Nice guidelines on T3

[Name4]

Hi, can anyone tell me what the NICE guidlines are for T3 prescribing?

Thank you in advance

[Jaydee1507 Administrator]

The NICE guidelines are not particularly helpful but you will need to be referred to an NHS Endocrinologist (choose one from the Thyroid UK list, email [e-mail] for a copy) and have a 3 month trial of treatment with T3 added to your Levo. Once this is successful and you are settled on your dose the Endo will write to your GP and ask them to take over prescribing.

1.3.4 Do not routinely offer liothyronine for primary hypothyroidism, either alone or in combination with levothyroxine, because there is not enough evidence that it offers benefits over levothyroxine monotherapy, and its long-term adverse effects are uncertain.

This doesn't mean that your Endocrinologist shouldn't prescribe T3, just not as a routine.

Thyroid hormone replacement

The committee agreed that hypothyroidism needs thyroid hormone replacement. Potential treatments are levothyroxine, usually prescribed to everyone, liothyronine, which is sometimes prescribed when levothyroxine fails, and natural thyroid extracts (which is currently unlicensed for use in the UK). Overall the evidence from 7 randomised controlled trials suggested that combination treatment with levothyroxine and liothyronine did not offer any important health benefits compared with levothyroxine monotherapy and was significantly more expensive. However, the committee noted that some of the trials did show some small benefits in specific quality of life domains and anecdotal evidence from some committee members suggested beneficial effects of combination treatment with levothyroxine and liothyronine in small subgroups of patients. The committee were aware that some people reported still feeling unwell with levothyroxine monotherapy and agreed that in this group adding liothyronine could potentially have greater benefit than in the general population with hypothyroidism, although there are no trials in this population. Some evidence suggested that combination therapy with levothyroxine and liothyronine could be harmful because it may suppress the production of TSH and its long-term adverse effects are uncertain. The committee was aware that the use of combination therapy is a critical issue in hypothyroidism. They could not recommend liothyronine either alone or in combination treatment based on the evidence available and its current list price but agreed a research recommendation to help inform future guidance in this important area. NHS England's specialist pharmacy service has produced advice on prescribing liothyronine.

thyroiduk.org/if-you-are-hy...

[Name4 in reply to Jaydee1507]

Thanks Jaydee, really appreciate

[TaraJR]

NICE try to get away with not advising people have T3. Certain members of the NICE thyroid committee are devoutly against T3. However, the final outcome was that they said T3 is not routinely recommended. It does not mean 'do not use' it means thyroxine is the first-line treatment, and T3 can be used as a second-line treatment if thyroxine doesn't work.

Sadly, many drs and ICBs (used to be called CCGs) interpret, or choose to interpret, the NICE guideline as 'do not ever prescribe'!

NICE also make reference to the NHSE RMOC guidance which details how patients can have T3 if T4 doesn't work for them. The understanding seems to be that, if NICE references something, then that is a recommendation to follow.

Hope that makes sense.

[Name4 in reply to TaraJR]

Hi Tara, Thanks so much for your reply, and information, very helpful, thank you!

Apologies for not responding before now,

Many thanks