HYPOTHYROIDISM AS A CAUSE OF DIFFUSE CORONARY ARTERY ATHEROSCLEROSIS IN A YOUNG WOMAN (CLINICAL CASE)

Introduction. Thyroid dysfunction is most common in young women. Hypothyroidism is an additional cardiovascular risk factor due to elevated levels of total cholesterol (TC) and LDL in this pathology. Clinical example. Patient M., 41 years old, was admitted to AKKD with suspected angina. BMI - 47 kg/m2. At the age of 25, diffuse toxic goiter was detected. In 2013 - strumectomy, in the postoperative period pronounced hypothyroidism, bilateral laryngeal paralysis, surgical treatment in 2015. History of bronchial asthma. Clinical presentation of angina for about two years, progression 3 weeks before admission. On admission, 6-minute walk test: 280 meters (shortness of breath, pressing pain behind the sternum). According to ECG at admission: disturbance in the repolarization phase along the anterolateral wall of the left ventricle. Coronary angiography (CAG) was performed: LAD - stenosis in the initial section 80% occlusion in the middle third, distal sections do not spill. LCX - 70% stenosis in the initial section of the stenosis of the and LCX distal up to 70%. RCA - occlusion in the initial section of the flow from the LCA. According to echocardiography (EchoCG): ejection fraction (EF) according to Teicholz: 62.805. Violation of the diastolic function of the obstructive left ventricle using the Doppler method. By duplex of vessels of the head and neck: Signs of the atherosclerosis of carotid arteries without hemodynamically significant stenosis. In the tests: TSH - 33.60 (normal 0.4 -4.0) μIU/ml), free T4 -16.4 (normal 10.3 - 24.5) pmol/l, sugar -6.2 mmol/l, cholesterol - 11.30 mmol/l, TG - 2.90 mmol/l, HDL-C - 1.20 mmol/l, LDL-C - 8.78 mmol/l, CKD-EPI 113 ml/min/1.73 sq.m. The documents were sent to the Federal Center (FC) to resolve the issue of aortocoronary bypass grafting (ACB). Given the diffuse type of coronary artery disease affecting the distal bed, surgical treatment is not recommended, conservative management. Discharged with selected antianginal therapy in a satisfactory condition. Outpatient clinical dynamics: angina pectoris type 2, conservative management. Discussion. The interest of the clinical case is that the cause of diffuse coronary bed in this case is severe hypercholesterolemia, in the background of prolonged postoperative hypothyroidism, as a result of impaired utilization of LDL due to a decrease in the level of expression of LDL receptors in the background of severe hypothyroidism. In this case, it is recommended to initiate combined lipid lowering therapy, given the very high risk of LDL levels greater than 8 mmol/l. Furthermore, strict correction of hypothyroidism therapy with dynamic hormone monitoring is necessary. Conclusion. Thus, it is obvious that thyroid function deficiency serves as a significant reason to initiate primary and secondary prevention of coronary heart disease with strict control of thyroid hormone levels.