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<p>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.</p><p>NHS England’s
recommendations to clinical commissioning groups (CCGs) take account of those of the
BTA and are to:</p><p>- Advise CCGs that prescribers in primary care should not initiate
liothyronine for any new patient;</p><p> </p><p>- 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</p><p>
</p><p>- 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.</p><p>A number
of CCGs had already created local policies on the prescribing of liothryronine before
the national consultation started in July 2017.</p>
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