offered through their online magazine Pulse. This has just announced its latest module on hypothyroidism - this is how they attempt to sell it:-
'While thyroxine is the mainstay of hypothyroidism treatment, patient advocates of T3 are developing a significant voice in conversations about managing the condition. GPs should not start thyroxine-T3 combination therapy in primary care and additionally the drug is significantly more expensive and has a shorter half-life. All things considered, it’s important for GPs to have a robust knowledge of the clinical and medicolegal implications of T3 therapy when counselling hypothyroid patients.'
I'm confused. So many people are being told T3 would not be prescribed but now they offer training for the use of it, though not through primary care.
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jezebel69
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If and its a big if, given present-day opinions, T3 is to be prescribed, we have to admit its a more difficult hormone to prescribe than T4. This is because it is more active and the possibility of overdosing is higher. That said, it is perfectly possible to use it, so long as the physician overseeing it is uptodate and knows how to help the patient to control treatment. Its this that is lacking in GP education. Until we get a re-education of GPs in this, then T3 will continue to be a pariah as far as conventional medicine is concerned.
I agree with what you are saying. However, there have been no reported deaths due to T3 overdose in the UK, in spite of so many of us self-medicating with it, while there have been deaths attributed to T4. We don't know how many people are dying due to complications resulting from unmedicated or poorly medicated thyroid disorders as other conditions are recorded as causes of death e.g. suicide, cardiac arrest, complications of diabetes ...
I would guess it depends on who GPs think is the boss - their CCG or the organisations which are more arms length and not taking responsibility for the day-to-day budget.
Also - I think this confusion about who is responsible for denying T3 is deliberate so that each section of the NHS can blame another group - the GPs, the CCGs, NHS England, the endocrinologists etc.
Other countries are producing quality T3 and at a fraction of the price. In the UK, the problem is the monopoly of one producer of T3 and worse than that is the government allowing this to continue.
A few years ago when UK liothyroine was unavailable the company said it was because it was imported from Europe and there were supply difficulties. The tablets are produced by Custom Pharmaceuticals, whether they now make the active ingredient or import it I don't know.
Oooh, but he price difference is vastly significant... a full, eye-watering 20p cheaper from Morningside compared to Concordia! Yes, you can really see the NHS falling for that one, eh? What's that you say? They already have??? Tw*ts!!! And we still have to continue suffering their ignorance... 😡
The change in the price has been "enormous" so far" Morningside T3 is the whole 20p cheaper than Concordia T3... We will see what Teva will come up with...
As a GP is often unable to get FT3 tested by lab, even if they request it, an endo overseeing the prescribing is probably necessary.
The problem with seeing an NHS endo is you often get to see different one at each consultation.
Increasing numbers are pro T3 and start their patient on it, only for same patient to then see different endo further down the line, who perhaps has opposing view on T3 and then takes it away. Usually with disastrous results
Learning to read the very different appearance of blood tests when on T3 is essential for both GP's and endo's. The number that freak out at low TSH and adjust solely on TSH alone is terrible.
Plus prescribing T3 for Hashimoto's, without first correcting low vitamins or considering gluten intolerance often ends in disaster, perpetuating the belief that T3 is difficult to manage.
Routine testing of vitamin D, folate, ferritin and B12 is essential. Advising Hashimoto's patients to try strictly gluten free diet to see if it reduces symptoms and lowers antibodies would also be very helpful.
Totally agree. Needs more than a gp as it fluctuates. It's need. It needs very careful monitoring that a gp hasnt got time to spendon one patient. As the expense of other patient needs. Gp time.
also cortisol levels should be checked as well if T3 is not working along with the iron and B12 made mention of here. T3 will not be able to do its "thing" if levels are not optimum with any of these.
i am paid by leicester university and NHS to give talks to final year med students about my thyroid story, i can honestly say t3 is not a subject they are familiar with even with all the media attention it is getting, interest in endocrinology is zero.
As teaching hospitals and university's get support and funding from drug companies I dont see this changing. I have asked the direct question of how they feel about price gouging and the accountants in ccg's removing t3 from formulary preventing trained endo's from doing their jobs properly, I suspect that will leave them between a rock and a hard place and unable to comment.
I do the talks to make jnr drs aware of how devastating a lax attitude is to ladies of a certain age, dismissing us as depressed, menopausal, unfit etc I tell them its dangerous to rely on TSH as my thyroid was removed and my TSH never went much above 5. I do it to raise awareness and hope that the new generation of drs will have more common sense!
My feeling is although I am paid, if the teaching hospitals do not take a stand against CCG's, NHS England, DOH, corrupt suppliers etc and start teaching practical medicine instead of box ticking I will no longer waste my time. The university say healthcare should be patient led and there must be accountability. Personally I dont see it changing anytime soon.
Niy just 'women if a certain age'. I was 22 when I knew there was something wrong (hypo) but was dismissed and only diagnosed when in a hyper phase 7 years later. (24 overactive then even more hypo at 26). I realise I was probably hyper at 18 too so seemed to go in a 2year cycle going up and diwn. I diagnosed my daughter when she was 15 and luckily I was around as again she was being fobbed off. Just being female is enough to get you dismissed.
I was 24 when I tested positive for hashi and poor thyroid function. Now in late ‘50’s and if seeing a new Doctor who arrogantly assumes my poor thyroid function being a sign of menopause I have to restrain myself from reaching over and grab them by the tie (yep, usually a male making that assumption) and instead suggest they actually read my history.
Yes Clutter - that was the only way I could get it prescribed but I was questioning why they offered any training at all when Liothyronine was now on the list of 14 items no longer to be prescribed. It seems a contradiction....
NHS England can impose national bans but not until after consulting and considering the impact a ban will have on patients and stakeholders.
Local health authorities and CCGs are able to make local decisions about prescribing but must also consult and consider the impact of their actions on patients and stakeholders. They may be in breach of agreements if they didn't consult before banning Liothyronine and other prescription items.
I’ve just been to see a GP for the second time to discuss T3, as the CCG is trying to persuade patients to give it up because of the cost. He had no idea that it’s so cheap in other countries, or that there are no restrictions on the pricing of generic drugs in the UK. ‘Why doesn’t someone do something?’ he said, and gave me a private prescription to source T3 myself. Maybe some professional development on how drug companies work would be good!
Your GP gave you a private prescription for T3? I am confused as i keep reading that only consultants should prescribe T3... So how does one go about asking a GP to prescribe t3?
Sorry for hijacking the post but I was more than surprised a GP could prescribe T3...
I was prescibed T3 15 years ago by an endocrinologist, and my GPs have continued that. The CCG wants them to stop prescribing it because it's got so expensive in the UK. The private presciption is so that I can buy it for a fraction of the UK price from Germany online. The GP didn't know that was possible.
Their argument is simply flawed as possibly presented by Pharma.
Yes, T3 is more expensive than T4 in the UK, everyone can understand that but refusing to recognise it and to prescribe it because it has 'shorter half-life' says a great deal.
They can 'flood' the non-convertors patients' blood with T4, cheap and longer 5-7 days half-life and the patients will remain ill and their suffering continues.
"Patient advocates of T3 are developing a significant voice in conversations about managing the condition." - it means that OUR VOICE is being heard and we need to SCREAM LOUDER
jezebel69 : have you posted this info about GP training on T3 on ITT FB page? It's important.
It's supposed to just be consultation on a ban on prescribing in PRIMARY care.
If an NHS endo says you need T3, the ongoing prescribing is via your GP. This should still continue
Many CCG's have bullied GP's incorrectly into stopping.
If a patient is prescribed T3 on clinical need, in consultation with an NHS endocrinologist, then they should still be getting it, via GP absolutely regardless of CCG's "guidelines ".
This has been underlined as correct by senior executives in NHSCC board at the recent consultation meeting in London.
Not that I am aware of, though the meeting was recorded.
Dr Graham Jackson was asked this three times. Each time clearly said if endo say you have clinical need, you should still be prescribed T3 and that CCG can not block it.
I went to a support group in the 80's after years of frustrating, condescending treatment. Patient groups should be recommended from day 1. I felt like a walking thyroid for years.
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