Trends in costs and prescribing for liothyronine and levothyroxine in England and wales 2011–2020

Stedman, Mike; Taylor, Peter; Premawardhana, Lakdasa; Okosieme, Onyebuchi; Dayan, Colin; Heald, Adrian

doi:10.1111/cen.14414

Cited by 11 publications

(14 citation statements)

References 12 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Recent surveys of the UK population have revealed significant variability in practice reflecting differences in local guidance, access to liothyronine across health authorities, and interpretations of existing guidelines. 60,61 In addition, further trials of liothyronine/levothyroxine combination therapy, as well as the use of thyroid extracts, have recently been published, again with negative results. 43,62 In addition, online surveys both in the United Kingdom and the United States show that most patients have persistent symptoms despite liothyronine/levothyroxine combination or DTE therapy.…”

Section: Potential Role Of Liothyronine As Combination or Monotherapymentioning

confidence: 99%

Use of liothyronine (T3) in hypothyroidism: Joint British Thyroid Association/Society for endocrinology consensus statement

Ahluwalia

Baldeweg

Boelaert

et al. 2023

Clinical Endocrinology

Self Cite

View full text Add to dashboard Cite

Persistent symptoms in patients treated for hypothyroidism are common. Despite more than 20 years of debate, the use of liothyronine for this indication remains controversial, as numerous randomised trials have failed to show a benefit of treatment regimens that combine liothyronine (T3) with levothyroxine over levothyroxine monotherapy. This consensus statement attempts to provide practical guidance to clinicians faced with patients who have persistent symptoms during thyroid hormone replacement therapy. It applies to non-pregnant adults and is focussed on care delivered within the UK National Health Service, although it may be relevant in other healthcare environments.The statement emphasises several key clinical practice points for patients dissatisfied with treatment for hypothyroidism. Firstly, it is important to establish a diagnosis of overt hypothyroidism; patients with persistent symptoms during thyroid hormone replacement but with no clear biochemical evidence of overt hypothyroidism should first have a trial without thyroid hormone replacement. In those with established overt hypothyroidism, levothyroxine doses should be optimised aiming for a TSH in the 0.3-2.0 mU/L range for 3 to 6 months before a therapeutic response can be assessed. In some patients, it may be acceptable to have serum TSH below reference range (e.g. 0.1-0.3 mU/L), but not fully suppressed in the long term.We suggest that for some patients with confirmed overt hypothyroidism and persistent symptoms who have had adequate treatment with levothyroxine and in whom other comorbidities have been excluded, a trial of liothyronine/levothyroxine combined therapy may be warranted. The decision to start treatment with liothyronine should be a shared decision between patient and clinician. However,

show abstract

Section: Potential Role Of Liothyronine As Combination or Monotherapymentioning

confidence: 99%

Use of liothyronine (T3) in hypothyroidism: Joint British Thyroid Association/Society for endocrinology consensus statement

Ahluwalia

Baldeweg

Boelaert

et al. 2023

Clinical Endocrinology

Self Cite

View full text Add to dashboard Cite

show abstract

“…Some clinicians regard NDT as an agent that could benefit people with ongoing symptoms of hypothyroidism despite levothyroxine treatment, and as a “lifeline” to people who may for many years have experienced debilitating symptoms. While 436 people in England were prescribed NDT by their general practitioners in 2018‐2019, at a total cost of £1,013,356, 23,24 the need for a definitive clinical trial is essential to support the licencing and use of NDT in the UK.…”

Section: Discussionmentioning

confidence: 99%

Is there a role for natural desiccated thyroid in the treatment of levothyroxine unresponsive hypothyroidism? Results from a consecutive case series

Heald

Premawardhana

Taylor

et al. 2021

Int J Clinical Practice

Self Cite

View full text Add to dashboard Cite

Introduction Some levothyroxine unresponsive individuals with hypothyroidism are prescribed a natural desiccated thyroid (NDT) preparation such as Armour Thyroid® or ERFA Thyroid®. These contain a mixture of levothyroxine and liothyronine in a fixed ratio. We evaluated the response to NDT in individuals at a single endocrine centre in terms of how the change from levothyroxine to NDT impacted on their lives in relation to quality of life (QOL) and thyroid symptoms. Methods The ThyPRO39 (thyroid symptomatology) and EQ‐5D‐5L‐related QoL/EQ5D5L (generic QOL) questionnaires were administered to 31 consecutive patients who had been initiated on NDT, before initiating treatment/6 months later. Results There were 28 women and 3 men. The dose range of NDT was 60‐180 mg daily. Age range was 26‐77 years with length of time since diagnosis with hypothyroidism ranging from 2 to 40 years. One person discontinued the NDT because of lack of response; two because of cardiac symptoms. EQ‐5D‐5L utility increased from a mean (SD) of 0.214 (0.338) at baseline, to 0.606 (0.248) after 6 months; corresponding to a difference of 0.392 (95% CI 0.241‐0.542), t = 6.82, P < .001. EQ‐VAS scores increased from 33.4 (17.2) to 71.1 (17.5), a difference of 37.7 (95% CI 25.2‐50.2), t = −4.9, P < .001. ThyPRO scores showed consistent fall across all domains with the composite QoL‐impact Score improving from 68.3 (95% CI 60.9‐75.7) to 25.2 (95% CI 18.7‐31.7), a difference of 43.1 (95% CI 33‐53.2) (t = 5.6, P < .001). Conclusion Significant symptomatic benefit and improvement in QOL was experienced by people with a history of levothyroxine unresponsive hypothyroidism treated with NDT, suggesting the need for further evaluation of NDT in this context.

show abstract

“…The matter of longitudinal trends in prescribing LT4 and LT3 in England is the subject of a separate paper. 17 …”

Section: Discussionmentioning

confidence: 99%

Liothyronine and levothyroxine prescribing in England: A comprehensive survey and evaluation

Stedman¹,

Taylor

Premawardhana

et al. 2021

Int J Clin Pract

Self Cite

View full text Add to dashboard Cite

Introduction The approach to thyroid hormone replacement varies across centres, but the extent and determinants of variation is unclear. We evaluated geographical variation in levothyroxine (LT4) and liothyronine (LT3) prescribing across General Practices in England and analysed the relationship of prescribing patterns to clinical and socioeconomic factors. Methods Data was downloaded from the NHS monthly General Practice Prescribing Data in England for the period 2011‐2020. Results The study covered a population of 19.4 million women over 30 years of age, attending 6,660 GP practices and being provided with 33.7 million prescriptions of LT4 and LT3 at a total cost of £90million/year. Overall, 0.5% of levothyroxine treated patients continue to receive liothyronine. All Clinical Commission Groups (CCGs) in England continue to have at least one liothyronine prescribing practice and 48.5% of English general practices prescribed liothyronine in 2019‐2020. Factors strongly influencing more levothyroxine prescribing (model accounted for 62% of variance) were the CCG to which the practice belonged and the proportion of people with diabetes registered on the practice list plus antidepressant prescribing, with socioeconomic disadvantage associated with less levothyroxine prescribing. Whereas factors that were associated with increased levels of liothyronine prescribing (model accounted for 17% of variance), were antidepressant prescribing and % of type 2 diabetes mellitus individuals achieving HbA1c control of 58 mmol/mol or less. Factors that were associated with reduced levels of liothyronine prescribing included smoking and higher obesity rates. Conclusion In spite of strenuous attempts to limit prescribing of liothyronine in general practice a significant number of patients continue to receive this therapy, although there is significant geographical variation in the prescribing of this as for levothyroxine, with specific general practice and CCG‐related factors influencing prescribing of both levothyroxine and liothyronine across England.

show abstract

Trends in costs and prescribing for liothyronine and levothyroxine in England and wales 2011–2020

Cited by 11 publications

References 12 publications

Use of liothyronine (T3) in hypothyroidism: Joint British Thyroid Association/Society for endocrinology consensus statement

Use of liothyronine (T3) in hypothyroidism: Joint British Thyroid Association/Society for endocrinology consensus statement

Is there a role for natural desiccated thyroid in the treatment of levothyroxine unresponsive hypothyroidism? Results from a consecutive case series

Liothyronine and levothyroxine prescribing in England: A comprehensive survey and evaluation

Contact Info

Product

Resources

About