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BNSSG Adult Joint Formulary

6.9 Thyroid disorders

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6.9.1 Hyperthyroidism

First line drugs Second line drugs Specialist drugs Secondary care drugs



Recommended: (TLS Green)


Alternative: (TLS Blue)


Specific indication:

Propranolol (TLS Blue)

  • Relief of thyrotoxic symptoms

Atenolol (TLS Blue)

  • Relief of thyrotoxic symptoms

Aqueous Iodine Oral Solution (Lugol's Solution) (TLS Red)

  • Thyrotoxicosis (crisis and pre-operatively)


6.9.2 Hypothyroidism

Thyroid hormones

The metabolism of some drugs may be altered in hyperthyroidism - seek specialist advice

Recommended: (TLS Green)


Specialist use only (TLS Red)


  • Hypothyroid coma / rapid response desired
  • Approved for maintenance therapy in combination with levothyroxine for patients with severe thyroid deficiency, including patients with thyroid cancer, in compliant T-4-treated patients who have persistent complaints despite reference range serum TSH, provided they have received adequate chronic disease support and associated autoimmune diseases have been ruled out
  • Non-formulary as monotherapy
  • NHSE Liothyronine – advice for prescribers


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