Template Letter to Send to Your MP

Template Letter to Send to your MP

[Your address]

[MP’s name

Address 1

Address 2

Address 3

Postcode]

[Date]

Dear [MP’s name],

I am writing to ask for your help for myself and for other people with hypothyroidism by either tabling and/or signing an Early Day Motion in the House of Commons regarding the diagnosis and treatment of hypothyroidism for patients for whom levothyroxine does not relieve their symptoms.

[Say something very briefly here that describes you and why you want things to change.]

Hypothyroidism affects 2% of the population, the majority of whom are women.1 The thyroid produces two hormones, thyroxine (T4) and tri-iodothyronine (T3).

The “Gold Standard” test for diagnosing hypothyroidism is the TSH test but this test misses conditions such as hypopituitarism, non-conversion of T4 to T3 and the DIO2 gene polymorphism. Unfortunately, getting tested for T3 is not as easy as it sounds – many doctors refuse to do this test and, in some cases, doctors request this test but the NHS laboratory refuses, even though they have never seen the patient.2

The standard medication for hypothyroid patients is levothyroxine (T4) but in up to 16% of patients, this medication does not relieve their symptoms.3-5

Some clinicians think that these patients have somatoform disorders (mental illnesses that cause bodily symptoms, including pain) and The British Thyroid Association (BTA) et al in their Statement “Management of Primary Hypothyroidism”6 state that, “…patients should be thoroughly evaluated for other potentially modifiable conditions.”

Once other conditions have been discounted, these patients are left without any support from the NHS.

There are, however, alternative treatments that have been found to improve the quality of life in these patients – liothyronine (T3) and natural desiccated thyroid (NDT).

Unfortunately, the BTA et al6 states that treatment with T3 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. However, the European Thyroid Association, in their 2012 Guidelines,7 states, “Consider L-T4 and L-T3 as an experimental approach in compliant LT4-treated hypothyroid patients who have persistent complaints despite serum TSH values within the reference range, provided they have previously been given support to deal with the chronic nature of their disease and associated autoimmune diseases have been ruled out.”

The BTA et al also state, “Many clinicians may not agree that a trial of L-T4/LT3 combination therapy is warranted in these circumstances and their clinical judgement must be recognized as being valid given the current understanding of the science and evidence of the treatments.”

According to the Hypothyroid Patient Experiences Survey2 conducted by Thyroid UK for the Scottish Government, 27% of the respondents requested T3 and 72% were refused with the main reasons being “Lack of knowledge (about the medication)” and “No evidence of superiority over other medication.” 13% of the refusals were because the doctors were not allowed to prescribe this medication.

The BTA et al warn6, “There is no convincing evidence to support routine use of thyroid extracts, L-T3 monotherapy, compounded thyroid hormones, iodine containing preparations, dietary supplementation and over the counter preparations in the management of hypothyroidism.”

NDT has been in use since the 19th Century and is not a licenced drug due to the fact that it was in use before licencing came into being. However, it is approved in the US and in Canada and there is no research showing harm to patients. Recent research, in fact, shows that for some patients, it improves their quality of life.8

Thyroid UK’s survey2 shows that 24% of the respondents requested NDT and 92% were refused for reasons above. Once again, 13% of the refusals were because the doctors were not allowed to prescribe this. The fact that some doctors want to prescribe these medications but feel they are not allowed to, contradicts the BTA statement that the clinician’s judgement must be recognized.

The BTA statement is used as guidelines by some clinicians and guidelines can be biased.9,10 If clinicians are aware that these medications do help their patients, then they should be allowed to use their clinical judgement and prescribe them without fear of being reported to the General Medical Council (GMC).

[If you are willing to meet up with your MP tell him/her here and ask him/her to contact you to arrange a suitable time, adding your contact details here]

Thank you for your help with this matter.

I look forward to hearing from you at your convenience.

Yours sincerely,

[Your name]

Research

1. Thyroid hormone in health and disease. J Endocrinol. Boelaert K, Franklyn JA; 2005 Oct;187(1):1-15.
2. Thyroid UK Hypothyroid Patient Experiences Survey
3. Do we need still more trials on T4 and T3 combination therapy in hypothyroidism? Wilmar M Wiersinga (Journal of Clinical Endocrinology and Metabolism - 2009 May;94(5):1623-9
4. New insights into the variable effectiveness of levothyroxine monotherapy for hypothyroidism. Elizabeth A McAninch, Antonio C Bianco. The Lancet; Volume 3, No. 10, p756–758, October 2015
5. New Treatment Targets for Hypothyroid Elderly -
6. Management of Primary Hypothyroidism - Statement by the British Thyroid Association Executive Committee Endorsed by the Association for Clinical Biochemistry and Laboratory Medicine, British Thyroid Foundation, Royal College of Physicians and the Society for Endocrinology.
7. 2012 ETA Guidelines: The Use of L-T4 + L-T3 in the Treatment of Hypothyroidism. Wilmar M. Wiersinga; Leonidas Duntas; Valentin Fadeyev; Birte Nygaard; Mark P.J. Vanderpump; Eur Thyroid J 2012;1:55–71
8. Desiccated thyroid extract compared with levothyroxine in the treatment of hypothyroidism: A randomized, double-blind, crossover study. Endo Hoang; J Clin Endo-crinol Metab 2013;98:1982-90.
9. Conflict of Interest in Medical Research, Education, and Practice - http://www.ncbi.nlm.nih.gov/books/NBK22928/
10. Ensuring the integrity of clinical practice guidelines: a tool for protecting patients. Jeanne Lenzer; Jerome R Hoffman; Curt D Furberg; John P A Ioannidis; BMJ 2013;347:f5535