Meeting of the Parliament 04 December 2018
I thank the Public Petitions Committee for securing the debate, and the convener, Johann Lamont, for moving the motion.
I offer my personal thanks to the petitioner, Lorraine Cleaver, and to Elaine Smith, and I commend those who have shared their personal experiences throughout the work on the petition over a number of years.
The Scottish Government is committed to ensuring that everyone in Scotland who is living with thyroid and adrenal conditions is able to access the best possible care and support. The petition urges the Scottish Government to take action to ensure that GPs and endocrinologists are able to accurately diagnose thyroid and adrenal disorders and provide the most appropriate treatment.
The petitioner also asked for the inclusion of free tests for T3 and reverse T3 thyroid hormones, as well as tailored treatment consisting of either T4 alone, T4 in combination with T3, T3 alone or natural desiccated thyroid.
I will highlight some of the progress that has been made since the members’ business debate on hypothyroidism last November. My predecessor, Aileen Campbell, met the petitioner and Elaine Smith MSP in February this year, when it was agreed that stronger communication and a consistent approach from GPs are important. Following that meeting, the deputy chief medical officer, Dr Gregor Smith, met representatives from NHS Education Scotland to discuss the development of an endocrine learning module for GPs, which would set out helpful steps to diagnosis and pathways of care for GPs.
In response to the committee’s final report on the petition, which was published in March, the Scottish Government confirmed that the Scottish clinical biochemistry managed diagnostic network had agreed to review evidence in relation to variation in thyroid testing. I can now confirm that the network is in the process of developing a guideline, which I hope will be helpful. I am pleased that, through the hard work of the committee, Lab Tests Online-UK now also provides people with the relevant information about testing options.
The chief medical officer’s specialty adviser for endocrinology is also leading work to support a consistent approach to specialist input across the country. That includes exciting work to develop an endocrine information technology system to support the modernisation of outpatient endocrine care and to facilitate clinical audit and research.
It is imperative that accurate guidance is available to all clinicians to ensure accurate thyroid diagnosis. The leading UK body for thyroid disorders, the British Thyroid Association, set out clear recommendations in its 2015 statement on the management of primary hypothyroidism. That statement was based on a current literature review of the published positions of the European Thyroid Association and American Thyroid Association. A number of expert bodies including the British Thyroid Foundation and the Royal College of Physicians endorsed the statement.
In 2016, NICE published its clinical knowledge summary on hypothyroidism. It is also developing a guideline on thyroid disease, with an expected publication date of November 2019. I appreciate that that is a year away, but it reflects the extensive and rigorous process of guideline development, which includes wide consultation across stakeholders including—importantly—people who are living with thyroid conditions.
With regard to treatment, the British Thyroid Association’s position statement takes into account the wide-ranging international evidence base and concludes that T4 provides
“a safe, rational ... approach to the correction of hypothyroidism”
and that it improves the “physical and psychological well-being” of “the vast majority of patients”.
However—this is an important point that the convener made—healthcare professionals should recognise that a small proportion of patients do not tolerate T4. In that instance, with the expert opinion of an endocrinologist, patients can be prescribed a combination of T4 and T3 or, indeed, T3 alone when they feel that is safe and effective.