Donald Michaelmd wrote:

> Lab work didn't look as seriously ill as he did, but a careful trial of thyroid
> replacement seemed to help.

>
> After several months, he was in my office talking about his walking "3 miles
> a day to build my heart back up."
>
> "You look too healthy to need a heart transplant," I observed, and I sent him
> over for an echo cardiogram. I got the results in the afternoon. His cardiac
> function was almost normal. I sat at my desk, shaking inside, for the rest of
> the day.

From the pharmacological action of thyroid hormones, one can
readily see its advantage in congestive Heart Failure associated with
hypothyroidism, more than the current methodology: ACE Inhibitors
--remodels but takes too long; digitalis with associated toxicity;
they're even
trying to push beta blockers - main contraindication in the past was
CHF because chronic use was implicated to cause symptoms of CHF. The
vasodilation not only of cardiac vasculature but also of the
peripheral bed, the
positive inotropy of increased oxygen consumption and adrenergic
action in cardiac musculature,
resolution of the heart enlargment due to movement of the mucinous
fluid (readily
evidenced by x-ray), increased echo parameters (ejection fraction in
particular)
--what else could be better than thyroid. Even Barnes started thyroid
treatment
to post heart attack patients with success (starting at low dose of
course). Some incidental findings in some studies showed that thyroid
even resolves Left Ventricular Concentric
Hypertrophy -- what else could be better than thyroid in relieving the
pressure
and fluid overload once the peripheral bed opens, renal perfusion
increases, and the
filtration rate increases. The problem is no one sponsors studies
using thyroid
as compared to the very very huge funding used in pharmaceutical
sponsored
studies with weird sounding Acronyms.

Your astute observations and clinical acumen deserves recognition.

Greg

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