Management of the myxedematous patient with symptoms of cardiovascular disease

Abstract

1. 1. In myxedema, variations in blood proteins are of no value in following the results of therapy. 2. 2. In myxedema with cardiac failure, variations in the weight of the patient, his basal metabolic rate, and his circulation time are of no value in ascertaining his thyroid status at any particular moment. 3. 3. When taken in conjunction with the initial level, i.e., before treatment, the total blood cholesterol has been a very reliable method of ascertaining the degree of thyroid sufficiency in myxedema with cardiac failure, for it is uninfluenced by the latter in the absence of signs of liver damage. 4. 4. An increase in capillary permeability is a constant feature of myxedema. A decrease from the initially high permeability is one of the earliest and most constant signs of improvement. 5. 5. Thyroid therapy must be used cautiously in myxedema with cardiac failure. The dose should be sufficiently small to avoid an aggravation of the cardiac phenomena, but, no matter how severe the failure is, some hormone should be used. An effort should be made to make the initial dose sufficiently large to effect a decrease in capillary permeability. 6. 6. Satisfactory initial daily doses of thyroid hormone, as desiccated thyroid substance, have ranged from 0.05 to 1 grain. In thirteen cases, stabilization was attained through the daily use of amounts varying from 0.5 to 3 grains.