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\begin{document}

\title{Liothyronine and Levothyroxine Prescribing in England: A Comprehensive
Survey and Evaluation}



\author[1]{Mike Stedman}%
\author[2]{Peter N. Taylor}%
\author[2]{Lakdasa Premawardhana}%
\author[2]{Onyebuchi Okosieme}%
\author[2]{Colin Dayan}%
\author[3]{Adrian Heald}%
\affil[1]{RES Consortium}%
\affil[2]{University of Wales Cardiff}%
\affil[3]{Salford Royal Hospitals NHS Trust}%


\vspace{-1em}



  
  \date{May 20, 2024}


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\begin{abstract}
Introduction: The approach to thyroid hormone replacement varies across
centres but the extent and determinants of variation is unclear. We
evaluated geographical variation in levothyroxine (LT4) and liothyronine
(LT3) prescribing across General Practices in England and analysed the
relationship of prescribing patterns to clinical and socioeconomic
factors. Methods: Data was downloaded from the NHS monthly General
Practice Prescribing Data in England for the period 2011-2020. Results
Overall, 0.5\% of levothyroxine treated patients continue to receive
liothyronine. All Clinical Commission Groups (CCGs) in England continue
to have at least one liothyronine prescribing practice and 48.5\% of
English general practices prescribed liothyronine in 2019-20. Factors
strongly influencing more levothyroxine prescribing (model accounted for
62\% of variance) were the CCG to which the practice belonged and the
proportion of people with diabetes registered on the practice list plus
antidepressant prescribing, with socioeconomic disadvantage associated
with less levothyroxine prescribing. For liothyronine prescribing (model
accounted for 17\% of variance), factors that were associated with
increased levels of liothyronine prescribing were antidepressant
prescribing and \% of type 2 diabetes mellitus individuals achieving
HbA1c control of 58mmol/mol or less. Factors that were associated with
reduced levels of liothyronine prescribing included smoking and higher
obesity rates. Conclusion: In spite of strenuous attempts to limit
prescribing of liothyronine in general practice a significant number of
patients continue to receive this therapy, although there is significant
geographical variation in the prescribing of this as for levothyroxine,
with specific general practice and CCG related factors influencing
prescribing of both levothyroxine and liothyronine.%
\end{abstract}%



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\includegraphics[width=0.70\columnwidth]{figures/Fig1-GP-Prcatice-Variation/Fig1-GP-Prcatice-Variation}

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\includegraphics[width=0.70\columnwidth]{figures/Fig2a-CCG-Variation/Fig2a-CCG-Variation}

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\includegraphics[width=0.70\columnwidth]{figures/Figure-2b-Key-to-CCG-map/Figure-2b-Key-to-CCG-map}

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\end{figure}\selectlanguage{english}
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\includegraphics[width=0.70\columnwidth]{figures/Fig3-Levothyroxine-Regr/Fig3-Levothyroxine-Regr}

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\end{figure}\selectlanguage{english}
\begin{figure}[H]
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\includegraphics[width=0.70\columnwidth]{figures/Fig4-Liothyronine-Regr/Fig4-Liothyronine-Regr}

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\end{figure}

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