Subclinical hyperthyroidism (SH) is a state of mild thyroid gland overactivity, defined by measurement of thyroid hormones in the blood. It is quite common, affecting about 2% of elderly people. Rather like high blood cholesterol levels, most people have no symptoms of SH, but it is associated with an increased risk of vascular disease. The problem is that we don`t know whether treating SH is worthwhile, in terms of benefit to vascular disease rates and other problems. We will carry out a trial comparing radioiodine treatment of the thyroid gland overactivity to standard therapy for cardiac risk factors in patients with SH. We will follow people with SH for 5 years after the treatment to find out whether this improves the rate of vascular diseases and other problems. This trial will form the first randomised study of treatment for this condition and will inform healthcare decision making for about 200,000 elderly people each year in the UK.

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Our brains are made up of many thousands of billions of cells called neurons. In order for our brains to function properly clusters of these neurons must communicate with each other to understand information coming from our senses, and to control out movements. Neurons communicate with each other by generating tiny electrical charges but, for the most part, these charges do not pass directly from one neuron to another. Instead, electrical activity passes down long, wire-like extensions of the neuron until it reaches a specialised part of the ?wire? ? the synapse - that sits right next to other neurons. Electrical activity reaching this synapse causes it to release small amounts of a chemical which changes the electrical properties of the target neuron. In using this chemical, non-direct, form of communication the brain sacrifices speed and fidelity of communication in favour of a very broad and exquisitely adaptable range of effects of one neuron on another. However, another type of communication between neurons exists which DOES involve direct passage of electrical activity. This ?non-synaptic? communication involves neurons directly touching each other and sharing electric charge rapidly. This is a far more crude scheme than the elegant, chemical synaptic method of communication. It does not allow for a broad range of effects of one neuron on another and it is far less adaptable, but it does have the advantage of speed. It is present in humans as the nervous system is forming but was thought not to be important in our adult brains, but this idea is changing. Some forms of electrical activity in adult brains occur with neurons communicating at rates far too fast to be explained by chemical synapses. This type of activity appears critical for the normal function of our brains, but is usually ?drowned out? by the huge amount of chemical synaptic communication. This makes it very hard to study. However, for reasons we don?t yet understand, much larger amounts of fast communication between neurons is seen in the brains of patients suffering from epilepsy. In fact there appears to be a relationship between the amount of this fast communication and the underlying problems which generate the seizures themselves. This proposal intends to examine this relationship and take advantage of the large amount of fast communication present in epilepsy to understand how it occurs and to use it to aid better treatments for this debilitating neurological disorder.

No abstract available.

Medically Unexplained Symptoms (MUS), i.e. physical symptoms in the absence of physical disease, account for up to 30% of medical consultations. For a substantial minority, symptoms develop into chronic and disabling conditions such as Chronic Fatigue Syndrome or Fibromyalgia. Currently the best treatment for these conditions is cognitive behavioural therapy (CBT). However CBT therapists are scarce, so there has been a move to teach CBT skills to other health professionals dealing with these conditions. This forms the background to our project. Our aim is to develop a CBT enhanced treatment package that can be delivered by Speech Therapists to improve the voice and quality of life in patients with Functional Dysphonia, an MUS where people experience unexplained voice loss or hoarseness. Our research brings together Britain‘s leading dysphonia research team with a MUS-specialized CBT therapist. We will initially develop and test the treatment in an study comparing standard voice therapy to CBT enhanced treatment in 62 patients. We will use these findings to design a much larger trial to further test the feasibility of passing on clinically useful CBT skills. A positive finding will have far reaching benefits not only for dysphonia but for the treatment of MUS in general.