No abstract

No abstract

Women with symptomatic peripheral arterial disease were screened for impaired thyroid function using a sensitive immunoradiometric assay for thyrotrophin (TSH). The arterial disease in the aortotibial segment was documented by an abnormal brachial/ankle pressure index in 80 patients. An age-matched control group of elderly women (n = 30) with a normal pressure index was established. In the control group the mean serum TSH was 1.6 +/- 1.1 milliunits/l, median 1.5 milliunits/l and this established a normal range of 0.2-3.9 milliunits/l. Seven patients (8.8 per cent) were already receiving treatment for myxoedema. In the remaining patients, the overall distribution of serum TSH was skewed to higher levels; the mean was 3.7 milliunits/l, median 2.4 milliunits/l, P less than 0.001 compared with controls and 15 (19 per cent) had a serum TSH greater than 4 milliunits/l, compared with only one (3.3 per cent) of the controls. Therefore 22 patients (28 per cent) had myxoedema or a raised serum TSH. For all subjects with a normal TSH, there was a positive correlation of serum TSH with serum cholesterol, r = 0.68, P less than 0.001. For patients with a raised TSH, there was a continuing, but non-linear, increase of serum cholesterol with TSH. These results suggest that a raised serum TSH may be one of the risk factors for the development of peripheral arterial disease in women, possibly by increasing cholesterol levels.

Academic medicine often seems to be swayed more by fashion than science. Establishment team consensus is only needed where there is ambiguity. Evidence-based medicine is a new term for informed decision making and facilitated learning is purported to do away with authoritarian indoctrination. Problems that arise from the emphasis on team decisions, evidence based medicine and facilitated learning are discussed.

No abstract