Problems in the Treatment of Cardiac Failure in Myxedema

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Abstract
Twenty patients with myxedema were admitted to the hospital with cardiac failure. The myxedema itself was the only recognizable cause of the failure in 4 patients. Of the remaining 16, generalized arteriosclerosis was noted in 12, with demonstrable coronary sclerosis in 9, three of whom had developed coronary sclerosis shortly before entrance into the hospital. Hypertension was present in 7 cases, and syphilis, diabetes mellitus, and thrombosis of the pulmonary artery each in 1 instance. The progress of treatment with desiccated thyroid was followed in 13 patients by serial examinations with the following conclusions: Blood glucose and phosphatase were always normal. Free cholesterol moved in consonance with the total cholesterol. Blood proteins were usually high in the untreated patient but variations under treatment bore no significant relationship to the patient''s clinical condition. The weight, pulse rate, and circulation time were of little value in determining the proper therapeutic course when myxedema and cardiac failure were simultaneously present. Capillary permeability, uninfluenced by cardiac failure, was always high in the myxedematous state; a decrease was a constant and early sign of improvement in the thyroid status. Total blood cholesterol invariably decreased as the myxedematous state improved, but apparently it was not influenced by the cardiac complications. A lowered voltage of all complexes in each of the three limb leads not dependent upon the presence of hydroperi-cardium, was the most commonly observed alteration in the electrocardiogram of myxedematous patients. Under treatment with desiccated thyroid, roentgenographic silhouette of the heart of the patient with myxedema became slightly smaller, but the change was of little use in directing the course of therapy. In myxedema initially tolerated doses of desiccated thyroid have ranged from 0.05-3.0 grains and maintenance doses from 1.0 to 3.0 grains daily.

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