Myocardial Perfusion&Hypothyroidism

HAVE ALREADY POSTED THIS IN "HYPOTHYROIDISM" FORUM, BUT HAVE CROSS-POSTED BASED ON RECOMMENDATIONS THERE.  THANKS!
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Hi, there - Greatly appreciate in advance any help or advice someone can provide on the painfully circular issue we're presented with that I explain below!  I imagine hypothyroid patients and some doctors alike will find some of this familiar :)  Since we are having a lot of trouble getting our doctors to speak to us as thinking beings and not brainless idiots, we need to do our own investigation so we can make an informed decision.

HISTORY:
My partner recently quit smoking after a cold (about 5 months ago) and almost immediately began experiencing terrible lethargy\fatigue, weight gain (despite an extreme and positive change in diet), ankle edema, shortness of breath and a sinus infection.  These were not symptoms she'd experienced while she was smoking, so we both thought it could possibly be a product of nicotine withdrawl (withdrawal).  When it continued, she saw a doctor and was subsequently diagnosed as having severe hypothroidism.  TSH was above 100 and T3\T4 were equally out of whack.  She'd obviously been functioning before because of the smoking\nicotine, which is ironic.

Her GP prescribed 50mcg Levothroid and told her to get in touch with an endo, which she did.  After an initial consultation, the endo recommended aggressive treatment and that she go up to 75mcg.  After a few days, she experienced chest tightening and continued shortness of breath so the endo told her to go back to 50mcg and schedule a diagnostic appointment with a cardiologist.

All of the above took about two months from diagnosis-to-cardiology appt.

After an unsuccessfull treadmill stress test was performed (the fatigue would not allow her to get up the required heart rate) the results of myocardial imaging pre\post stress indicated abnormal MP along with moderate reversible apical defect - "moderately decreased activity in the inferoapical segment" - and global hypokinesis.  Vent cavity size is normal and blood pressure\heart rate is also normal pre\post stress.  EF% is 49.  She did not experience any chest pain or discomfort during the test, only severe shortness of breath and muscle cramps in her legs.

Here's our dilemma:  

a) The cardiologist told her she needs to now go in for catheter angiography and that she could have a blockage or lesion.  To be frank, he barely acknowledged our questions and wouldn't speak to the connection between myocardial perfusion and severe hypothyroidism.  He told us we were "over-intellectualizing" when we tried to ask about the hypothyroidism as it related to the mild myocardial perfusion.  He told us we were in denial when we asked whether the failed stress test could be used as a gauge since she wasn't even able to get up to the required heart rate.

b) Our endo will not aggressively treat her for the severe hypothyroidism unless she's cleared by a cardiologist and we're positive that 50mcg is not getting her balanced, so the hypo symptoms are plaguing her every single day.

An aside - we're going off to find another cardiologist and have scheduled an appointment with one highly-recommended a week or so from now.

The cardiologist won't clear her until she has this angiography so we're stuck and she's miserable!  

I have read that mild-to-moderate myocardial perfusion could be considered "typical" and even "frequent" for patients with severe hypothyroidism who have recently started a regimen of thyroxine and that those symptoms right themselves once the body balances out with the new level of hormone.  Since all of this has gone on and she hasn't been able to adjust her medication adequately, we still don't know if she's one of the lucky ones that will produce T3 from T4 (levothryoid) so the cardio test results could be even more skewed due to her untreated hormone imbalance.

I know I'm probably a doctor's worst nightmare since I research everything from a simple car purchase to a serious health issue, but all I want to know is whether we should consider this relatively risky invasive procedure since it seems we don't get help from any specialist until she goes through it.

We're both very worried that in her compromised state, she may be more at risk than the average patient and could have complications during the procedure.

Has anyone been through this sort of thing?  Did you opt to have the angiography, get a "clean" bill of health and proceed with getting balanced?  Am I silly to worry about this procedure?  

I do understand that angiography is the gold standard in ruling out underlying problems, but I just want to make sure we take everything into consideration.  I do not look back later and find that the procedure caused more damage that it was worth when the symptoms and test results were due to the hypothyroidism all along - particularly since time's going by and it's not even being treated.  

Geesh, sorry for the long post.  Again, greatly appreciate any insight.  

Jen

[ed34]

Well, to be frank with you, an angiogram is very low risk indeed. A patient is continuallly monitored during the procedure and to be even safer, the patient is wide awake. I have had four of these now and there is no discomfort at all. I would have thought you would be looking at having the angiogram with more enthusiasm. There is no more accurate method to see what is going on inside the coronary arteries and a complete map of the
blood vessels along with their condition will be saved on a computer for future reference.
I would see it as "better safe than sorry". If there is a blockage then it can be treated
at the same time which will produce good benefits health wise. Why wait for a heart attack to happen when you can have the opportunity of such a good check up. An angiogram is not really an 'invasive' procedure as there is only a tiny incision made at the top of the inner thigh. The chest is not opened and I would class that as invasive.
You don't feel the catheter moving around, all you occassionally feel is a 'heat' sensation
if they squirt a large amount of the radio isotope into the vessels.
Just a couple of hours after the procedure you are up and walking about like nothing had
happened.

[kenkeith]

A ct scan-64 slice angiogram is almost  as good as a cath angiogram when viewing the lumen.  I have had both.  The cath implant was performed when I was in ICU for congested heart failure about 5 years ago. The recent scan was able to view blood into the stented RCA 5 years ago and the blood flow out to assess the implant's effectiveness.

A calcium score was caculated recently with a ct-scan and is representative of the soft plaque between the layers of the vessel as well as the lumen.  The higher the score the higher the risk of a heart attack. A cath only views the lumen for any blockage (hard plaque).

When the ct-128 slice scan when available will be better than the 64 scan.  The scan is not appropriate for every individual.  There is med injected to slow the heart rate, and there is a need to be able to hold your breath during the scan.

[ed34]

It's also all down to cost. Scanners cost huge amounts of money and most hospitals in
the UK unfortunately only have one. On average there are 3 cat labs in a hospital and an
extra available for emergencies. It's a shame that new technology always has to regain
research/development costs so quickly and investors expect a huge profit on top.