Ellyin F, Fuh C Y, Singh S P, Kumar Y
Postgrad Med. 1986 May 15;79(7):93-8. doi: 10.1080/00325481.1986.11699412.
Management of patients with chest pain and hypothyroidism is a clinical dilemma. Thyroid replacement therapy may exacerbate angina pectoris. Administration of a beta blocker such as propranolol (Inderal) concomitantly with thyroid replacement therapy is useful in treatment of angina. However, beta blockers can induce variant angina owing to increased norepinephrine secretion and enhanced alpha-mediated responsiveness in the hypothyroid state. Hypotension and syncopal episodes may develop in the hypothyroid patient after administration of nitrates. Cardiac catheterization and revascularization are well tolerated by myxedematous patients with angina. After surgery, full thyroid replacement therapy should be initiated gradually and with caution.
胸痛合并甲状腺功能减退患者的管理是一个临床难题。甲状腺替代疗法可能会加重心绞痛。在进行甲状腺替代疗法的同时给予β受体阻滞剂如普萘洛尔（心得安）对心绞痛治疗有用。然而，在甲状腺功能减退状态下，β受体阻滞剂可因去甲肾上腺素分泌增加和α介导的反应性增强而诱发变异型心绞痛。甲状腺功能减退患者服用硝酸盐后可能会出现低血压和晕厥发作。心绞痛的黏液性水肿患者对心脏导管插入术和血运重建术耐受性良好。手术后，应谨慎并逐渐开始进行全量甲状腺替代治疗。
