Dear (add MPs name) (You can find the email address of your MP here:

(Make sure you give your name and address near the top of the email so that your MP knows you are a constituent)

As one of your constituents I am writing to raise my concerns that many local CCGs are not following NHS England policy or updated clinical guidance from the British Thyroid Association (BTA) when prescribing liothyronine (T3) - a vital thyroid medicationthat 10-15% of patients with hypothyroidism need. I am one of those patients.

An adjournment debate has been tabled by Vince Cable MP, Leader of the Liberal Democrats for Monday 21st May at 2.30pm and I am asking that you support this debate.

Thyroid disease affects approximately 2% to4% of the UK population – 1,200,000 to2,400,000 people – and disproportionately affects women. The symptoms are serious and require daily medication. The standard medication is levothyroxine (T4) but it is well known that 10% - 15% of patients require the addition of T3 to resolve all of their symptoms.

Clinical Commissioning Groups (CCGs) have been withdrawing T3 treatment due to a 6,000% increase in the cost of the drug by the manufacturer Concordia, who were subsequently referred to the Competition and Markets Authority by the Department of Health.

NHS England recently held a consultation - "Items which should not routinely be prescribed in primary care: a consultation on guidance for CCGs" which included liothyronine. The NHS England Board decided to continue prescription of T3 for those patients who cannot be adequately treated by T4 but stated that it should only be prescribed in secondary care, even though T3 has been prescribed by many doctors in primary care without any problems.

However, abundant evidence shows that some CCGs are effecting a blanket policy banning T3 in both primary and secondary care which is having a serious impact on the health of thyroid patients. Divisions are emerging between those areas where prescription is continuing - a postcode lottery and between wealthy patients who can afford private prescriptions or who can travel to Europe where it is readily available at a fraction of the cost - 25p per tablet compared with £9 in the UK -and those poorer patients who lack the means and therefore remain ill.

This situation threatens good medical practice as clinical recommendations and opinion are being superseded by what appear to be poorly researched and managed purchasing decisions.

A joint report by Thyroid UK, Improve Thyroid Treatment (ITT), Midlands Thyroid support group and Thyroid Patient Advocacy entitled, "Improving T3 Prescription in the UK - a Joint Campaign on behalf of Thyroid Patients” sets out the following recommendations:

  1. The cost of liothyronine is reduced by proper management of procurement. Either, it is sourced from existing EU sources at reasonable competitive prices or lower pricing is negotiated using The Health Service Medical Supplies (Costs) Act. There should be comparable costs of liothyronine tablets in the UK to that of EU prices. Poor budgetary management should not be an excuse for a forced change in clinical decision-making.
  1. CCGs are given clear guidelines by NHS England and asked to comply with NHS England guidance that:
  1. Liothyronine prescribing, once instigated in secondary care, is passed back to primary care thus sharing the costs
  2. Patients who are clinically well on T3 continue to benefit from it without threat of removal
  3. New patients, where there is clear indication that levothyroxine is not working, are referred to an endocrinologist to start a trail of T3
  4. Patients who have been well for many years on T3 should be allowed to continue without referral as this is putting undue pressure on secondary care.
  1. CCGs, Hospital Trusts and Health Boards should, in the meantime, authorise clinicians to prescribe licenced liothyronine products from Europe on a named-patient basis, as has happened in the past due to supply issues, until the cost of UK liothyronine products are reduced to a level that is comparable with the EU market place

You can read the full report here:

I understand that there will be a members' debate on the cost and policy concerns, outlined in the report, and I ask that you offer your support.

I look forward to hearing from you.

Kind regards,