Hypothyroidism and atherosclerotic heart disease: pathogenesis, medical management, and the role of coronary artery bypass surgery.

Abstract

OVERT HYPOTHYROIDISM is associated with a number of abnormalities in lipid metabolism which may predispose patients to accelerated coronary artery disease. Despite a high prevalence of severe atherosclerosis found at autopsy, hypothyroid patients have a relatively low frequency of angina pectoris and myocardial infarction during life. Problems typically arise during thyroid hormone replacement therapy when the new onset of angina, unstable angina, myocardial infarction, or sudden death may occur, making treatment of the hypothyroidism difficult and potentially dangerous. For many years the possible hazards of anesthesia and surgery in hypothyroid patients discouraged the use of coronary revascularization as a treatment for their angina pectoris. Many patients had to remain hypothyroid in order to avoid exacerbation of their cardiac symptoms. Since 1974 however, 49 hypothyroid patients with chest pain and an inability to tolerate thyroid hormone have been successfully treated with coronary revascularizatio...