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[Surgical treatment of ischemic heart disease combined with hypothyroidism]
S Sawa1, M Kawasuji, H Tsujiguchi
1Department of Surgery (I), Kanazawa University School of Medicine, Japan.
Insights
For patients with ischemic heart disease and hypothyroidism, coronary artery bypass grafting (CABG) is safe. Maintaining slightly low thyroid function before surgery prevents angina worsening and ensures successful recovery.
Area of Science:
- Cardiology
- Endocrinology
- Thyroid Function
Context:
- Ischemic heart disease and hypothyroidism present treatment challenges, particularly regarding thyroid hormone administration and angina.
- Coronary artery bypass grafting (CABG) is a common procedure for severe coronary artery disease.
Purpose:
- To determine an appropriate thyroid function control strategy for hypothyroid patients undergoing CABG.
- To monitor thyroid function changes during the postoperative period in these patients.
Summary:
- Five hypothyroid patients received minimal L-Thyroxine doses pre-CABG to maintain slightly low thyroid function.
- Postoperative thyroid function was monitored and compared to a control group with normal thyroid function.
- No significant differences in hemodynamics were observed between groups; hypothyroid patients experienced angina relief and tolerated hormone replacement.
Impact:
- This study demonstrates that CABG can be safely performed in patients with angina and hypothyroidism.
- Maintaining a slightly suppressed preoperative thyroid function is a safe and effective strategy for this patient population.
Abstract:
Treatment for patients with ischemic heart disease and hypothyroidism contains many difficulties, such as a dilemma that thyroid hormone to hypothyroid patients may worsen angina. The purpose of this study is to propose an appropriate control of thyroid function in these patients before coronary artery bypass grafting (CABG), and to clarify the change of thyroid function during postoperative period. Because of progressive angina pectoris, five hypothyroidism patients underwent CABG. Preoperatively, minimal dose of L-Thyroxine (0-75 micrograms, daily) was administered orally to keep thyroid function at slightly low level before CABG. Ten consecutive CABG patients with normal thyroid function were selected as control group. Between both groups, there was no significant difference in age, coronary artery disease, and the number of bypass grafts. Serum T4, free-T4, T3, free-T3, and TSH were measured at 1st, 2nd, 3rd, and 7th P.O.D. In control group, pituitary-thyroid function was suppressed transiently. In hypothyroid group, T4 revealed no change and was kept at slightly low level during observed period. There was no significant difference in postoperative hemodynamics between both groups. Postoperatively all of hypothyroid patients got free from angina and received an adequate thyroid hormone replacement therapy without complications. It is concluded that CABG for patients with angina and hypothyroidism can be performed safely by keeping preoperative thyroid function at slightly low level.