Cardiopulmonary Bypass: &amp;lsquo;A Low T&lt;sub&gt;4&lt;/sub&gt; and T&lt;sub&gt;3&lt;/sub&gt; Syndrome&amp;rsquo; with Blunted Thyrotropin (TSH) Response to Thyrotropin-Releasing Hormone (TRH)

Robuschi, G.; Medici, D; Fesani, F; Barboso, G; Montermini, Mara; d’Amato, L.; Gardini, E.; Borciani, E; Dall’Aglio, Elisabetta; Salvi, Mario

doi:10.1159/000180311

Cited by 86 publications

(23 citation statements)

References 18 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…5) In patients with a left ventricular ejection fraction below 30%, T3 administration at the end of operation and during the initial 24 hours after operation was associated with a significantly reduced need for conventional inotropic agents and diuretics; also in patients with a left ventricular ejection fraction over 40%, T3 administration resulted in significantly improved stroke volume and cardiac output with reduced systemic and pulmonary vascular resistances.13) In another group of patients, TRH administered during cardiopulmonary bypass elicited a markedly blunted TSH response which might be the consequence of the elevation of FT4 and FT3 due to heparin administration. 18) In our study, the clinical results showed a good correlation with the other studies. The concentrations of total T3 and FT3 decreased progressively after the institution of cardiopulmonary bypass and remained below normal throughout the study intervals, whereas there was no significant difference in the concentrations of either total T4, FT4 or TSH.…”

Section: Discussionsupporting

confidence: 88%

The Effects of Thyroid Hormones on the Heart Following Global Ischemia. A Clinical and Experimental Study.

et al. 1994

View full text Add to dashboard Cite

SUMMARYCardiopulmonary bypass is associated with a reduction in plasma thyroid hormone concentrations in patients undergoing cardiac surgery. However, studies of the effects of cardiopulmonary bypass on thyroid function are limited and many studies report conflicting data concerning only the period of cardiopulmonary bypass.In this study, we tried to clinically determine the effects of cardiopulmonary bypass on concentrations of thyroid hormones by comprehensive thyroid function tests in 10 patients before and after surgery, and observed the benefits of triiodothyronine supplementation after global ischemia on myocardial function experimentally in guinea pigs. In patients undergoing surgery, concentrations of total triiodothyronine and free triiodothyronine decreased progressively on the institution of cardiopulmonary bypass and remained below normal levels until 24 hours postoperatively.In the guinea pig hearts studied in a Langendorf perfusion apparatus, T3 supplementation enhanced percentage recovery of ventricular contractile force, heart work and heart rate with respect to other groups receiving no T3 supplementation or T3 supplementation without any ischemic interval. (Jpn Heart J 35: 443-454, 1994)

show abstract

Section: Discussionsupporting

confidence: 88%

The Effects of Thyroid Hormones on the Heart Following Global Ischemia. A Clinical and Experimental Study.

et al. 1994

View full text Add to dashboard Cite

show abstract

“…In addition to severe heart diseases, deficiency of T3 has also been reported in patients after cardiopulmonary bypass surgery [24,25], and in heart transplantation donors and recipients, and may contribute to donor heart dysfunction after heart transplantation [26]. Treatment with TH has been shown to improve LV function in several heart diseases including MI [10].…”

Section: Discussionmentioning

confidence: 99%

Short term triiodo-l-thyronine treatment inhibits cardiac myocyte apoptosis in border area after myocardial infarction in rats

Chen

Kobayashi

Chen

et al. 2008

Journal of Molecular and Cellular Cardiology

107

View full text Add to dashboard Cite

Thyroid hormone (TH) levels decline after a myocardial infarction. Treatment with TH has been shown to improve left ventricular (LV) function in myocardial infarction (MI) and other cardiovascular diseases, but the mechanisms are not clear. We have previously shown that TH can prevent myocyte apoptosis via Akt signaling in cultured neonatal rat cardiomyocytes. In this study, the effects of triiodo-L-thyronine (T3) on LV function and myocyte apoptosis after MI was examined in rats. After surgery, MI rats were treated with T3 for 3 days. Compared with sham-operated rats, MI rats showed significantly increased LV chamber dimension during systole and decreased LV function. T3 treatment increased LV ±dP/dt but did not change LV chamber dimensions. MI rats also showed significantly increased myocyte apoptosis in the border area as assessed by DNA laddering and TUNEL assay. T3 treatment decreased the amount of DNA laddering, and reduced TUNEL positive myocytes in the border area, which was associated with phosphorylation of Akt at serine 473. These results suggest that T3 can protect myocytes against ischemia induced apoptosis, which may be mediated by Akt signaling.

show abstract

“…A significant reduction in plasma FT 3 has been documented in patients undergoing open heart procedures on CPB (Bremner et al 1978, Robuschi et al 1986, Novitzky et al 1989a, Novitzky & Cooper 1990). We proposed the hypothesis that it was this reduction in circulating FT 3 that was in part responsible for a deterioration of myocardial function in such patients.…”

Section: Studies On T 3 Therapy Following Transient Global Myocardialmentioning

confidence: 99%

Thyroid hormone and the stunned myocardium

Novitzky¹,

Cooper²

2014

Journal of Endocrinology

View full text Add to dashboard Cite

Acute critically ill patients experience a rapid decline in plasma free thyroid hormone levels (free triiodothyronine (FT 3 ) and free levothyroxine (FT 4 )), with a marked elevation of reverse T 3 , recognized as the euthyroid sick syndrome (ESS) or low-T 3 syndrome. The ESS is also often associated with depressed myocardial function, sometimes referred to as the 'stunned myocardium'. Its clinical effects may vary from minimal hemodynamic impairment to cardiogenic shock. Medical management may range from aspirin alone to placement of a left ventricular assist device. With adequate supportive therapy, recovery usually occurs within days or weeks. The effect of T 3 /T 4 therapy has been studied in three conditions in which the ESS and myocardial functional depression have been documented -i) transient regional myocardial ischemia and reperfusion, ii) transient global myocardial ischemia in patients undergoing cardiac surgery on cardiopulmonary bypass, and iii) transient inadequate global myocardial perfusion in brain-dead potential organ donors. Under all three conditions, myocardial ischemia leads to rapid loss of high-energy phosphates, accumulation of myocardial tissue lactate, and probably loss of homeostasis of cytosolic calcium, which may further increase cell injury. There is an inability to generate ATP through the Krebs cycle, which reduces the high-energy phosphate pool essential for all cell ATPases. Under all three conditions, following administration of T 3 /T 4 , the myocardial dysfunction was rapidly reversed. We, therefore, cautiously advocate the use of thyroid hormonal therapy to any patient with the ESS and/or a stunned myocardium.

show abstract

Cardiopulmonary Bypass: ‘A Low T<sub>4</sub> and T<sub>3</sub> Syndrome’ with Blunted Thyrotropin (TSH) Response to Thyrotropin-Releasing Hormone (TRH)

Cited by 86 publications

References 18 publications

The Effects of Thyroid Hormones on the Heart Following Global Ischemia. A Clinical and Experimental Study.

The Effects of Thyroid Hormones on the Heart Following Global Ischemia. A Clinical and Experimental Study.

Short term triiodo-l-thyronine treatment inhibits cardiac myocyte apoptosis in border area after myocardial infarction in rats

Thyroid hormone and the stunned myocardium

Contact Info

Product

Resources

About