The thyroid gland secretes the thyroid hormones thyroxine (T4) and triiodothyronine (T3) with T3 being the biologically active hormone. Over 1 million people in the UK take levothyroxine (L-T4) which is the recommended strategy for replacing thyroid hormone deficiency as it is easily converted by the body to the active T3 in cells. Most patients respond satisfactorily, but a minority of treated individuals experience persistent symptoms despite evidence of adequate biochemical correction. The care of such individuals is challenging and remains the subject of considerable public interest. Liothyronine (L-T3) is available to be prescribed but is not used routinely. Endocrinologists occasionally suggest a trial of a combination of L-T4 with L-T3 if symptoms persist on an experimental basis.
Recently, many patients have been informed of a lack of L-T3 availability on the basis of cost. The price increase in L-T3 has arisen because generic products in the NHS are not price-controlled to encourage competitive pricing and keep prices down. However, this can have the opposite effect where there is a limited number of suppliers for a product, as suppliers can choose to increase prices unilaterally. Many years ago, L-T3 became generic with a single supplier, Goldshield, which became AMCo, and now Concordia. There has been a gradual and marked price increase, particularly in the last 3 years, and this increase appears to have occurred more notably in the UK relative to other European countries. The Competition and Markets Authority (the competition watchdog) has now reported on this issue.