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Liothyronine and Levothyroxine Prescribing in England: A Comprehensive Survey and Evaluation
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  • Mike Stedman,
  • Peter N. Taylor,
  • Lakdasa Premawardhana,
  • Onyebuchi Okosieme,
  • Colin Dayan,
  • Adrian Heald
Mike Stedman
RES Consortium
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Peter N. Taylor
University of Wales Cardiff
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Lakdasa Premawardhana
University of Wales Cardiff
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Onyebuchi Okosieme
University of Wales Cardiff
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Colin Dayan
University of Wales Cardiff
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Adrian Heald
Salford Royal Hospitals NHS Trust
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Abstract

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 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 2019-20. 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. For liothyronine prescribing (model accounted for 17% of variance), factors that were associated with increased levels of liothyronine prescribing were antidepressant prescribing and % of type 2 diabetes mellitus individuals achieving HbA1c control of 58mmol/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.

Peer review status:ACCEPTED

07 Jan 2021Submitted to International Journal of Clinical Practice
07 Jan 2021Submission Checks Completed
07 Jan 2021Assigned to Editor
09 Jan 2021Reviewer(s) Assigned
14 Mar 2021Review(s) Completed, Editorial Evaluation Pending
28 Mar 20211st Revision Received
29 Mar 2021Submission Checks Completed
29 Mar 2021Assigned to Editor
31 Mar 2021Reviewer(s) Assigned
03 Apr 2021Review(s) Completed, Editorial Evaluation Pending
12 Apr 2021Editorial Decision: Accept