Euthyroid sick syndrome in paediatric and adult patients requiring extracorporeal circulatory support and the role of thyroid hormone supplementation: a review

Nistal-Nuño, Beatriz

doi:10.1177/0267659120914136

Cited by 7 publications

(2 citation statements)

References 62 publications

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“…Mainwaring et al found that neonatal TSH, FT3, and thyroglobulin levels decreased by 80% after CPB ( 18 ). Additionally, CPB is well-known to cause systemic inflammatory response syndrome, and inflammatory cytokines such as IL-6 have been shown to inhibit peripheral conversion of T4 to T3 ( 19 ). Abnormal circulating thyroid hormone levels are found during systemic disease, especially after cardiac surgery with CBP in the absence of primary thyroid disease.…”

Section: Discussionmentioning

confidence: 99%

Predictors of Low Cardiac Output Syndrome in Infants After Open-Heart Surgery

Zou

Wang

et al. 2022

Front. Pediatr.

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ObjectiveTo evaluate the predictors of low cardiac output syndrome (LCOS) in infants with congenital heart disease (CHD) after cardiopulmonary bypass (CPB).Study designA total of 217 infants were enrolled and classified according to whether they developed LCOS after cardiac surgery. Each infant's preoperative and intraoperative clinical variables were collected.ResultsThe incidence of LCOS was 28.11% in our study. The univariate analysis showed that the LCOS group was younger than the non-LCOS group (25.69 ± 25.01 days vs. 44.45 ± 26.97 days, P < 0.001), with a higher proportion of neonates (60.7 vs. 27.6%, P < 0.001) and a higher proportion of patients with a RACHS-1 score ≥4 (50.8 vs. 17.9%, P < 0.001). A lower weight (3.70 ± 0.74 vs. 4.23 ± 1.10 kg, P = 0.001), longer ACC time (61.96 ± 21.44 min vs. 41.06 ± 18.37 min, P < 0.001) and longer CPB time (131.54 ± 67.21 min vs. 95.78 ± 62.67 min, P < 0.001) were found in the LCOS group. The levels of free triiodothyronine (FT3) (4.55 ± 1.29 pmol/L vs. 5.18 ± 1.42 pmol/L, P = 0.003) and total triiodothyronine (TT3) (1.80 ± 0.56 nmol/L vs. 1.98 ± 0.54 nmol/L, P = 0.026) were also lower in the LCOS group. The multivariate binary logistic regression analysis and receiver operating characteristic (ROC) indicated that the ACC time, FT3 level and body weight were independent predictors of LCOS.ConclusionsIn our patient population, we first propose that preoperative FT3 can predict the occurrence of postoperative LCOS. ACC time, FT3 level and body weight are independent predictors of LCOS and maybe helpful in reducing the incidence of postoperative LCOS in the future.

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Section: Discussionmentioning

confidence: 99%

Predictors of Low Cardiac Output Syndrome in Infants After Open-Heart Surgery

Zou

Wang

et al. 2022

Front. Pediatr.

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“…It is often associated with a poor outcome. Despite decreased levels of T3 in combination with normal or decreased levels of T4 and TSH, most studies showed no benefit to treat these patients with intravenous thyroid hormones [49,50].…”

Section: Use In Intensive Carementioning

confidence: 99%

Indications for Intravenous T3 and T4

Feldkamp,

Feldkamp

2024

Horm Metab Res

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Therapy with thyroid hormones normally is restricted to substitution therapy of patients with primary or secondary hypothyroidism. Typically, thyroid hormones are given orally. There are few indications for intravenous use of thyroid hormones. Indications for parenteral application are insufficient resorption of oral medications due to alterations of the gastrointestinal tract, partial or total loss of consciousness, sedation in the intensive care unit or shock. In almost all cases levothyroxine is the therapy of choice including congenital hypothyroidism. In preterm infants with an altered thyroid hormone status studies with thyroid hormones including intravenous liothyronine showed a normalisation of T3 levels and in some cases an amelioration of parameters of ventilation. A benefit for mortality or later morbidity could not be seen. Effects on neurological improvements later in life are under discussion. Decreased thyroid hormone levels are often found after cardiac surgery in infants and adults. Intravenous therapy with thyroid hormones improves the cardiac index, but in all other parameters investigated, no substantial effect on morbidity and mortality could be demonstrated. Oral liothyronine therapy in these situations was equivalent to an intravenous route of application. In myxedema coma intravenous levothyroxine is given for 3 to 10 days until the patient can take oral medication and normal resorption in the gastrointestinal tract is achieved by restoring at least peripheral euthyroidism. Intravenous levothyroxine is the standard in treating patients with myxedema coma. A protective effect on the heart of i.v. levothyroxine in brain-dead organ donors may be possible.

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