Letters

Trial of thyroxine treatment for biochemically euthyroid patients has been approved

BMJ 1997; 315 doi: https://doi.org/10.1136/bmj.315.7120.1463 (Published 29 November 1997) Cite this as: BMJ 1997;315:1463
  1. E H McLaren, Consultant physiciana,
  2. C J G Kelly, Specialist registrar in endocrinologya,
  3. M A Pollock, Principal biochemista
  1. a Stobhill NHS Trust, Glasgow G21 3UW

    Editor—Skinner et al's suggestion that patients with symptoms of hypothyroidism and normal results of thyroid function tests might benefit from treatment with thyroxine1 received considerable publicity in our local evening newspaper. As a result, several patients were referred to our clinic.

    Since they complained of a considerable reduction in their quality of life, which had not been helped by other measures, we decided that it was justifiable to try treating two of them with 100 μg thyroxine daily (after we had explained the lack of scientific rationale and obtained their written consent). Much to our surprise, they both reported a considerable improvement in their condition, while the results of thyroid function tests remained within the reference range; one of them returned to work after an absence of four years. Although this may well have been a placebo response, it should be noted that such patients are often given repeated courses of antidepressants (at worst an expensive and dangerous placebo)without apparent effect.

    While our present state of knowledge suggests that there is no scientific justification for this treatment, it is intellectually arrogant to assume that we know everything about the physiology of thyroid secretion and its controlling hormones or the pharmacological effects of exogenous thyroxine.2 In view of the lack of effective treatment for this group of patients, we believe that further investigation of the effect of thyroxine is justified, as Skinner et al proposed. We have now received approval from our local ethics committee for a double blind, placebo controlled trial of thyroxine in patients with symptoms of hypothyroidism and normal results of thyroid function tests.

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