Endocrine and cytokine changes during elective surgery.

Wellby, M.L.; Kennedy, Jennifer A.; Barreau, P.; Roediger, W. E. W.

doi:10.1136/jcp.47.11.1049

Cited by 34 publications

(14 citation statements)

References 9 publications

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“…The insignificant alterations of cytokines (interleukins 1β and 6 and TNF-α) probably excludes a systemic effect of the transient thyroid hormones changes, as has been suggested. 12 We did not find any correlation of the thyroid hormones with noradrenaline, cortisol or ACTH, in accordance with previous studies 3 . A possible role of beta-endorphin in regulating thyroid status at the hypothalamic level has also been suggested, though recent research has questioned such a role.…”

Section: Thyroid Hormonessupporting

confidence: 93%

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The differential impact of volatile and intravenous anaesthetics on stress response in the swine

Kostopanagiotou¹,

Kalimeris²,

Christodoulaki³

et al. 2010

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OBjEcTIVE: To compare the effects of various anaesthetics on stress response in the presence and absence of surgical stimulation. DESIGN: Twenty-nine pigs scheduled to undergo surgical central vein catheter placement were randomly allocated to receive only sedation with ketamine-midazolam (group SHAM, n=5) or general anaesthesia with either propofol 8 mg/kg/h (group PROP, n=8), sevoflurane 1.0 MAc (group SEVO, n=8) or desflurane 1.0 MAc (group DESF, n=8). Following surgery, anaesthesia was maintained for a total period of 4 hours. Thyroid hormones, noradrenaline, cortisol, corticotrophin (AcTH), β-endorphin, interleukin-1β and -6 and tumor necrosis factor-α were determined by appropriate methodology after premedication (t0), after surgical procedure (t1) and at the end of 4h (t2). RESULTS: At t1 AcTH and β-endorphin increased in all groups, thyroxin in groups SEVO, DESF and PROP, noradrenaline in group SEVO and cortisol in the SHAM and PROP groups. At t2 cortisol and AcTH levels were lower in the PROP compared to SEVO group. Serum cytokines were not significantly altered in either group. cONcLUSIONS: The choice of the general anaesthetic did not affect thyroid hormones levels in either the presence or absence of surgical stimulus. In the presence of surgical stimulation, sevoflurane resulted in higher noradrenaline levels and in higher activity of the AcTH-cortisol axis compared to propofol.

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Section: Thyroid Hormonessupporting

confidence: 93%

“…[8][9][10][11] To further complicate the issue, upon exposure to anaesthetics both increases and decreases of thyroid hormones have been found. 3,[12][13][14][15][16] These diverse results may be due to differences in the study set-up and/or in the study populations, the presence of surgical stress and the varying degrees of surgical stimulation.…”

mentioning

confidence: 99%

The differential impact of volatile and intravenous anaesthetics on stress response in the swine

Kostopanagiotou¹,

Kalimeris²,

Christodoulaki³

et al. 2010

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“…Following a dose of IL-6 that was chosen to produce transient elevations in IL-6 levels comparable with those reported with acute severe stress (12,16,17), there were differences between the stress hormone responses of FM patients and healthy controls. The peak ACTH response was delayed in FM patients compared with controls.…”

Section: Discussionmentioning

confidence: 99%

Responses of the sympathetic nervous system and the hypothalamic–pituitary–adrenal axis to interleukin-6: A pilot study in fibromyalgia

Torpy

Papanicolaou

Lotsikas

et al. 2000

Arthritis & Rheumatism

189

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Exaggerated NE responses and heart rate increases, as well as delayed ACTH release, were observed among female FM patients compared with age-matched female controls. Delayed ACTH release after IL-6 administration in FM is consistent with a defect in hypothalamic CRH neuronal function. Exaggerated NE release may reflect abnormal regulation of the sympathetic nervous system, perhaps secondary to chronically deficient hypothalamic CRH. The excessive heart rate response after IL-6 injection in FM patients may be unrelated to the increase in NE, or it may reflect an alteration in the sensitivity of cardiac beta-adrenoceptors to NE. These responses to a physiologic stressor support the notion that FM may represent a primary disorder of the stress system.

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“…Recently, such a role of cytokines in the pathogenesis of low T 3 syndrome has been challenged. At least the early phase of low T 3 syndrome seemed not to be caused by IL-6, since changes in thyroid hormones preceded increased cytokine levels in surgical patients [41]. Moreover, endotoxin-induced low T 3 syndrome was not attenuated when IL-1, IL-6, or TNF were neutralized [6,10,11].…”

Section: Discussionmentioning

confidence: 89%

Low T3 Syndrome in Head-Injured Patients is Associated with Prolonged Suppression of Markers of Cell-Mediated Immune Response

et al. 2005

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European Journal of Trauma Ab stractPurpose: To clarify the association between disturbed thyroid hormone metabolism (low T 3 syndrome) and release of cytokines and markers of cell-mediated immune response. Material and Methods: Concentrations of cytokines as well as of thyroid hormones were determined in 32 patients suffering from severe traumatic brain injury: interleukin-(IL-)1, IL-6, IL-10, tumor necrosis factor, transforming growth factor-(TGF-)β, soluble interleukin-2 receptor (sIL-2R), neopterin, and β 2 -microglobulin (β2m) in serum and cerebrospinal fluid; triiodothyronine (T 3 ), free T 3 , thyroxine (T 4 ), free T 4 , thyrotropin, thyroxine-binding globulin, and albumin in serum. Additionally, clinical parameters were assessed: Glasgow Coma Score, CT scan, intracranial pressure, Glasgow Outcome Score, and occurrence of pneumonia. Results: Among 31 patients with a low T 3 syndrome, those with additional low serum T 4 levels (n = 13) showed a prolonged suppression of serum β2m, neopterin, and sIL-2R, and a higher secondary increase of serum β2m, neopterin, and TGF-β, as well as lower T 3 levels (all p < 0.05). These patients also had a longer stay in the intensive care unit (34 ± 6 days vs. 22 ± 12 days; p = 0.008). Increased levels of β2m correlated with a preceding decrease of thyrotropin (cerebrospinal fluid: r = -0.53; p = 0.004; serum: r = -0.41; p = 0.029). Associations of thyroid hormone metabolism with either other cytokines or with clinical parameters were not detected. Conclusion:These results show that low T3 syndrome is a very common pathophysiological feature after severe traumatic brain injury. The association of a low T 3 syndrome in combination with low serum T 4 levels, with an altered time course of markers of cell-mediated immunity led the authors to hypothesize that a disturbed thyroid hormone metabolism may be interrelated with a prolonged cellular immune dysfunction after traumatic brain injury.

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Endocrine and cytokine changes during elective surgery.

Cited by 34 publications

References 9 publications

The differential impact of volatile and intravenous anaesthetics on stress response in the swine

The differential impact of volatile and intravenous anaesthetics on stress response in the swine

Responses of the sympathetic nervous system and the hypothalamic–pituitary–adrenal axis to interleukin-6: A pilot study in fibromyalgia

Low T3 Syndrome in Head-Injured Patients is Associated with Prolonged Suppression of Markers of Cell-Mediated Immune Response

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