Compromise therapy in the patient with angina pectoris and hypothyroidism. A clinical assessment

The teaching that thyroid replacement therapy can aggravate angina or induce myocardial infarction in patients with hypothyroidism and coronary disease, and thus compel acceptance of incomplete control of either, was substantiated in 51 patients (18 with iatrogenic and 30 with idiopathic primary hypothyroidism, and three with secondary hypothyroidism as a component of panhypopituitarism). Based upon clinical and laboratory criteria, control of hypothyroidism was unsatisfactory in two fifths of the patients. Judged by frequency and ease of induction of angina and nitroglycerine requirement, control of angina was unsatisfactory in one-third. In many patients maximal tolerated dose of thyroid varied with time. The effect of combined propranolol and thyroid therapy in 13 patients was quite satisfactory in seven patients, fair in three and poor in three, but excellent in none. Transfusions were useful as a short- or long-term expedient in a few. Of 12 patients considered for coronary revascularization, three were rejected because of other medical problems and one showed prompt improvement after the dose of thyroid was decreased. Five of the remaining eight studied by coronary cineangiography were rejected as unsuitable for surgery. The remaining three were subjected to coronary revascularization. One did well for a time, apparently until a graft became occluded, the remaining two are still doing well. Coronary bypass graft surgery may deserve a larger role in the future management of these patients.