Intended for healthcare professionals

Rapid response to:

Practice Guidelines

Thyroid disease assessment and management: summary of NICE guidance

BMJ 2020; 368 doi: (Published 29 January 2020) Cite this as: BMJ 2020;368:m41

Rapid Response:

BMJ should reflect on choice of adverts for thyroid treatment

Dear Editor,

We write to ask if the BMJ should reflect on its choice of advertisements associated with the publication. This week’s edition of the BMJ (8th February 2020) came wrapped in an advert for liothyronine. The use of liothyronine (T3) for the management of hypothyroidism remains controversial, with little evidence-base for its use. Its prescription is not supported by latest NICE guidance on the management of hypothyroidism published in this week’s BMJ (BMJ 2020; 368 doi:

Given that the power of pharmaceutical advertising is likely to promote product prescription, we question whether it is a wise decision for the BMJ to advertise a product that has a questionable evidence base. The accompanying manufacturers’ prescribing information suggests up to 60 mcg liothyronine a day, a dose not recommended by any UK or European guideline that would cost the NHS £11,576 per annum for a single patient taking 6 x 10 mcg tablets per day. By comparison, guidance recommended use of levothyroxine (T4) would cost £62 per annum for a patient requiring 100 mcg once daily receiving a prescription every 28 days (levothyroxine price obtained from the British National Formulary).

The BMJ should be praised in that it has always set the bar very high when it comes to whether pharmaceutical companies should be involved in influencing clinicians to use their products. The cover of this week’s issue highlights an article questioning the involvement of industry in influencing indoor tanning research. The decision to advertise liothyroinine appears questionable and at odds with messages previously expressed by the BMJ. We would invite a review of the decision to advertise liothyronine in the very same issue in which guidance is published expressing caution against T3 use.

Yours sincerely,
Dr Augustin Brooks
Consultant Physician Diabetes
Royal Bournemouth Hospital

Dr Tristan Richardson
Consultant Physician Endocrinology
Royal Bournemouth Hospital

Competing interests: Dr Brooks declares that he has received honoraria from Astra Zeneca and Sanofi for speaking at educational events and sponsorship from Lilly and Janssen to attend conferences.

13 February 2020
Augustin M Brooks
Consultant Physician
Dr Tristan Richardson
Royal Bournemouth Hospital
Royal Bournemouth Hospital, Bournemouth BH7 7DW