Abstract
Hypothyroid patients with unstable angina pectoris present difficult problems in clinical management. Thyroid hormone treatment prior to cardiac catheterization and coronary revascularization has been advocated but to date there are no reports comparing the management and surgical outcome in patients with or without thyroid hormone replacement. We have reviewed all hypothyroid patients who have undergone coronary artery surgery at our institution since 2005. Of 56 patients with unstable angina pectoris, 15 were hypothyroid at presentation either with no treatment (n=8) or after a short-term thyroid replacement (n=7). The 8 patients (5F, 3M; ages 41-65 yrs) who had received no thyroid hormone prior to catheterization and surgery, had a median serum T4 value of 2.2 mcg/dl (0.5-3.8) (normal 5-13.5 mcg/dl) and a median serum TSH value of 65 mU/L (30-200) (normal 0-10 mU/L). Of the 7 patients (3F, 4M; ages 44-65 yrs) who had received L-thyroxine therapy (0.075-0.15 mg/day) four were biochemically euthyroid with serum T4 values of 5.6-7.3 mg/dl at the time of surgery. All 15 patients underwent successful coronary angiography and coronary arterial bypass surgery. Both groups received a median of 2 saphenous vein grafts (1-3) without operative complications. There was one death in a non-treated group due to cerebrovascular accident 2 years after the procedure. The current median follow-up period in the non-treated group is 29 months (1-59), and in the treated group, 49 months (11-70). In patients with recognized hypothyroidism and unstable angina we found no difference in the operative mortality and follow-up between patients who received thyroid hormone and those who were not treated prior to catheterization and surgery. We concluded that in this clinical situation the primary concern should be the need for catheterization and possible surgery, both of which can be performed safely with or without thyroid hormone replacement.