NDT Availability on the NHS - Brands & Cost

[BreifneKing]

Hi, does anyone know if there are any restrictions on the brands of NDT that are available on the NHS?

Also, is the cost of NDT on the NHS a standard tariff like most meds or does it vary from brand to brand?

The reason I ask is that my NHS endo originally told me that only Erfa could be prescribed via NHS, but six months later the hospital pharmacy gave me Armour. Now the pharmacy is saying they can no longer get Erfa and it's Armour or nothing, despite the fact I have gone downhill on Armour.

I also had strange blood results which the endo has said is due to NDT being a natural product so its strength will vary from batch to batch 🙄 and that I'll have the same issue regardless of brand!

[helvella]

The manufacturers of desiccated thyroid do measure the amounts of T4 and T3 (and, I believe) total iodine in desiccated thyroid.

The first stage of this is that raw desiccated thyroid powder is assayed and blended, and a diluent (often lactose or another sugar) added, in order to achieve consistency.

The next stage uses this powder to make tablets. The tablets themselves should also be assayed.

There have been all too many recalls of levothyrxine over the years for anyone, least of all someone who should know better, to imply that desiccated thyroid is worse. Even in the UK, we had the withdrawal of a whole make of levothyroxine as it was failing to deliver what it claimed.

Desiccated thyroid is not on the tariff.

[BreifneKing in reply to helvella]

Hi Helvella,

It's common sense really, isn't it? How could a doctor prescribe a drug that may work for 4 months but may not work when the next prescription is dispensed and expect a patient to live with it?

The funny thing is he told me 2 years ago that NDT was the gold standard for treating hypothyroidism!

I honestly believe he heard that patients of another doctor got better on NDT so he followed suit, but instead of doing some independent research on NDT he is just echoing the false statements put out by NICE.

If NDT is not on the tariff does that mean a pharmacy is more likely to dispense the most expensive NDT brand i.e. Armour to generate the most profit?

And does it also mean an NHS consultant should be more open to prescribing a cheaper brand such as WP or Acella?

[helvella in reply to BreifneKing]

Some parts of the medical establishment claim that desiccated thyroid varies because each animal is different. Utterly ludicrous to think for one minute, nay, one second, that individual thyroids are processed such that this could be the case.

In the very early years of using animal thyroids, consistency was a major issue. Yes, individual thyroids were supplied to individual patients. Increasing volumes wiped that out very quickly. Consistency was subject to numerous things such as time of year. This is one reason pigs were, and are, widely used - far less variation over the year than other likely species.

Armour, when a separate company, had their own laboratory. They dosed animals with finished product to check that the product was consistent. (Other manufacturers at the time were not so careful.)

Nowadays, our biochemical testing procedures are much, much better.

[BreifneKing]

If NDT is not on the tariff does that mean a pharmacy is more likely to dispense the most expensive NDT brand i.e. Armour to generate the most profit?

And does it also mean an NHS consultant should be more open to prescribing a cheaper brand such as WP or Acella when a patient has ‘issues’ with Armour?

[helvella in reply to BreifneKing]

Is a hospital pharmacy able to make a profit?

If the prescription says "Armour Thyroid", that is what should be dispensed. If it says "Erfa Thyroid", then that should be dispensed. However, if a product is not available, there are rules about substitutions which can, at the extreme, require the pharmacy to contact the prescription writer.

NHS consultants are likely to be relatively unaware of prices.

What you might see as a cheaper brand might not be cheaper when supplied through a specialist importer.

I think all you can do is ask - the pharmacy and the prescriber.

[BreifneKing in reply to helvella]

Im sure an NHS pharmacy would be non-profit but as both the inpatient and outpatient pharmacy’s at the hospital are Lloyd’s, I’d be surprised if they were operating on the same basis?

The endo said all NDT costs the same as it is on a tariff!