2018.03.20 13:16
2018.03.20 13:22
2018.03.20 13:31
2018.03.21 13:01
Thyroid hormone in cardiac patients has been topics of management -interest of cardiac patient.
Even in post CABG patients, there was a time, IV T3 treatment was proposed in 90's and used
in cases with poor LV function etc. It slowly disappeared in daily management scene in the cardiac surgery patients.
Bundang Hospital Endocrinology published on this issue in 2009 in Annals of THoracic Surgery,
which included many patients I operated in 2003-2004. "Subclinical Hypothyroidism Might Increase the
Risk of Transient Atrial Fibrillation After Coronary
Artery Bypass Grafting"
Few weeks ago, they submitted the interesting follow up paper on
this issue,:"Subclinical hypothyroidism increased coronary revascularization after CABG"
Will see if they accept this for publication in the Journal.
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It is a common practice for an internist to treat the so called subclinical hypothyroidism,
as defined in this article.
I used to dispute the practice and personally never accepted the practice and
feel exonerated by reading this article.
The reluctance to accept the practice on my part had to do with the awareness that
levothyroxine is directly stimulating to the heart and won't be good to any adult patients,
especially the elderly.
I started Cardiology practice on July 1, 1971, and clearly remember the accepted clinical practice,
which I also resorted to as well, in dealing with coronary patients with intractable angina.
We cardiologists induced hypothyroidism in those patients by either utilizing drugs or radioactive iodine
and observed easing of chest pains in those patients further confirming the direct relationship of the thyroid
hormone and the heart. The early 1970's were the days before the CABG, coronary angioplasty and all the
fancy antianginal drugs arrived in the mainstream of medical practice.
These two articles quoted here once again give internists warning to be aware of this adverse effect.