Thoughts on the recent news on liothyronine (T3) .
After the NHS decided not to withdraw T3 due to the response it recieved in favour of keeping it on prescription following their consultation on what they called 'low value' medicines, Prescqipp published its response which was posted on this forum by one of the Adminstrators.
It seems as though the response from Prescqipp has effectively made T3 inaccessible for patients who need it. This document advises access to it available only through Endocrinologists and in rural counties there is often no Endocrinologist or only a diabetic specialist and no thyroid specialist. In addition if CCG's make patients access Endocrinology to get liothyronine prescribed, then patients who need it may be deprived through inability to gain an Endo referral via their GP.
Endocrinologists are unlikely to prescribe T3 due to cost effectively excluding patients from accessing it even if they need it. In addition, in many areas labs rarely test FT3 which means that patients have to access private blood tests to evidence low T3 levels and these results may not be accepted by NHS doctors.
Levothyroxine, once ingested becomes indistiguishable from endogenous hormone so levothyroxine acts to replace endogenous thyroxine and the body has to convert this to liothyronine or T3. There are many factors that may prevent the proper absorption and conversion of T4 (leaving patients symptomatic) some of these are as follows:
Taking levothyroxine orally, predisposes patients to small intestinal bacterial overgrowth which prevents proper absorption of nutrients and probably also interferes with the proper absorption of levothyroxine.
There are genetic factors known to affect conversion of T4 to T3.
There has been a long history of problems with levothyroxine manufacture so that many patients have suffered symptoms due to a number of manufacturing and storage factors and failures. Additionally, the excipients, carriers and solutions used can effect levothyroxine dissolution rate which has a profound effect on patient health. Many factors have been found to affect the bioequivalence and bioavailability of levothyroxine and all of the factors may not yet be known.
See MHRA reveiw of levothyroxine - similar reviews in New Zealand, France, Australia - all indicating problems with levothyroxine manufacturing.
Levothyroxine products are tested for bioequivalence and bioavailabiltiy in healthy human subjects and the rate of absorption and the way the product works may differ in diseased patients.
For these reasons it's important that patients have access to T3 because it is actually the only thyroid hormone needed by the cells. T4 being a precurser to T3. If a patient has insufficient T3 then they will become symptomatic and unwell. If there is any doubt that levothyroxine will be adequately absorped by all patients equally under any condition then T3 needs to be readily available to thyroid patients because even a small lack of hormone has a profound and all pervading effect on health.
My own veiw is that GP's should be able to prescribe a trial of T3 if a patient has low FT3 blood test levels. All thyroid patients if symptomatic should be able to have an FT3 blood test.
The issue of cost is a separate problem the govenment needs to address with a change of legislation and a change in NHS procurement practices as T3 is cheap and freely available in many European countries with adequate quality controls.
All the useful links if you need to back up your case if you get an Endo referral.