A Review of Thyroid Hormone Administration during Adult Donor Care

Abstract

Serum concentrations of thyroid hormones tetraiodothyronine and triiodothyronine commonly are low after head injury and brain death. Thyroid hormone replacement therapy, however, is a controversial part of donor management. This article reviews publications in which thyroid hormone administration was evaluated in human donors. A classification of the "quality" of study methods used in those publications is presented as part of the data review. No publications support the routine administration of thyroid hormone for all donors. "Rescue" replacement in support of cardiac inotropic function is supported by some studies, but the experimental design of those investigations is not optimal. Thyroid hormone replacement and its dosing should be decided by organ procurement organizations as part of treatment protocols.

Brain death and its implications for management of the potential organ donor

“…37,38 Other studies, however, could not confirm these results, 39 and in most human studies there is no correlation between plasma T3 levels, cardiac function, and the need for inotropic support. [40][41][42] In a review by Powner and Hernandez, 43 it was concluded that routine replacement of thyroid hormones for all donors could not be advocated. In a recent, randomized-controlled trial, T3 administration neither changed cardiac performance nor heart retrieval rate from human brain-dead donors.…”

How Does One Care for the Heart-Beating, Brain Dead, Adult Organ Donor Patient?

“…Routine therapy is not recommended, 5,29 and other use remains controversial. Routine therapy is not recommended, 5,29 and other use remains controversial.…”

“…Routine therapy is not recommended, 5,29 and other use remains controversial. 29 Because T 3 is rarely available as an intravenous preparation, tetraiodothyronine (T 4 ), 100 mg intravenous bolus followed by 50 mg every 12 hours, is advocated, although the peripheral conversion of T 4 to T 3 is expected to be low. 29 Because T 3 is rarely available as an intravenous preparation, tetraiodothyronine (T 4 ), 100 mg intravenous bolus followed by 50 mg every 12 hours, is advocated, although the peripheral conversion of T 4 to T 3 is expected to be low.…”

Brain Death and Donor Management

“…53 More recent studies have been unable to document abnormal hormone levels, however, and speculate that the previous interpretations are more consistent with the inflammatory response of critical illness and brain death. 66 Of the 10 studies reviewed, 4 supported the use of thyroid hormones, 51,53,56,75 whereas 4 did not offer support. 66 Of the 10 studies reviewed, 4 supported the use of thyroid hormones, 51,53,56,75 whereas 4 did not offer support.…”