Coronary Revascularization in Patients with Intractable Angina and Hypothyroidism

The experience with 13 patients who had unstable angina and who were found to be clinically and chemically hypothyroid at the time of cardiac catheterization and coronary revascularization is reviewed. Three of seven patients given thyroid replacement therapy experienced an exacerbation of angina. All patients underwent cardiac catheterization and coronary angiography using the Sones or Judkins technique. Because angina could not be controlled with medical management, coronary artery bypass surgery was performed on all patients while they were still hypothyroid. These patients underwent a total of 43 saphenous vein bypass grafts with a mean of 3.3 grafts per patient. No mortalities occurred; however, there were three complications, none of which were related to hypothyroidism. Two patients had stable angina and 11 patients were asymptomatic at follow-up examinations which included stress tests, and they were found to be clinically and chemically euthyroid on replacement therapy. It is concluded that (1) cardiac catheterization and coronary revascularization can be safely performed with minimal to no thyroid replacement; (2) coronary revascularization is the procedure of choice for patients with intractable angina and hypothyroidism; (3) the euthyroid state can be safely achieved postoperatively and relief from angina attained.