Dear National Institute for Health Research,
We would like to have information on the guideline decided to decline funding for combination levothyroxine/liothyronine trials for patients with hypothyroidism (1), and the decision to prioritise RAI over other available treatments in hyperthyroidism (2).
In the NICE NG145 Guidance issued November, 2019, the authors called for more research (Point 1 in the NICE guidelines, “Key recommendations for research”) into combined levothyroxine/liothyronine treatment therapies. They conclude that no trials have been made in the population the guidelines cover.
Please provide copies of minutes where the NIHR declined funding for combination levothyroxine/liothyronine trials; and any citation lists of clinical publications used to support this decision and supporting papers including any costings or cost benefit analysis (investment cost analysis, cost-allocation analysis, cost-effectiveness analysis, etc) relating to the decision in 2019 not to commission research into combination levothyroxine/liothyronine treatments as per your key recommendations.
In recent NICE Guidance NG145, Radioactive Iodine (RAI) as a treatment for hyperthyroidism was deemed first line treatment, due to cost.
However, it was acknowledged by the Clinical Lead for NG145, Dr K Boelaert, in a meeting organised by the Thyroid Trust, in London, 25th January, 2020 that the costs of the patient being ill and out of work, alongside the costs of benefits, loss of tax revenue and the costs of further treatment for ensuing hypothyroidism, were not taken into account.
With regards to the above we appreciate that while these issues are not in the direct purlieu of NIHR, why is there no research currently recommended in the guidelines or commissioned by NIHR that might ascertain these costs? Whereas the direct cost of RAI is comparatively small, we would like to know if the combined after-treatment effects (emotional, social, economic, ethical (“Do No Harm”) and physical cost to the patient and the society) would trump that of other types of treatment for hyperthyroidism. Please provide any relevant minutes, notes, correspondence, research applications, commissions, and clinical or research publications.
Improve Thyroid Treatment, ITT
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