Thyroxine replacement and ischaemic heart disease in the elderly

Elderly patients with coronary artery disease and hypothyroidism should be treated cautiously with thyroid hormone replacement to avoid precipitating or exacerbating angina pectoris, precipitating acute myocardial infarction, and precipitating or aggravating ventricular arrhythmias or congestive cardiac failure. However, despite this, 7% will develop angina at the time of starting thyroxine replacement therapy and nearly half of these will not respond to standard antianginal therapy. We present a case of thyroxine replacement induced angina and its management as well as a review of the medical literature concerning the potential therapeutic options in the management of unmasked ischaemic heart disease, hypothyroidism and thyroxine replacement therapy.