Meeting of the Parliament 04 December 2018
What people are experiencing on the ground is really important. The guidelines make it clear that, if T4 is not working for an individual, the endocrinologist is able to prescribe T3.
That brings me to the accessibility of T3. In 2017, the Scottish Government’s effective prescribing programme board looked at medication for a wide range of conditions and at best practice in the management of hypothyroidism, concluding that there is currently insufficient clinical evidence of effectiveness to support the use of T3, either alone or in combination, as the first line of treatment of hypothyroidism. That reflects the current best practice that T4 is the preferred first-line treatment for the vast majority of patients. NHS boards were therefore asked to review the position of T3 in their formularies to ensure that T3 is initiated only on the advice of an endocrinologist, who is a specialist.
That review must be carried out in a person-centred manner, which means that face-to-face consultations are essential before any change is made. An assurance should be given that the individual can return to the original treatment if mutually agreed outcomes are not achieved. I am referring specifically to someone who is currently on T3. The Scottish Government is clear that an endocrinologist can prescribe T3 for an individual patient if their symptoms are not adequately controlled with T4. Nevertheless, I recognise Elaine Smith’s point.
The diagnosis and management of hypothyroidism should also not rely solely on the results of biochemical tests, and it should take account of the individual’s circumstances, experiences and goals. That is in line with the realistic medicine approach, which emphasises that the making of decisions about an individual’s healthcare should be focused on the individual and discussed and agreed between them, their family or carer and the clinician.
Time has rushed by. I have a few more points to make, which I may be able to cover in my closing remarks.
I thank the Public Petitions Committee for the huge amount of work that it has done. I also thank the petitioner, Sandra Whyte, and others in the public gallery, and Elaine Smith, who has put a huge amount of effort into this.
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