Queries re GP prescribing erfa thyroid

[Guest guest]

Hello everyone

Please could anyone give me some help with some of my queries. I am sorry in

advance that the post is so long! I am going to see my GP soon to ask him if he

will consider prescribing me erfa thyroid. I am thinking it will be easier and

may increase the chance of him saying yes if I ask him if he will consider

prescribing it on a private prescription. I have in the past had problems with

funding from my PCT with other 'issues' as has my mum and I don't really want

the stress of any battles with them at the moment. If my GP agrees to prescribe

for me privately I could always approach it being on the NHS in the future but

at the moment would prefer to go down this route. (although I will be taking him

the relevant info regarding NHS prescribing to try and increase my chances of

him prescribing privately.) I have been looking into things over the last few

weeks and printing things out for him etc. It will probably be another few week

before I get my brain in gear to be ready to see him though! Anyway I just had a

few queries before my appointment and wondered if any one may be able to help

me/give me some tips please.

- Is it OK for GPs to give their NHS patients a private prescription? Is there

anyone else who gets erfa thyroid from their GP on a private prescription?

- so far I have printed off some information from http://thyroid.erfa.net/ and

the letter from the files section - MHRA confirmation re Nature Throid and

Westhroid. Does anyone know if there is anything specific I can print off that

has confirmation from the MHRA specifically re erfa thyroid? I know that what

is in the letter applies to erfa but am thinking it would be good if I had

something to show my GP that specifically mentions erfa.

- In the MHRA letter I have printed off it states that 'other brands are

authorised by the FDA as medicines and are standardised to the specification of

the United States Pharmacopoeia'. As Erfa thyroid is Canadian does it still fit

this quote ie is it licensed in America in the same way as nature throid,

westroid and armour thyroid are or is it because it is licensed in Canada that

it is OK to prescribe it here. If so does Canada also use the FDA and USP?

- if I am very lucky and my GP says he will prescribe please can you tell me

what he would need to put on the prescription. I would only need a half grain

initially so would he just put 'erfa thyoid half grain' or does he put 30mg and

does he just need to put on the prescription 'for the treatment of

hypothyroidism' or is there anything else eg a letter he would need to give me?

- Initially I was going to ask him if he would consider a 3 month trial - I am

hoping by wording it like that it will increase the chance of him saying yes!

So I was going to ask him to prescribe the 100 tablets but if he was willing to

prescribe it in the long-term I would have liked him to prescribe the 500

tablets as I assume this brings the cost down? Does anyone know if a GP can

prescribe the bottles with 500 tablets. At our surgery if we get things on the

NHS we can only get a months supply at a time but I assume this wouldn't apply

to a private prescription even if it was a GP prescribing?

- Please can people tell me approximately what they pay per month for half grain

tablets? I know I could get 1 grain and cut into 4 to make it cheaper but I

would prefer to get the half grain as I didn't find I could accurately cut 1

grain armour (old armour was better to cut but I still didn't get it exact so

would prefer to stick to half grain at the moment).

- Where is the cheapest place to send a private prescription to buy erfa? I

know when I used to buy armour there were some huge differences in price. I

used to use Mountford's Chemist which cost around £30 for 100 1 grain armour but

when I had to get it from my local boots as supply was short it cost me just

over £50 and when I asked for a price from my local chemist they quoted me about

£100! Therefore I realise it is best to shop around and am even wondering if it

is cheaper to send it directly to http://thyroid.erfa.net/ or any other online

places?

Thank you for any replies. If anyone was able to answer even part of my queries

I would be really grateful. If anyone has any additional tips on approaching a

GP and anything else you think I should print out for him that would be great.

Even though I am thinking of asking him for a private prescription I still want

to take any relevant information about prescribing it on the NHS to increase the

chance of him saying yes! Maybe I should take something regarding it being

prescribed on a named-patient basis if on the NHS? Would anyone know any

suitable articles about this?

I'm sorry again that this post is so long!

Thanks again

Love Elle x

[Guest guest]

If you are going to ask your GP if he will prescribe natural

thyroid extract, you should be prepared for him to refer you to an

endocrinologist but make sure that whoever he refers you to is one who already

does prescribe T4/T3 combination, 3 alone or natural thyroid extract. I have

sent you a list of doctors recommended by our members, so ask if you can be

referred to one of these.

You should also copy the rebuttal I sent to the British Thyroid

Association's misleading and in parts, incorrect statement on Armour

Thyroid-v-L-thyroxine only therapy in case he believes everything the BTA says http://www.tpa-uk.org.uk/tpa_responds1.php

- Is it OK for GPs to give their NHS patients a private

prescription? Is there anyone else who gets erfa thyroid from their GP on a

private prescription?

Any doctor can write a private prescription for a patient if

they feel it is clinically appropriate and they are happy to take

responsibility for that prescribing decision. Under the NHS regulations, a GP

or his deputy can write a private prescription for a patient but cannot charge

the patient for writing a private prescription if the patient is registered for

NHS care with that GP or any other GP in the same practice.

The only exceptions to this rule are when an NHS GP writes either a private

prescription for drugs that are requested by the patient 'just in case' of the

onset of illness while outside the UK, or else when a private prescription is

required for the prevention (chemoprophylaxis) of malaria. See http://www.bma.org.uk/health_promotion_ethics/drugs_prescribing/InfoOnPrescrib0904.jsp?page=2

- so far I have printed off some information from http://thyroid.erfa.net/ and the letter

from the files section - MHRA confirmation re Nature Throid and Westhroid. Does

anyone know if there is anything specific I can print off that has confirmation

from the MHRA specifically re erfa thyroid? I know that what is in the letter

applies to erfa but am thinking it would be good if I had something to show my

GP that specifically mentions erfa.

Check the attached document showing the MHRA's views on Armour

Thyroid, Erfa Thyroid, Nature Throid and Westhroid. These are responses that

the MHRA sent to me when I asked whether NHS doctors could prescribe all of

these. If you want the more official looking response from them re Armour, I have

attached this too

- In the MHRA letter I have printed off it states that

'other brands are authorised by the FDA as medicines and are standardised to

the specification of the United States Pharmacopoeia'. As Erfa thyroid is

Canadian does it still fit this quote ie is it licensed in America in the same

way as nature throid, westroid and armour thyroid are or is it because it is

licensed in Canada that it is OK to prescribe it here. If so does Canada also

use the FDA and USP?

We are talking about natural thyroid extract being

" authorised " by the FDA. This does not mean that they

" approve " it. The Erfa Thyroid is licensed in Canada and is authorised

by the FDA and MHRA.

- if I am very lucky and my GP says he will prescribe please

can you tell me what he would need to put on the prescription. I would only

need a half grain initially so would he just put 'erfa thyoid half grain' or

does he put 30mg and does he just need to put on the prescription 'for the

treatment of hypothyroidism' or is there anything else eg a letter he would

need to give me?

He would use the private prescription forms (not sure what their

number is) and he should write - 30mgs Erfa 'Thyroid' and at the side, he

should write " for the treatment of hypothyroidism " .

- Initially I was going to ask him if he would consider a 3 month trial - I am

hoping by wording it like that it will increase the chance of him saying yes!

So I was going to ask him to prescribe the 100 tablets but if he was willing to

prescribe it in the long-term I would have liked him to prescribe the 500

tablets as I assume this brings the cost down? Does anyone know if a GP can

prescribe the bottles with 500 tablets. At our surgery if we get things on the

NHS we can only get a months supply at a time but I assume this wouldn't apply

to a private prescription even if it was a GP prescribing?

Sorry, cannot answer this question. You would need to discuss

this with your GP.

- Please can people tell me approximately what they pay per

month for half grain tablets? I know I could get 1 grain and cut into 4 to make

it cheaper but I would prefer to get the half grain as I didn't find I could

accurately cut 1 grain armour (old armour was better to cut but I still didn't

get it exact so would prefer to stick to half grain at the moment).

- Where is the cheapest place to send a private prescription

to buy erfa? I know when I used to buy armour there were some huge differences

in price. I used to use Mountford's Chemist which cost around £30 for 100 1

grain armour but when I had to get it from my local boots as supply was short

it cost me just over £50 and when I asked for a price from my local chemist

they quoted me about £100! Therefore I realise it is best to shop around and am

even wondering if it is cheaper to send it directly to http://thyroid.erfa.net/ or any other

online places?

Attached

is a list of reputable Internet Pharmacies where you can buy thyroid

medications (including natural thyroid extract) without the requirement of a

prescription from your doctor. Here you will get an idea of the cost of tablets

from each one. You will probably find that it works out much cheaper buying

this way than getting a private prescription from your GP.

Thank you for any replies. If anyone was able to answer even

part of my queries I would be really grateful. If anyone has any additional

tips on approaching a GP and anything else you think I should print out for him

that would be great. Even though I am thinking of asking him for a private

prescription I still want to take any relevant information about prescribing it

on the NHS to increase the chance of him saying yes! Maybe I should take

something regarding it being prescribed on a named-patient basis if on the NHS?

Would anyone know any suitable articles about this?

Check out all the information in our FILES section, accessible

from the Home Page of this Forum. On the page that opens, click on 'All Natural

Thyroid Extract' and you will probably find lots more information that you

could take to show him from there.

Actually, it might work much better if you were to write a nice

letter to your GP setting out your case and ask him to contact you after he has

read all the information. This gives him time to digest all the information,

rather than suddenly facing him with it all at a face to face consultation.

That puts a lot of pressure on doctors. It also gives  him time to do some of

his own research.

You could also copy off the 'How to Treat Using Natural Thyroid

Extract' that you will find in this Folder too.

Hope that helps

Luv - Sheila

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3 of 3 File(s)

Internet Pharmacies.doc

MHRAletter.doc

MHRA confirmation re Natur1.doc

[Guest guest]

Hi Sheila

Thank you for your reply to my queries and for sending me the list of doctors.

Also thank you for the attachments.

>If you are going to ask your GP if he will prescribe natural thyroid extract,

you should be prepared for him to refer you to an endocrinologist but make sure

that whoever he refers you to is one who already does prescribe T4/T3

combination, 3 alone or natural thyroid extract.>

I think you are right that he will probably say about referring me to an

endocrinologist. The main problem I have is I live in Wales and can't get

funding to go to England. Unfortunately we don't have the same policy in Wales

as England where by you have the right to be referred to any specialist.

However I notice there is one specialist in Wales so if he says no to

prescribing the erfa I will ask if I can be referred there if that's what I

decide but I have a feeling we have to stick to our local specialists and the

one on the list isn't near where I live. I may post about one of our local

specialists to see if anyone has any experience of her views on NDT/T3 etc

aswell.

>Actually, it might work much better if you were to write a nice letter to your

GP setting out your case and ask him to contact you after he has read all the

information. This gives him time to digest all the information, rather than

suddenly facing him with it all at a face to face consultation. That puts a lot

of pressure on doctors. It also gives him time to do some of his own research.>

I think that will be a really good idea. At least if he says no I will know

that he has read what I have sent him and had time to think about it. If I just

face him with it I have a feeling he could just say no before reading any of it

because he is unsure about what I am asking and hasn't got time to give it any

proper thought.

Thanks again

Love Elle x

PS Please can I just ask you a question regarding transferrin saturation %. You

advised in another post that I should take some iron supplements as my

haemoglobin was on the low side and to try to get this up to about 14.5. If I

am going to take supplements anyway do I still need to ask my GP to check my

transferrin saturation %? If so please could you let me know a bit more about

what this test is for and what I would say to my GP if he says I don't need it

if I've already had my haemoglobin checked? Thank you!

[Guest guest]

Hello Elle

Another name for 'transferrin saturation' is 'total iron binding

capacity' (TIBC). Related tests are iron and ferritin. Transferrin is tested along with iron and ferritin to evaluate those who are suspected off having too

much or too little iron. Usually, about one third of the transferrin measured

is being used to transport iron. In iron deficiency, iron is low, but TIBC is

increased. In iron overload, such as in haemachromatosis, iron will be high and TIBC will be low or normal. Because

transferrin is made in the liver, TIBC and transferrin will also be low with liver

disease.

TIBC measures the total capacity of your blood to transport iron,

and therefore reflects your body's iron stores. TIBC correlates with the amount

of the protein transferrin in your blood. Transferrin is a protein that attaches

iron molecules and transports iron to the blood. Transferrin is largely made in

the liver and regulates your body’s iron absorption into the blood. A

few laboratories are now measuring the number of sites on transferrin that are

not already carrying iron; this is referred to as unsaturated iron binding

capacity (UIBC). This number can be added to the serum iron to calculate the

TIBC.

TIBC (or transferrin)

measurements may be requested when it appears that you have too much or too

little iron in your system. If you have anaemia, especially if the red cells are small

and pale (microcytic and hypochromic), this may be due to iron deficiency and iron tests are usually performed. If your

doctor suspects you may have too much iron, or if you have a family history of haemachromatosis, iron and TIBC

(or transferrin or UIBC) may be used to see if further testing is needed.

High TIBC usually

indicates iron deficiency. A low TIBC may occur if you have too much stored

iron), anamia

caused

by infections and chronic diseases, malnutrition, cirrhosis, or a kidney disease that

causes loss of protein in urine.

Luv - Sheila

PS Please can I just ask you a question regarding transferrin saturation %. You

advised in another post that I should take some iron supplements as my

haemoglobin was on the low side and to try to get this up to about 14.5. If I

am going to take supplements anyway do I still need to ask my GP to check my

transferrin saturation %? If so please could you let me know a bit more about

what this test is for and what I would say to my GP if he says I don't need it

if I've already had my haemoglobin checked? Thank you!

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[Guest guest]

Thanks very much for you reply Sheila. Love Elle x