Question to the Department of Health and Social Care:

To ask Her Majesty’s Government what steps they have taken to help patients with undiagnosed hypothyroidism who present clinical signs and symptoms of that condition, but are refused any treatment as their blood test results remain normal.

A blood test measuring hormone levels is the only accurate way to find out if there is a thyroid problem.

Best practice on the identification and management of hypothyroidism has been set out by the Royal College of Physicians (RCP) in its guidance, The Diagnosis and Management of Primary Hypothyroidism, first published in 2008. The guidance, which is attached, was developed on behalf of key organisations, including the British Thyroid Association (BTA), the British Thyroid Foundation (BTF) and the Society for Endocrinology (SOE), and is endorsed by the Royal College of General Practitioners. A copy of the UK Guidelines is attached.

The RCP guidance sets out that the only validated method of testing thyroid function is through a blood sample, which must include measurement of the levels of thyroid‐stimulating hormone (TSH) and free thyroxine (FT4) in serum, as recommended in the UK Guidelines for the Use of Thyroid Function Tests published by the BTA.

The RCP guidelines set out that overwhelming evidence supports the use of thyroxine hormone replacement (T4 or tetra-iodothyronine) alone in the treatment of hypothyroidism, with this usually being prescribed as levothyroxine. However, this does not prevent clinicians considering other forms of thyroid hormone replacement if appropriate.

The guidance remains up-to-date and a statement from the BTA Executive Committee supporting the existing guidelines was published in May 2015 in Clinical Endocrinology and endorsed by the Association for Clinical Biochemistry and Laboratory Medicine, the BTF, the RCP and the SOE. The full statement is attached and available online at:

http://onlinelibrary.wiley.com/doi/10.1111/cen.12824/full

Regarding international guidance and harmonisation on approaches to testing, the existing United Kingdom guidelines have now been supported by new guidance published in the United States of America which draws on the latest research and available evidence on the management of the condition. The USA guidance also includes a section on the ethics of prescribing thyroid hormone combination therapies when the potential long-term harmful effects are not known.