Subclinical hypothyrodism, is it mild thyroid failure to treat or acompansated state?

Subclinical hypothyroidism "SCH" affects of general 5-15% of general population, however the need of lifelong L-thyroxin "LT4" therapy is still controversial. As the serum lipids and myocardium are main targets of thyroid hormone action, we investigate whether SCH induces serum lipids and cardiovascular alterations and we evaluate the effect of L-T4 replacement therapy on clinical symptoms, serum lipids and echocardiographic parameters in patients with SCH. We studied 20 premenopausal women with subclinical hypothyroidism with age ranging from 18-45 years and 20 premenopausal euthyroid women as control group matched to SCH patients for age and body mass index [BMI]. Patients were randomly classified into two sub-group each included 10 women, one group received L-T4 therapy and the other group receive placebo for the same period. All were subjected to through clinical assessment, assessment of tissues hypothyroidism using zulewski Score, serum total cholesterol [TC] law density lipoprotein cholesterol "LDL-C", high density lipoprotein cholesterol "HDL-C" and triglycerides "TG" also echocardiography 2D, M-Mode and Doppler study. Our study revealed significant elevation of total cholesterol and LDL-C in SCH patients than control and after L-T4 therapy, there was significant improvement of both clinical score and serum lipids. Also SCH patients had significantly higher isovolumetric relaxation time "IVRT' and peak A value than control moreover preejection period "PEP" as well as PEP/ET were significantly longer in patients than controls and these changes fully reversed after L-T4 therapy. SCH patients has negative clinical metabolic and echocardiographic effects and these negative effects are fully reversible after LT4 therapy. Therefore subclinical hypothyroidism is better considered a condition of minimal tissues hypothyroidism than a compensated state. Indeed, L-T4 replacement therapy should be advised for these patients with the aim to prevent both the progression to frank hypothyroidism and the development of clinically significant myocardial dysfunction

Assessment of myocardial perfusion by harmonic power doppler intermittent imaging and real time Coherent imaging: comparison with SPECT imaging

In this study, 41 patients with suspected or known coronary artery disease were examined by myocardial contrast echocardiography [MCE] using randomly either harmonic power Doppler with intermittent imaging [27 patients] or real time coherent imaging [14 patients] using intravenous Levovist infusion. All patients underwent single photon emission computed tomography [SPECT] after the injection of technetium-99m [Tc-99m] sestamibi or thallium-201 [Th 201] at rest within one to three days of MCE. Both echocardiographic and scintigraphic images were analyzed by two experienced cardiologists in a blinded manner using the same 16-segment model of the left ventricle and the same scale used for perfusion grading. The concordance between MCE [harmonic power Doppler intermittent imaging [HPDI] or real time imaging [RTI]] and SPECT for the detection of segments with normal or abnormal perfusion was analyzed