Tracey Buckenham and Tara Riddle of Norfolk Thyroid Group have been working really hard campaigning to reinstate the vital drug liothyronine for patients who need it. Liothyronine was blacklisted by the Norfolk and Waveney Clinical Commissioning Group (NWCCG) but after their hard work, it has now been reinstated.
Yes, they do and that's part of the problem. They don't bother to send patients to endos because they have been told by the CCGs that T3 is not available.
I don't think it's most CCGs that have fallen into line. Not from what we are hearing anyway.
Truth finder | GP Partner/Principal29 Jul 2019 10:50am
We are not endocrinologists and do not pretend to be. Stop pushing work to us!
Dr T***** R****** FFCI | Locum GP29 Jul 2019 3:05pm
So to save money in primary care we have to spend unecessary money in secondary care. There is no evidence that liothyronine needs to be used. What are the onsultants going to do? See the patient, tell them to change and send them back to the GP. Madness
Took Early Retirement
Took Early Retirement | GP Partner/Principal | Hampshire29 Jul 2019 7:35pm
Usual rubbish.
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anonymouse3 | Salaried GP30 Jul 2019 12:36pm
Dear Dr G****,
Firstly, liothyronine is NOT a 'routinely prescribed item' in primary care! it is, amd should remain, an exceptional item for prescription by Consultants only.
Secondly, patients CAN, and DO, use private medical opinions to presurise GPs. We can only overcome this by education and guidelines and compulsory messages to the CONSULTANTS.
Thankyou, GP
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DR R | Salaried GP30 Jul 2019 4:23pm
Why has the cost gone up so much ?
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S****** HOPKINS | Locum GP30 Jul 2019 11:08pm
Instead of grouching about whose responsibility it is to prescribe T3, how about, as GPs, we listen to our patients. or is this now considered reactionary and we should all be good little civil servants and follow the algorithms set by our betters?
My patients tell me that when T3 is stopped and they are put on T4, they feel tired and put on weight.
When T3 is reinstated, the weight problems, along with the Diabetes and Hypertension, get better.
I would like to think that colleagues listen to and advocate for their patients. What a shame we are reduced to squabbling over budgets and who should do the work.
How will we progress if GPs no longer listen and think critically for themselves.
Steve Hopkins
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WhoamI | Locum GP31 Jul 2019 12:32pm
Lots of patients think things work for them- homeopathy for instance. It doesn’t mean it’s anything beyond placebo. I’m not saying T3 doesn’t help just needs proof beyond “the patient thinks it works”
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Angus P****** | GP Partner/Principal31 Jul 2019 2:18pm
@ ******* Hopkins
Levothyroxine 50 mcg per day = £30 per year
levothyroxine 100 mcg per day = 30 per year
Liothyronine 20mcg daily= £3,000 per year
My T shirt might seem to look better with the word Nike on it, but all it might have achieved is just ripping me off and making someone else rich.
Proper evidence is needed, as is lacking at the moment.
@Anonymouse3
Also have heard of private medical opinions being used - these endocrinologists should know better.
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Andrew C*** | GP Partner/Principal31 Jul 2019 6:30pm
So those patients who have seen the endocrinologist and complained that they can't tolerate levothyroxine do what exactly what when the endocrinologist doesn't care about their side effects?
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Angus P******** | GP Partner/Principal01 Aug 2019 12:44pm
How about some blind randomised controlled trials for starters?
I personally find most of the Dr's comments in tattybogle post to be quite offensive and wonder why they are even GP's with that attitude! I can just imagine what they write about patients behind their backs!
The basic problem with T3 is cost, whichever way you look at it. A GP can pass the buck by sending a patient to a Consultant. The Consultant may well agree with the patient and write back to the GP stating they should be on T3 BUT the GP will not prescribe it, not necessarily because the CCG won't allow it but because they dont want it in their budget. Even if the Consultant does prescribe it, and most dont because they dont want the headache and waste of time of spending time with a patient only to have a battle within their own budgeting area, they can do so for three months or until the patient is stable and then again ask the GP to take over care. Once again the GP refuses to prescribe. So it goes round and round in circles, never breaking prescribing guidelines, just kicking it from one budgeting area to another.
CCG's in many areas will pass the buck to GP's by saying they are free to prescribe whats in the best medical interest of their patient, however, as we know, the GP's dont want the cost or to be seen to be going against what they know to be a sensitive dictate.
Unless and until the drug companies that produce T3 are made to reduce the price, or the NHS procurement process changes so that they can source from cheaper areas so it forces the cost down, no amount of favourable trials or pressure on CCG's will change anything until prices reduce.
As an example if T3 cost 0.50p a pill and T4 was 1p, no Dr would think twice about prescribing it if a patient said they preferred it to T4, in fact they would probably be telling us to take it!
I think the anti T3 problem goes much deeper than cost, and pre-dates the price scandal. but obviously, the rip off price now just makes it so much easier to justify the game of pass the parcel between Endo /GP.
I've seen much more offensive remarks from Hardcore anti T3 ers, in comments in the BMJ. Most of the comment's above are only of the 'show me the evidence, because i'm too disinterested to read any research on my own' variety.
But i would say Andrew C, Dr R, and Steve Hopkins were all very encouraging.
Well done Tara and Tracey...I know this has been a long arduous journey but you did it! You should both be very proud of yourselves. Lets hope this is a flood gate opening!
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Liothyronine (T3) in India
My local Clinical Commissioning Group (CCG) has made a new policy THIS MONTH to stop prescribing T3 and Armour in my area. 
