Paragraph 1. Relates to patients established on Liothyronine. Would definitely take your case to health ombudsman. Is your husband able to help?
This is the BTA response to the NHS England consultation
PRESCRIPTION OF LIOTHYRONINE IN PRIMARY CARE
We write in response to the consultation process by NHS England on prescription of
Liothyronine in primary care. NHS England proposes that CCGs stop prescription of
Liothyronine and systematically change patients already on Liothyronine to Levothyroxine
treatment. In support of their proposal, their recommendation cites the BTA 2015 position
statement on the management of hypothyroidism.
The BTA has received numerous enquiries from patients expressing great anxiety about this
proposal. Some patients have already experienced difficulty with ongoing prescription of
Liothyronine. In some cases, following guidance from local health authorities, patients on
longstanding Liothyronine treatment have been changed abruptly to Levothyroxine therapy,.
We wish to emphasise that any decision to continue or to stop Liothyronine treatment in a
patient should be based on clinical criteria. The BTA position statement on hypothyroidism
should not be interpreted as a recommendation to not use Liothyronine or as an
endorsement for its discontinuation.
Levothyroxine therapy is the standard of care in hypothyroidism, being effective and welltolerated
in the vast majority of patients. In randomised controlled trials, there is insufficient
evidence to show that combination treatment with Levothyroxine and Liothyronine is superior
to Levothyroxine therapy alone in improving quality of life. Nevertheless, in a small proportion
of patients with persistent symptoms, a carefully monitored trial of combination therapy with
Levothyroxine and Liothyronine may occasionally be warranted .
Therefore, in accordance with the best principles of good medical practice we recommend the
1. Patients already established on Liothyronine and experiencing symptomatic benefit should
be allowed to continue with Liothyronine treatment prescribed in primary care. Abrupt
change in treatment may impact negatively on well-being. Changing to Levothyroxine
therapy should only be considered if the patient is not experiencing benefit from
Liothyronine and any change should only be made following informed discussion with the
patient and, if necessary, advice from an endocrinologist.
2. For patients with hypothyroidism who are not on Liothyronine but wish to be treated with
Liothyronine, the principles guiding decision-making should follow those outlined in the
BTA statement . Combination treatment with Levothyroxine and Liothyronine should
only be initiated and supervised by accredited endocrinologists . Patients experiencing
symptomatic benefit on a combination Levothyroxine and Liothyronine regimen should be
able to continue such therapy prescribed from primary care.
3. In patients with a diagnosis of thyroid cancer where Liothyronine is recommended in
preparation for radioiodine ablation, radioiodine therapy, diagnostic iodine scanning or
stimulated thyroglobulin test, access to Liothyronine is essential and substitution of
Levothyroxine in these circumstances is wholly inappropriate .
4. The NHS England proposals are driven by the recent enormous increase in the cost of
Liothyronine, with such increased cost being quite disproportionate and unique to the
United Kingdom in comparison to its cost in other European countries. We suggest that
the NHS pursues alternative procurement strategies to reduce the current cost of
Professor Krishna Chatterjee
President, British Thyroid Association