Template Letter for your Clinician if your T3 (Liothyronine) has been Withdrawn.
(Please delete any parts of the template that are not relevant to you. Make sure you send this letter a few days before your appointment with your GP so that he has time to read it.)
Dear Dr (name of your doctor/endo),
As you are aware, my liothyronine has been stopped by you/the CCG/Endo due to the exorbitant cost. I am not very happy about this and would like to discuss the following with you:
· The British Thyroid Association guidelines (Management of Primary Hypothyroidism: statement by the British Thyroid Association Executive Committee (May 2015) – (http://www.british-thyroid-association.org/sandbox/bta2016/bta_statement_on_the_management_of_primary_hypothyroidism.pdf) state that, “L-T4/L-T3 combination therapy in patients with hypothyroidism should not be used routinely, as there is insufficient evidence to show that combination therapy is superior to L-T4 monotherapy (1/++0).” This does not mean “should never be used”. It means that some people may need to have it prescribed for them.”
· The British Thyroid Association has issued further guidelines stating that patients who are doing well on liothyronine should not have their liothyronine stopped: Switching from Liothyronine (LT-3)to Levothyroxine (LT-4)? – 2016
http://www.british-thyroid-association.org/current-bta-guidelines-
· The BMA are not happy about the fact that NHS England plan to stop prescribing drugs for patients and neither are other medical bodies:
BMA responds to NHS England action plan on wasteful drug use
https://www.bma.org.uk/news/media-centre/press-releases/2017/july/bma-responds-to-nhs-england-action-plan-on-wasteful-drug-use
NHS England’s plan to reduce wasteful and ineffective drug prescriptions
Azeem Majeed
BMJ 2017;358:j3679
https://doi.org/10.1136/bmj.j3679
CCG reported to advertising watchdog for 'misleading' patients on OTC prescribing
http://www.pulsetoday.co.uk/clinical/prescribing/ccg-reported-to-advertising-watchdog-for-misleading-patients-on-otc-prescribing/20034946.article
GPC warning ignored as CCGs roll out bans on GPs prescribing OTC drugs
David Millett - 27 July 2017
http://www.gponline.com/gpc-warning-ignored-ccgs-roll-bans-gps-prescribing-otc-drugs/article/1440618
· Levothyroxine alone does not relieve all of my symptoms. Here is a list of the symptoms that remain when I take levothyroxine only (list symptoms). This is making me very miserable and is affecting my family, work and social life.
· I have the DIO2 polymorphism which means I do not convert my T4 to T3 sufficiently/I have not been tested for the DIO2 polymorphism. This may be why I feel better on T3.
· I had low T3 levels when I was on levothyroxine which is why I need T3 to make me feel better.
· I am now having to pay for a private prescription for my T3. This is costing me (insert cost). This goes against the ethos of the NHS.
· I am now having to purchase my T3 online/from (insert another country.) This is costing me (insert cost).
· T3 has changed my life/is making me feel much better (explain how it has changed your life)
· I need a treatment that works for me. T3 is not an alternative drug, it is an essential drug for me.
· Lawfully, you do not have to comply with the CCG. It is your decision. Please read these links:
CCG reported to advertising watchdog for 'misleading' patients on OTC prescribing
http://www.pulsetoday.co.uk/clinical/prescribing/ccg-reported-to-advertising-watchdog-for-misleading-patients-on-otc-prescribing/20034946.article
GPC warning ignored as CCGs roll out bans on GPs prescribing OTC drugs
David Millett - 27 July 2017
http://www.gponline.com/gpc-warning-ignored-ccgs-roll-bans-gps-prescribing-otc-drugs/article/1440618
· You have seen how much I improved on T3. Please consider re-prescribing it.
· Please help me by completing an Independent Funding Request to the CCG to appeal against the withdrawal of my T3.
· NHS England are having a consultation about routinely prescribed over the counter drugs and have included liothyronine. Please go to this link and participate: https://www.engage.england.nhs.uk/consultation/items-routinely-prescribed/
· If T3 is so expensive and you know how much it helps me, perhaps I could try a trial of natural desiccated thyroid instead as it is cheaper?
Alternatively, please give me a prescription/private prescription for some Thybon-Henning brand of T3 by Sanofi-Aventis Deutschland GmbH (20mcg tablets) or the German brand, Sandoz, (25mcg tablets) which are much, much cheaper than the Concordia brand.
I have made an appointment to come and see you and look forward to discussing the above points.
Yours sincerely,