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Gold, incentives and meh

Why aren't the police or GMC taking action?

I would like to respond to the comments in '3 GPs' Views' (Features, September 6) regarding the use of thyroxine in patients with ME/CFS.

The views of the three GPs are, I am sure, typical of most GPs trained in mainstream medicine. Chronic fatigue syndrome (CFS) is one of the more difficult conditions we are faced with in clinical practice and requires a considerable time commitment to adequately assess. Conventional treatment options are limited and this leads to frustration for both doctor and patient, increasing the likelihood of complaints.

However, there is some evidence that treating clinically hypothyroid but biochemically euthyroid CFS patients with thyroxine produces a favourable clinical response1.

The endocrine abnormality in CFS is proposed to involve the hypothalamic-pituitary-thyroid axis with diminished TSH production by the pituitary resulting in declining thyroid hormone production, ie secondary hypothyroidism. Full assessment of the thyroid therefore requires THS, free T4 and free T3 estimation which is often unavailable to GPs on the NHS.

Offering to arrange these tests privately would gain the respect of patients and, armed with the results, GPs would be better able to justify refusal to thyroxine treatment. On the other hand, they may find an abnormality that is indeed worth treating and provided that repeated TFTs are kept within reference ranges then everyone should be happy.

Dr Chris Dawkins



1 Skinner et al. Journal of Nutritional and Environmental Medicine (2000) 10, 115-124. 2. Skinner. Letter to BMJ,

June 14, 1997.

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