NDT and bloods advice

[cllano]

Hello

Have been stable on ERFA 125 mg + 75mcg levothyroxine for last few years. Bloods recently TSH < 0.01 ft4 26 and sadly just seen that they only measured Total T3 ( got it done at my GP practice).

Tried to see if my GP would prescribe off-licence NDT (saw an FY2) who discussed with GP partners and advised contact Endo. So he obv doesnt recommend armour or NDT and advsied keeping TSH above 0.1.

,My free T4 is in higher range but I feel great. Just wondering if maybe dont need the extra T4 (and save me the hassle of ordering if from my GP) ... can I ask what you think?

Any more up to date info re MHRA and non licenced prescribing? I am training to be a GP and for me this is useful for my own practice.

Thanks

[SeasideSusie Remembering]

cllano

What's an FY2?

My free T4 is in higher range but I feel great. Just wondering if maybe dont need the extra T4 (and save me the hassle of ordering if from my GP) ... can I ask what you think?

Over range or still within range? You've given a result of 26 but no range and as ranges vary from lab to lab it's important for us to know the range so that we can interpret the result.

Going by what you've said I would think you don't need that much T4, most people on NDT are good with FT3 in the upper range but we generally see FT4 lower.

TSH < 0.01

So he obv doesnt recommend armour or NDT and advsied keeping TSH above 0.1.

Unlikely to happen when taking NDT, it's usual to see a low or suppressed TSH when on NDT, it's just what happens as it contains T3.

Any more up to date info re MHRA and non licenced prescribing? I am training to be a GP and for me this is useful for my own practice.

I don't know of anything new, is this something you may be privvy to in advance of the general public as you're training to be a GP?

[cllano in reply to SeasideSusie]

FY2 = Foundation Year 2 doctor. Just out of medical school.

Ft4 26 (range is 9-28)

re MHRA and non licencing I wll definately hunt out some more info from my side.

The FY2 was certainly sympathetic but I guess with more years of experience the more rigid one gets and less open.

Thanks

[helvella Administrator Thyroid UK in reply to cllano]

This seems to be the MHRA's current guidance on prescribing unlicensed products.

The supply of unlicensed medicinal products (“specials”)

MHRA Guidance Note 14

assets.publishing.service.g...

My suspicion is that the bigger issues (than MHRA view) are/will be:

Colleagues and their views

Practice and ICB views

Issues about private prescriptions in an NHS context

NHS/pharmacy rules and guidance and reimburesment

[1tuppence in reply to cllano]

Why do you think "with more years of experience the more rigid one gets and less open"?

Why would those things go together? Shouldn't more experience equal more wisdom and knowledge, and therefore less rigid and more open?

[SlowDragon Administrator]

As per previous post here

healthunlocked.com/thyroidu...

Increasingly rare to even get Ft4 …..and almost never Ft3 tested

NHS in Scotland only tests Total T3

You will need to test privately before seeing endocrinologist

Email Thyroid U.K. for list of recommended thyroid specialist endocrinologist and doctors who will prescribe T3 or NDT

[e-mail]

Extremely rare (virtually impossible) to get NDT on NHS

Data for England

Liothyronine - 60,200 prescriptions in last year

openprescribing.net/analyse...

Erfa - 326 prescriptions in last year

openprescribing.net/analyse...

Armour - 2500 prescriptions in last year

openprescribing.net/analyse...

[Lalatoot in reply to SlowDragon]

NHS in Scotland does test ft3 . I'm in the NE Scotland and it is always ft3 that is tested.

[SlowDragon Administrator in reply to Lalatoot]

interesting……central Scotland….or at least Edinburgh/Glasgow seems to only test TT3

[Lalatoot in reply to SlowDragon]

Maybe it goes by health authority. I am in NHS Grampian.