RMOC guidance

  • The Regional Medicines Optimisation Committee (RMOC) have clarified the guidance issued to Clinical Commissioning Groups (CCGs) on the prescribing of liothyronine. This updated guidance was published in July 2019 and can be found on this link. 

https://www.sps.nhs.uk/articles/updated-rmoc-guidance-prescribing-of-liothyronine/

NICE guideline 2019 Thyroid disease: assessment and management

  • Section 1.3.4 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.'
  • However, the committee noted that the use of combination therapy is a critical issue in hypothyroidism and some committee members suggested beneficial effects of combination treatment with levothyroxine and liothyronine in small subgroups of patients. They could not recommend liothyronine either alone or in combination treatment based on the evidence available and its current list price but agreed a research recommendation to help inform future guidance in this important area. The NICE guideline directs readers to the advice on prescribing liothyronine produced by NHS England's specialist pharmacy service (see RMOC guidance above). 

https://www.nice.org.uk/guidance/ng145/chapter/Recommendations#managing-primary-hypothyroidism

Switching your patient from liothyronine to levothyroxine

  • Most health authorities now advise GPs to switch patients on liothyronine (L-T3) to levothyroxine (L-T4). The British Thyroid Association has produced guidance for GPs in these circumstances. 

Switching your patient from liothyronine to levothyroxine: answering GPs' frequently asked questions

When a trial of L-T3/L-T4 might be considered for treatment of hypothyroidism

(Video shared with kind permission from CoMICS bit.ly/SimbaComics)

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