Myerowitz P D, Kamienski R W, Swanson D K, Chopra P S, Berkoff H A, Kroncke G M, Rowe G G, Vander Ark C R, Dhanani S P
J Thorac Cardiovasc Surg. 1983 Jul;86(1):57-60.
A retrospective analysis of 38 patients undergoing cardiac catheterization with the diagnoses of hypothyroidism and chest pain revealed 23 to be euthyroid while receiving replacement therapy and 15 to be hypothyroid. Cardiac index was significantly reduced (p less than 0.01) in hypothyroid and euthyroid patients with thyroxine values between 4 and 7 micrograms/dl (2.8 +/- 0.7 and 3.0 +/- 0.9 L/min/m2, respectively), compared to euthyroid patients with thyroxine values greater than 7 micrograms/dl with or without coronary artery disease (4.0 +/- 1.2 and 4.0 +/- 0.7 L/min/m2, respectively). Ten hypothyroid patients underwent coronary artery bypass. There were no deaths, and only one patient required prolonged postoperative intubation. With a mean follow-up of 36 months, there have been no myocardial infarctions and one late death, which occurred at 7 years secondary to stroke. We conclude that preoperative thyroid replacement therapy is theoretically dangerous and may not significantly improve hemodynamics until full replacement is achieved. Coronary bypass grafting can be performed safely despite hypothyroidism with excellent early results.
对38例诊断为甲状腺功能减退和胸痛并接受心导管检查的患者进行回顾性分析，结果显示，23例患者在接受替代治疗时甲状腺功能正常，15例患者甲状腺功能减退。甲状腺素值在4至7微克/分升之间的甲状腺功能减退和甲状腺功能正常患者的心脏指数显著降低（p<0.01）（分别为2.8±0.7和3.0±0.9升/分钟/平方米），而甲状腺素值大于7微克/分升的甲状腺功能正常患者，无论有无冠状动脉疾病，心脏指数分别为4.0±1.2和4.0±0.7升/分钟/平方米。10例甲状腺功能减退患者接受了冠状动脉搭桥术。无死亡病例，仅1例患者术后需要长时间插管。平均随访36个月，无心肌梗死发生，1例晚期死亡发生在7年后，死于中风。我们得出结论，术前甲状腺替代治疗理论上存在风险，在实现完全替代之前可能不会显著改善血流动力学。尽管存在甲状腺功能减退，冠状动脉搭桥术仍可安全进行，早期效果良好。
