However, if you are dying of something else, your choices are far more stark. Less than 5 per cent of referrals for palliative care have a non-cancer diagnosis. Terminally ill heart-failure patients – a disease of the elderly, which affects seven out of 10 people aged 80 to 89 – experience social isolation and increasing disability, frequently under the care only of their GP, according to a study in last month’s BMJ The last few months of these patients’ lives can be grim. They are typically spent being shunted from hospital to community and back again. Repeated admissions to different consultant teams are common, and patients’ medical notes sometimes arrive on the wards after the patient had been discharged or died. Their final days are likely to be spent in intensive care, still unprepared for what is to come.Change is coming – but it’s slow. Hospices are still largely supported by charities, targeted at cancer patients – and access to hospices is skewed against the elderly, as well as those from deprived areas and from minority groups.But palliative care is now taught routinely at medical schools and to junior doctors.

At Southampton, for instance, it’s part of the core curriculum, with lectures and workshops on care of the dying throughout the undergraduate course. And the National Institute for Clinical Excellence is due to issue its first draft guidelines on palliative care for cancer patients next month.But for real change to come about, end-of-life care will have to be taken much more seriously than it is currently at the level of policy and practice. Ideally this will be combined with an end to seeing death in purely medical terms. That is the idea behind the King’s College lecture series, which includes contributions from the arts, social scientists and humanities as well as clinicians. “Focusing on death isn’t necessarily depressing,” says Irene Higginson, Professor of Palliative Care and Policy at the college.

“It can encourage creativity and make a good life more achievable – and as the end approaches, it means doctors and patients can be more open with each other and thereby achieve a more humane, holistic system of care.”For information on events in ‘The Art of Dying’ symposium, call 020-7848 2929.This is an edited version of an article that appears in the December issue of the newsletter ‘Medicine Today’ ( ). I am a 41-year-old woman and some blood tests showed a raised level of thyroid stimulating hormone – TSH. I’ve been told my pituitary gland is having to work overtime to stimulate my thyroid to produce enough thyroxine Eventually I will have to take thyroxine tablets. What causes a thyroid gland to stop working? And does thyroid function have any bearing on fertility? I have had three attempts at IVF, but gave up due to poor response to ovulation-stimulation drugs.

The gland is stimulated by another hormone – TSH – produced by the pituitary gland. The body has a chemical feedback system that tells the pituitary gland to produce more TSH when the levels of thyroxine fall. A raised level of TSH usually means that the pituitary gland is doing its best, but the thyroid gland is not responding. The commonest cause is an auto-immune attack on the thyroid gland by your own body. This happens more frequently in women than in men, and it is relatively common.