Liothyronine (T3) is very difficult to get on the NHS now. NHS England held a consultation in 2017 – "Items which should not be routinely prescribed in primary care: a consultation on guidance for CCGs" because of the huge increase in the cost of T3. Their decision was that patients already on T3 should be referred to an endocrinologist for a review and that any new patients should be referred to an endocrinologist to ask for a trial of T3.
Since the NHS England guidance, there has also been guidance published in June 2019 by the Regional Optimisation Medicines Committee (RMOC), which shows, again, that some patients need liothyronine and should have access to it if they need it. It states:
“In rare situations where patients experience continuing symptoms whilst on levothyroxine (that have a material impact upon normal day to day function), and other potential causes have been investigated and eliminated, a 3 month trial with additional liothyronine may be appropriate. This is only to be initiated by a consultant NHS endocrinologist. Following this trial, the consultant NHS endocrinologist will advise on the need for ongoing liothyronine. Many endocrinologists may not agree that a trial of levothyroxine/liothyronine combination therapy is warranted in these circumstances and their clinical judgement is valid given the current understanding of the science and evidence of the treatments.”
More recently, NICE has issued guidance which, although states, “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.”, gives a link to the RMOC guidance albeit not very well placed for everyone to see as it’s in the “Why the committee made the recommendations” section on page 34.
The British Thyroid Association also published guidance for GPs, endocrinologists and patients.
Even though the guidance from these three organisations does state that some patients need it, many Clinical Commissioning Groups are not adhering to this decision. Also, many endocrinologists do not agree with treatment with T3 and therefore it would be a waste of time for patients to visit an endocrinologist such as this.
Some patients’ endocrinologists are prescribing T3 on the NHS so before getting a referral, do try and find out if the endocrinologist in your area is likely to prescribe it if you can show that you need it.
Some GPs and endocrinologists are willing to prescribe liothyronine on a private prescription which they can then use to obtain T3 from outside of the UK at a much cheaper cost. Some hospitals and clinicians are suggesting this to their patients because they are aware that they are much better with the addition of T3.
If you obtain a private prescription you can try taking it to your local pharmacy and ask them if they can obtain T3 from outside of the UK as this is much, much cheaper. It’s best to take your private prescription to an independent pharmacy as the larger chains tend to have a process whereby they cannot do this. However, do shop around as some charge much higher prices than others.
If you get no joy from your local pharmacy, you can try one of the pharmacies on our Pharmacies and Wholesalers list but again, do shop around for the best price. Roseway Pharmacy and some of the other pharmacies on our list do offer Thybon Henning liothyronine (which is cheaper than the UK brands) via private prescription and NHS prescription. Contact them first to find out how much it will cost you as it pays to shop around!