Question to the Department of Health and Social Care:

To ask Her Majesty's Government whether any Clinical Commissioning Groups refused to allow patients to be prescribed liothyronine (T3) before the consultation on Items which should not be routinely prescribed in primary care: Guidance for CCGs commenced; and if so, why.

We understand that the British Thyroid Association (BTA) advises that a small proportion of patients treated with the most commonly used drug, levothyroxine, continue to suffer with symptoms despite adequate biochemical correction. In these circumstances, where levothyroxine has failed and in line with BTA guidance, endocrinologists providing NHS services may recommend liothyronine for individual patients after a carefully audited trial of at least three months’ duration of liothyronine.

NHS England’s recommendations to clinical commissioning groups (CCGs) take account of those of the BTA and are to:

- Advise CCGs that prescribers in primary care should not initiate liothyronine for any new patient;

- Advise CCGs that individuals currently prescribed liothyronine should be reviewed by a consultant NHS endocrinologist with consideration given to switching to levothyroxine where clinically appropriate; and

- Advise CCGs that a local decision, involving the Area Prescribing Committee (or equivalent) informed by national guidance (e.g. from the National Institute for Health and Care Excellence or the Regional Medicines Optimisation Committee), should be made regarding arrangements for on-going prescribing of liothyronine. This should be for individuals who, in exceptional circumstances, have an on-going need for liothyronine as confirmed by a consultant National Health Service endocrinologist.

A number of CCGs had already created local policies on the prescribing of liothryronine before the national consultation started in July 2017.