Liothyronine and levothyroxine prescribing in England: A comprehensive survey and evaluation
Open accessAbstract
INTRODUCTION: The approach to thyroid hormone replacement varies across centres, but the extent and determinants of variation is unclear. We evaluated geographical variation in levothyroxine (LT4) and liothyronine (LT3) prescribing across General Practices in England and analysed the relationship of prescribing patterns to clinical and socioeconomic factors. METHODS: Data was downloaded from the NHS monthly General Practice Prescribing Data in England for the period 2011-2020. RESULTS: The study covered a population of 19.4 million women over 30 years of age, attending 6,660 GP practices and being provided with 33.7 million prescriptions of LT4 and LT3 at a total cost of £90million/year. Overall, 0.5% of levothyroxine treated patients continue to receive liothyronine. All Clinical Commission Groups (CCGs) in England continue to have at least one liothyronine prescribing practice and 48.5% of English general practices prescribed liothyronine in 2019-2020. Factors strongly influencing more levothyroxine prescribing (model accounted for 62% of variance) were the CCG to which the practice belonged and the proportion of people with diabetes registered on the practice list plus antidepressant prescribing, with socioeconomic disadvantage associated with less levothyroxine prescribing. Whereas factors that were associated with increased levels of liothyronine prescribing (model accounted for 17% of variance), were antidepressant prescribing and % of type 2 diabetes mellitus individuals achieving HbA1c control of 58 mmol/mol or less. Factors that were associated with reduced levels of liothyronine prescribing included smoking and higher obesity rates. CONCLUSION: In spite of strenuous attempts to limit prescribing of liothyronine in general practice a significant number of patients continue to receive this therapy, although there is significant geographical variation in the prescribing of this as for levothyroxine, with specific general practice and CCG-related factors influencing prescribing of both levothyroxine and liothyronine across England.
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Recent surveys of the UK population have revealed significant variability in practice reflecting differences in local guidance, access to liothyronine across health authorities, and interpretations of existing guidelines.
“Recent surveys of the UK population have revealed significant variability in practice reflecting differences in local guidance, access to liothyronine across health authorities, and interpretations of existing guidelines. 60,61”
From Use of liothyronine (T3) in hypothyroidism: Joint British Thyroid Association/Society for endocrinology consensus statement (2023) · cites this paper as [61]
The Results (Variation in LT4 and LT3 prescribing) and Discussion report substantial variation across English clinical commissioning groups, with local prescribing policies and guidance discussed as influences. The study covers general practices in England, not the whole UK, and does not directly establish differences in access to liothyronine or interpretations of guidelines as causes of the variation. (LLM, conf=0.84)
Experimental — accuracy not yet measuredOther factors include regional factors such as the levels of deprivation and the extent of antidepressant prescribing by general practitioners.
“Other factors include regional factors such as the levels of deprivation and the extent of antidepressant prescribing by general practitioners.187”
From Hypothyroidism (2024) · cites this paper as [187]
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Cites
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“Furthermore, early clinical studies used unduly high doses of LT3 that sometimes resulted in unpleasant adverse effects from iatrogenic thyrotoxicosis.(3) Accordingly, existing clinical guidelines do not support the routine use of LT3 in the management of hypothyroidism.”
Combined Thyroxine and Triiodothyronine for Thyroid Replacement Therapy
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Trends in costs and prescribing for liothyronine and levothyroxine in England and wales 2011–2020
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Self-citationOptimal thyroid hormone replacement
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“Recent surveys of the UK population have revealed significant variability in practice reflecting differences in local guidance, access to liothyronine across health authorities, and interpretations of existing guidelines.(60,61) In addition, further trials of liothyronine/levothyroxine combination therapy, as well as…”
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- Authors
- Stedman, M., Taylor, P., Premawardhana, L., Okosieme, O., Dayan, C., & Heald, A. H.
- Affiliations
- Res Consortium Andover UK
- Cardiff University (GB)
- Manchester Academic Health Science Centre (GB)
- Corresponding author
- Heald, Adrian H.
- ORCID
- Venue
- International Journal of Clinical Practice
- Publisher
- Wiley
- Published
- 2021-07-06
- Volume
- 75
- Issue
- 9
- Pages
- e14228-e14228
- ISSN
- 1368-5031 (ISSN-L)
- 1742-1241
- PMC
- PMC9285455
- OpenAlex
- W3155305904
- Cited by
- 8
- References
- 12
- Citations by year
- 2025: 1 · 2024: 3 · 2023: 2 · 2021: 2
- FWCI
- 1.31
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- International Journal of Clinical Practice (publishedVersion, cc-by-nc)
- PubMed Central (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- University of Birmingham Research Portal (University of Birmingham) (publishedVersion, cc-by-nc)
- ORCA Online Research @Cardiff (Cardiff University) (submittedVersion)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Thyroid Disorders and Treatments
- Health Sciences › Medicine › Surgery › Thyroid and Parathyroid Surgery
- Health Sciences › Health Professions › General Health Professions › Healthcare cost, quality, practices
- Keywords
- liothyronine, levothyroxine, thyroid hormone replacement, prescribing variation, regional variation, primary care prescribing, socioeconomic deprivation, type 2 diabetes, HbA1c control, antidepressant prescribing, smoking, obesity, England
- MeSH terms
- Diabetes Mellitus, Type 2, Female, Humans, Practice Patterns, Physicians', Thyroxine, Triiodothyronine, Hormone Replacement Therapy, General Practice
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