Cardiovascular Effects of Intravenous Triiodothyronine in Patients Undergoing Coronary Artery Bypass Graft Surgery

Bennett-Guerrero, E.

doi:10.1001/jama.1996.03530330031025

Cited by 134 publications

(22 citation statements)

References 51 publications

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“…This kind of study would demand a longer follow-up time and, in cases of prolonged NTIS, might also demand a reconsideration of hormone replacement therapy. Based on the assumption that NTIS associated with CABG can decrease left ventricular function postoperatively, T3 has sometimes been introduced in cardiac surgery patients, but the results of most studies by several authors denounced the benefits of hormone replacement therapy (13, 31-33). Still, the studies up to now were mostly short-term, and to clarify which patients can actually benefit from hormone replacement therapy, long and long-term prospective studies are necessary (2).…”

Section: Discussionmentioning

confidence: 99%

Nonthyroidal illness syndrome in off-pump coronary artery bypass surgery

Caluk

Caluk²,

Osmanović³

2015

Anatol J Cardiol

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Objective:It is well known that coronary artery bypass grafting (CABG) is often the cause of non-thyroidal illness syndrome (NTIS). Nonthyroidal illness syndrome (NTIS) is a state characterized by low levels of tri-iodo-thyronine (T3) and high levels of reverse T3 (rT3), with normal or low levels of thyroxin (T4) and normal, low-normal, or low levels of thyroid-stimulating hormone (TSH). Today, there are two main techniques of CABG: CABG with the use of cardiopulmonary bypass (on-pump coronary artery bypass - ONCAB) and CABG without the use of cardiopulmonary bypass (off-pump coronary artery bypass OPCAB), or ’beating-heart surgery.’ The OPCAB technique is considered to be less invasive. We prospectively investigated the influence of these surgical techniques on the occurrence of NTIS.Methods:Serum levels of free fractions of thyroid hormones (FT3 and FT4) and TSH were analyzed in 70 consecutive patients subjected to CABG surgery, using the ONCAB technique in 36 patients and OPCAB technique in 34 patients. The measurements of hormone levels were performed prior to surgery and 12 hours and 14 days after surgery.Results:The basic, the early, and the late postoperative serum levels of FT3 (p=0.458, p=0.632, p=0.869, respectively), FT4 (p=0.664, p=0.301, p=0.417, respectively), and TSH (p=0.249, p=0.058, p=0.324, respectively) were similar in both groups. The levels of FT3 and TSH were significantly lower 12 hours after surgery (p<0.0001, p<0.0001, respectively), and the FT4 levels rose at the same time (p<0.0001). The third measurement showed the return of all investigated parameters back to physiological levels, although they were still not precisely within the initial values.Conclusion:NTIS occurs significantly in patients subjected to CABG. Although the OPCAB technique is considered to be less invasive, its impact on the occurrence of NTIS does not differ significantly from the ONCAB technique.

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Section: Discussionmentioning

confidence: 99%

Nonthyroidal illness syndrome in off-pump coronary artery bypass surgery

Caluk

Caluk²,

Osmanović³

2015

Anatol J Cardiol

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“…It [27], and administration of T3 and/or T4 to experimental myocardial dogs [28] or infectious rats [29] failed to improve the natural courses of these diseases. Further investigations are needed to clarify the pathophysiology and impact of therapy in nonthyroidal illnesses.…”

Section: Discussionmentioning

confidence: 99%

Effect of Triiodothyronine Administration on Reduced Expression of Type 1 lodothyronine Deiodinase Messenger Ribonucleic Acid in Streptozotocin-induced Diabetic Rats.

et al. 1999

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Abstract.To examine the mechanism behind a decrease in type 1 iodothyronine deiodinase (D1) gene expression in diabetes mellitus, we evaluated the effect of administering T3 and/or insulin on Dl activity and the mRNA levels in the liver of streptozotocin (STZ)-induced diabetic rats. STZ (100 mg/kg BW) was administered to male Wistar rats, and the rats were divided into four groups as follows: (1) STZ alone, (2) STZ and T3 (5 pg/100 g BW daily for 7 days), (3) STZ and insulin (intermediate-acting insulin, 4 units/100 g BW daily for 7 days), and (4) STZ, T3, and insulin. Blood glucose levels increased in Group 1, but were normalized in Group 3. Serum T3 levels were markedly decreased in Group 1. They were within normal limits 24 hours after the last administration of T3 in Group 2 and after the administration of insulin in Group 3. T3 levels were supranormal in Group 4. TSH levels were normal in Groups 1 and 3, but were suppressed in Groups 2 and 4, suggesting that rats in Groups 2 and 4 were actually in a hyperthyroid state after injecting a large amount of T3. D1 activity in Group 1 was reduced significantly, but it was normal in Groups 2 and 3, and increased in Group 4. D1 mRNA levels in the liver in Group 1 decreased significantly, but they were increased to within normal limits by adding insulin in Group 3. They were also normal in Group 2 where hyperglycemia was evident and rats were hyperthyroid after administering T3. D1 mRNA in Group 4 increased significantly where glucose levels were normal and T3 levels were increased. We suggest that the decrease in hepatic D1 mRNA in STZ-induced diabetic rats is due to metabolic derangement caused by insulin deficiency in addition to a possible decrease in tissue T3 availability. to T3 in peripheral tissues [6][7][8][9], and reduced hypothalamic and plasma thyrotropin releasing hormone (TRH) [10, 11 ] . In these rats serum TSH is low [6, 10] or normal [12], which probably represents different stages of a dynamic process [13]. Since the cDNA for the type 1 iodothyronine deiodinase (D1) was isolated and Dl was classified as a selenoprotein [141, the regulation of D 1 gene expression has been studied [5,[15][16][17]. Dl mRNA levels and the deiodinating activity are reduced in STZ-induced DM rats, and the relatively late decreases in D 1 mRNA levels and the activity suggested that these changes are secondary to, rather than causative of, decreased serum and tissue T3

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“…Thyroid hormone administration has been shown to stabilize the function of the cardiovascular system of organ donors (Taniguchi et al, 1992). Similarly, T3 treatment has been shown to improve hemodynamic parameters in patients undergoing coronary artery bypass graft surgery (Bennett-Guerrero et al, 1996) or with severe congestive heart failure (Malik et al, 1999). In children, treatment with T3 after cardiopulmonary bypass operations improves myocardial function and reduces the need for postoperative intensive care (Bettendorf et al, 2000).…”

Section: Sparing Energy For Metabolic Requirements or Selenium For Glmentioning

confidence: 99%

“…Although NTIS patients might be evaluated as euthyroid regarding serum TSH levels, many authors have advocated that they would benefit from thyroid hormone replacement (Utiger, 1995; Bennett-Guerrero et al, 1996; Dulawa et al, 2007; Pingitore et al, 2008). The proposed physiopathological grounds for this comes from the fact that intratissular hypothyroidism would lead to exacerbation of the pathology itself.…”

Section: Sparing Energy For Metabolic Requirements or Selenium For Glmentioning

confidence: 99%

“…No benefit was observed for survival in patients with acute renal failure or renal transplantation, as well as intensive care patients randomly assigned to receive intravenous T4 or T3 vs. placebo (Brent and Hershman, 1986; Acker et al, 2000, 2002). Moreover, thyroid hormone was of no benefit in long-term outcomes of patients with severe congestive heart failure (Pingitore et al, 2008) or in patients who underwent myocardial revascularization (Bennett-Guerrero et al, 1996). Other studies even indicate that T3 replacement might have negative effects on protein and fat metabolism (Axelrod et al, 1983; Lim et al, 1985; Dulawa et al, 2007).…”

Section: Sparing Energy For Metabolic Requirements or Selenium For Glmentioning

confidence: 99%

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New Insights toward the Acute Non-Thyroidal Illness Syndrome

Wajner¹,

Maia²

2012

Front. Endocrin.

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The non-thyroidal illness syndrome (NTIS) refers to changes in serum thyroid hormone levels observed in critically ill patients in the absence of hypothalamic–pituitary–thyroid primary dysfunction. Affected individuals have low T3, elevated rT3, and inappropriately normal TSH levels. The pathophysiological mechanisms are poorly understood but the acute and chronic changes in pituitary–thyroid function are probably the consequence of the action of multiple factors. The early phase seems to reflect changes occurring primarily in the peripheral thyroid hormone metabolism, best seen in humans since 80–90% of the circulating T3 are derived from the pro-hormone T4. The conversion of T4 to T3 is catalyzed by type 1 (D1) and type 2 (D2) deiodinases via outer-ring deiodination. In contrast, type 3 deiodinase (D3) catalyzes the inactivation of both T4 and T3. Over the last decades, several studies have attempted to elucidate the mechanisms underlying the changes on circulating thyroid hormones in NTIS. Increased inflammatory cytokines, which occurs in response to virtually any illness, has long been speculated to play a role in derangements of deiodinase expression. On the other hand, oxidative stress due to augmented reactive oxygen species (ROS) generation is characteristic of many diseases that are associated with NTIS. Changes in the intracellular redox state may disrupt deiodinase function by independent mechanisms, which might include depletion of the as yet unidentified endogenous thiol cofactor. Here we aim to present an updated picture of the advances in understanding the mechanisms that result in the fall of thyroid hormone levels in the acute phase of NTIS.

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Cardiovascular Effects of Intravenous Triiodothyronine in Patients Undergoing Coronary Artery Bypass Graft Surgery

Cited by 134 publications

References 51 publications

Nonthyroidal illness syndrome in off-pump coronary artery bypass surgery

Nonthyroidal illness syndrome in off-pump coronary artery bypass surgery

Effect of Triiodothyronine Administration on Reduced Expression of Type 1 lodothyronine Deiodinase Messenger Ribonucleic Acid in Streptozotocin-induced Diabetic Rats.

New Insights toward the Acute Non-Thyroidal Illness Syndrome

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