Prevalence of subclinical hypothyroidism in hypercholesterolemic adults and influence of serum TSH on the serum total cholesterol level / 대한내과학회지

BACKGROUND: Subclinical hypothyroidism is frequently discovered from hypercholesterolemic adults. It is defined as an asymptomatic state which characterized by normal free thyroxine (FT4) and elevated thyroid stimulating hormone (TSH) level. Hypercholesterolemia is a major risk factor for coronary heart disease, however hypercholesterolemia caused by hypothyroidism can be easily managed by thyroid hormone replacement. The screening of thyroid disease in hypercholesterolemia patient must be emphasized in order to find out correctable hypothyroidism. So we screened the prevalence of overt and subclinical hypothyroidism at different hypercholesterol levels in middle-aged men and women and also analyzed the correlation between TSH and total cholesterol level. METHODS: We measured serum TSH levels and FT4 by radioimmunoassay from 491 patients with hypercholesterolemia. The subjects were divided into two groups according to serum cholesterol level. Group I was serum cholesterol > or = 240 - or = 300 mg/dL. Subclinical hypothyroidism was defined as TSH levels higher than 4 mU/L, in the presence of normal FT4 concentration. RESULTS: The overall prevalence of subclinical and overt hypothyroidism was 3.4% and 2.5% in men and 4.7% and 3.5% in women of middle age. In men the prevalence of overt and subclinical hypothyroidism increased from 2.3% of group I to 16.1% in the group II (p<0.05). In women that increased from 5.2 % to 12.9 % (p<0.05). After age correction, an increase of 1 mU/L TSH in men was associated with an increase of 3.2 mg/dL total cholesterol (p<0.01). A similar trend was also found in women (2.1 mg/dL p=0.052). CONCLUSION: In this population, the prevalence of hypothyroidism is up to 16.1% in middle-aged men, 12.9% in middle-aged women with high total cholesterol and it may justify screening of thyroid disease in hypercholesterolemic patients especially in clinical practice.

A Case of Three Major Coronary Arteries to Left Ventricular Fistulae via Common Channel

Multiple coronary arteries to communicating with the left ventricular fistulae is a very rare congenital anomaly in adults. This anomaly involves three major coronary arteries that have a direct communication between these arteries and the left ventricle. Hemodynamically, it induces myocardial ischemia due to coronary steal syndrome and diastolic volume overload from a left-to-left shunt. A 70-year-old woman with essential hypertension was admitted to our clinic to evaluate complaints of exertional dyspnea. Clinical examination revealed a diastolic murmur at the apex. A coronary angiogram showed a common fistular channel connecting the right coronary artery, the left circumflex coronary artery, and the first large diagonal branch of the left anterior descending coronary artery with the left ventricular chamber. The patient's symptoms were relieved by the administration of calcium channel blocker and angiotensin II receptor blocker. We report a very rare case of three major coronary arteries communicating to the left ventricular fistulae via a common channel.

A Case of Isolated Left Main Coronary Ostial Stenosis due to Acute Angle Takeoff

Isolated and severe left main coronary ostial stenosis is a rare case. In the majority of these patients ostial stenosis was associated with any of the conditions known to involve the coronary ostia. These conditions include syphilitic aortitis, Takayasu's aortitis, familial hypercholesterolemia, and aortic valve disease. A 34-year young female patient was presented with exertional and stabbing anterior chest pain. There was no history of syphilis, diabetes mellitus, hypertension, hyperlipidemia and smoking. Coronary angiogram showed isolated left main coronary ostial stenosis. Transesophageal echocardiography(TEE) showed acute angle takeoff of the left main coronary artery. She underwent surgical angioplasty of coronary ostia with a patch of autologous pericardium. After angioplasty, TEE showed dilatation of left main coronary ostium and her clinical symptom improved.