Dr Faizel Osman and colleagues (July 2001 JRSM, pp. 346-348) present two cases of thyrotoxicosis with heart block. For the second patient, who responded well only to steroid therapy, they raise the question whether the triad of thyrotoxicosis, heart block and raised erythrocyte sedimentation rate could be due to a single autoimmune disease; yet they do not say whether this was investigated or not.