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Severe Hypothyroidism & Mild Myocardial Perfusion
Hi, there - Greatly appreciate in advance any help or advice someone can provide on the painfully circular issue we're presented with that I explain below! I imagine hypothyroid patients and some doctors alike will find some of this familiar :) Since we are having a lot of trouble getting our doctors to speak to us as thinking beings and not brainless idiots, we need to do our own investigation so we can make an informed decision.
HISTORY:
My partner recently quit smoking after a cold (about 5 months ago) and almost immediately began experiencing terrible lethargy\fatigue, weight gain (despite an extreme and positive change in diet), ankle edema, shortness of breath and a sinus infection. These were not symptoms she'd experienced while she was smoking, so we both thought it could possibly be a product of nicotine withdrawl. When it continued, she saw a doctor and was subsequently diagnosed as having severe hypothroidism. TSH was above 100 and T3\T4 were equally out of whack. She'd obviously been functioning before because of the smoking\nicotine, which is ironic.
Her GP prescribed 50mcg Levothroid and told her to get in touch with an endo, which she did. After an initial consultation, the endo recommended aggressive treatment and that she go up to 75mcg. After a few days, she experienced chest tightening and continued shortness of breath so the endo told her to go back to 50mcg and schedule a diagnostic appointment with a cardiologist.
All of the above took about two months from diagnosis-to-cardiology appt.
After an unsuccessfull treadmill stress test was performed (the fatigue would not allow her to get up the required heart rate) the results of myocardial imaging pre\post stress indicated abnormal MP along with moderate reversible apical defect - "moderately decreased activity in the inferoapical segment" - and global hypokinesis. Vent cavity size is normal and blood pressure\heart rate is also normal pre\post stress. EF% is 49. She did not experience any chest pain or discomfort during the test, only severe shortness of breath and muscle cramps in her legs.
Here's our dilemma:
a) The cardiologist told her she needs to now go in for catheter angiography and that she could have a blockage or lesion. To be frank, he barely acknowledged our questions and wouldn't speak to the connection between myocardial perfusion and severe hypothyroidism. He told us we were "over-intellectualizing" when we tried to ask about the hypothyroidism as it related to the mild myocardial perfusion. He told us we were in denial when we asked whether the failed stress test could be used as a gauge since she wasn't even able to get up to the required heart rate.
b) Our endo will not aggressively treat her for the severe hypothyroidism unless she's cleared by a cardiologist and we're positive that 50mcg is not getting her balanced, so the hypo symptoms are plaguing her every single day.
An aside - we're going off to find another cardiologist and have scheduled an appointment with one highly-recommended a week or so from now.
The cardiologist won't clear her until she has this angiography so we're stuck and she's miserable!
I have read that mild-to-moderate myocardial perfusion could be considered "typical" and even "frequent" for patients with severe hypothyroidism who have recently started a regimen of thyroxine and that those symptoms right themselves once the body balances out with the new level of hormone. Since all of this has gone on and she hasn't been able to adjust her medication adequately, we still don't know if she's one of the lucky ones that will produce T3 from T4 (levothryoid) so the cardio test results could be even more skewed due to her untreated hormone imbalance.
I know I'm probably a doctor's worst nightmare since I research everything from a simple car purchase to a serious health issue, but all I want to know is whether we should consider this relatively risky invasive procedure since it seems we don't get help from any specialist until she goes through it.
We're both very worried that in her compromised state, she may be more at risk than the average patient and could have complications during the procedure.
Has anyone been through this sort of thing? Did you opt to have the angiography, get a "clean" bill of health and proceed with getting balanced? Am I silly to worry about this procedure?
I do understand that angiography is the gold standard in ruling out underlying problems, but I just want to make sure we take everything into consideration. I do not look back later and find that the procedure caused more damage that it was worth when the symptoms and test results were due to the hypothyroidism all along - particularly since time's going by and it's not even being treated.
Geesh, sorry for the long post. Again, greatly appreciate any insight.
Jen
HISTORY:
My partner recently quit smoking after a cold (about 5 months ago) and almost immediately began experiencing terrible lethargy\fatigue, weight gain (despite an extreme and positive change in diet), ankle edema, shortness of breath and a sinus infection. These were not symptoms she'd experienced while she was smoking, so we both thought it could possibly be a product of nicotine withdrawl. When it continued, she saw a doctor and was subsequently diagnosed as having severe hypothroidism. TSH was above 100 and T3\T4 were equally out of whack. She'd obviously been functioning before because of the smoking\nicotine, which is ironic.
Her GP prescribed 50mcg Levothroid and told her to get in touch with an endo, which she did. After an initial consultation, the endo recommended aggressive treatment and that she go up to 75mcg. After a few days, she experienced chest tightening and continued shortness of breath so the endo told her to go back to 50mcg and schedule a diagnostic appointment with a cardiologist.
All of the above took about two months from diagnosis-to-cardiology appt.
After an unsuccessfull treadmill stress test was performed (the fatigue would not allow her to get up the required heart rate) the results of myocardial imaging pre\post stress indicated abnormal MP along with moderate reversible apical defect - "moderately decreased activity in the inferoapical segment" - and global hypokinesis. Vent cavity size is normal and blood pressure\heart rate is also normal pre\post stress. EF% is 49. She did not experience any chest pain or discomfort during the test, only severe shortness of breath and muscle cramps in her legs.
Here's our dilemma:
a) The cardiologist told her she needs to now go in for catheter angiography and that she could have a blockage or lesion. To be frank, he barely acknowledged our questions and wouldn't speak to the connection between myocardial perfusion and severe hypothyroidism. He told us we were "over-intellectualizing" when we tried to ask about the hypothyroidism as it related to the mild myocardial perfusion. He told us we were in denial when we asked whether the failed stress test could be used as a gauge since she wasn't even able to get up to the required heart rate.
b) Our endo will not aggressively treat her for the severe hypothyroidism unless she's cleared by a cardiologist and we're positive that 50mcg is not getting her balanced, so the hypo symptoms are plaguing her every single day.
An aside - we're going off to find another cardiologist and have scheduled an appointment with one highly-recommended a week or so from now.
The cardiologist won't clear her until she has this angiography so we're stuck and she's miserable!
I have read that mild-to-moderate myocardial perfusion could be considered "typical" and even "frequent" for patients with severe hypothyroidism who have recently started a regimen of thyroxine and that those symptoms right themselves once the body balances out with the new level of hormone. Since all of this has gone on and she hasn't been able to adjust her medication adequately, we still don't know if she's one of the lucky ones that will produce T3 from T4 (levothryoid) so the cardio test results could be even more skewed due to her untreated hormone imbalance.
I know I'm probably a doctor's worst nightmare since I research everything from a simple car purchase to a serious health issue, but all I want to know is whether we should consider this relatively risky invasive procedure since it seems we don't get help from any specialist until she goes through it.
We're both very worried that in her compromised state, she may be more at risk than the average patient and could have complications during the procedure.
Has anyone been through this sort of thing? Did you opt to have the angiography, get a "clean" bill of health and proceed with getting balanced? Am I silly to worry about this procedure?
I do understand that angiography is the gold standard in ruling out underlying problems, but I just want to make sure we take everything into consideration. I do not look back later and find that the procedure caused more damage that it was worth when the symptoms and test results were due to the hypothyroidism all along - particularly since time's going by and it's not even being treated.
Geesh, sorry for the long post. Again, greatly appreciate any insight.
Jen
sorry..meant to read........It all came back clear with no blockages whatsever, NO lesions etc.
I would ask for an ultrasound to be done of the heart and valves first before being injected with an iodine dye for an Angiogram.
I had both as was born with a heart murmur, tachycardia and a heart attack in 1994.
The angiogram showed up absolutely nothing.
It all came back clear with no blockages whatsever, so lesions etc.
My heart attack was caused by stress from my husbands suicide 3 years previously.
But when an ultrasound was done when I was diagnosed with Graves Disease in 2007, it was found that I had prolapse of the mitral and tricuspid valve.
THIS caused shortness of breath.
At present it is 'trivial regurgitation' but basically means that the oxygenated blood is not getting to the heart properly.
Eventually I may have to have a valve replacement but I was also surprised at what 2 Cardiologists said.
They both said that patients with thyroid problems are more likely to have valve prolapse than any other patient they treat.
You learn something new everyday.
Thats why I say....ask for the ultrasound first as this will pick up any abnormailty of the heart, valves, arteries etc.
Also the ultrasound is less invasive than an Angiogram and if your Partner is extremely HYPO, she would be suffering from anxiety too.
If after the ultrasound, the Cardio wants an Angiogram done...then so be it but to start with...ask for a 'DOPPLER Ultrasound.
They are brilliant in what they can pick up in the way of abnormalities.
Good Luck :)
I had both as was born with a heart murmur, tachycardia and a heart attack in 1994.
The angiogram showed up absolutely nothing.
It all came back clear with no blockages whatsever, so lesions etc.
My heart attack was caused by stress from my husbands suicide 3 years previously.
But when an ultrasound was done when I was diagnosed with Graves Disease in 2007, it was found that I had prolapse of the mitral and tricuspid valve.
THIS caused shortness of breath.
At present it is 'trivial regurgitation' but basically means that the oxygenated blood is not getting to the heart properly.
Eventually I may have to have a valve replacement but I was also surprised at what 2 Cardiologists said.
They both said that patients with thyroid problems are more likely to have valve prolapse than any other patient they treat.
You learn something new everyday.
Thats why I say....ask for the ultrasound first as this will pick up any abnormailty of the heart, valves, arteries etc.
Also the ultrasound is less invasive than an Angiogram and if your Partner is extremely HYPO, she would be suffering from anxiety too.
If after the ultrasound, the Cardio wants an Angiogram done...then so be it but to start with...ask for a 'DOPPLER Ultrasound.
They are brilliant in what they can pick up in the way of abnormalities.
Good Luck :)
Hi ..... maybe cross post or PM the Heart CL's .. it's fine to mention I suggested it, too.
WELCOME .. I wish I knew more to help you.
C~
WELCOME .. I wish I knew more to help you.
C~
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