Sawa S, Kawasuji M, Tsujiguchi H, Takemura H, Tedoriya T, Iwa T
Department of Surgery (I), Kanazawa University School of Medicine, Japan.
Nihon Kyobu Geka Gakkai Zasshi. 1990 Jul;38(7):1106-11.
Treatment for patients with ischemic heart disease and hypothyroidism contains many difficulties, such as a dilemma that thyroid hormone to hypothyroid patients may worsen angina. The purpose of this study is to propose an appropriate control of thyroid function in these patients before coronary artery bypass grafting (CABG), and to clarify the change of thyroid function during postoperative period. Because of progressive angina pectoris, five hypothyroidism patients underwent CABG. Preoperatively, minimal dose of L-Thyroxine (0-75 micrograms, daily) was administered orally to keep thyroid function at slightly low level before CABG. Ten consecutive CABG patients with normal thyroid function were selected as control group. Between both groups, there was no significant difference in age, coronary artery disease, and the number of bypass grafts. Serum T4, free-T4, T3, free-T3, and TSH were measured at 1st, 2nd, 3rd, and 7th P.O.D. In control group, pituitary-thyroid function was suppressed transiently. In hypothyroid group, T4 revealed no change and was kept at slightly low level during observed period. There was no significant difference in postoperative hemodynamics between both groups. Postoperatively all of hypothyroid patients got free from angina and received an adequate thyroid hormone replacement therapy without complications. It is concluded that CABG for patients with angina and hypothyroidism can be performed safely by keeping preoperative thyroid function at slightly low level.
缺血性心脏病合并甲状腺功能减退患者的治疗存在诸多困难，比如甲状腺激素用于甲状腺功能减退患者可能会加重心绞痛这一困境。本研究的目的是提出在冠状动脉旁路移植术（CABG）前对这些患者进行适当的甲状腺功能控制，并阐明术后甲状腺功能的变化。由于进行性心绞痛，五名甲状腺功能减退患者接受了CABG。术前，口服最小剂量的左甲状腺素（每日0 - 75微克），以使甲状腺功能在CABG前维持在略低水平。选择十名连续的甲状腺功能正常的CABG患者作为对照组。两组在年龄、冠状动脉疾病和旁路移植数量方面无显著差异。在术后第1天、第2天、第3天和第7天测量血清T4、游离T4、T3、游离T3和促甲状腺激素（TSH）。在对照组中，垂体 - 甲状腺功能被短暂抑制。在甲状腺功能减退组中，T4在观察期内无变化并维持在略低水平。两组术后血液动力学无显著差异。术后所有甲状腺功能减退患者的心绞痛均缓解，并接受了充足的甲状腺激素替代治疗且无并发症。结论是，通过将术前甲状腺功能维持在略低水平，可为心绞痛合并甲状腺功能减退患者安全地进行CABG。
