Hypothalamo-pituitary-thyroid axis function during cardiopulmonary bypass

Bremner, W. F.; Taylor, Kenneth M.; Baird, S. G.; Thomson, J.E.; Thomson, John A.; Ratcliffe, John G.; Lawrie, T. D. V.; Bain, W H

doi:10.1016/s0022-5223(19)41266-x

Cited by 94 publications

(16 citation statements)

References 19 publications

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“…[31,32] The majority of studies investigating thyroid hormone levels in patients undergoing cardiac surgery have demonstrated a well-established reduction in the f T3 levels, particularly under cardiopulmonary bypass. [33][34][35] Murzi et al [35] showed a significant reduction in the fT 3 levels with a nadir at 48 h postoperatively and that the levels were still below baseline values at up to six days following surgery. The degree of the decline in the f T 3 levels was higher than the f T 4 levels.…”

Section: Discussionmentioning

confidence: 98%

Does thyroid dysfunction affect early mortality and morbidity after coronary artery bypass graft surgery?

Tarçın¹

2019

Cardiovasc Surg Int

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This study aims to evaluate to effect of thyroid dysfunction on early mortality and morbidity in patients undergoing coronary artery bypass grafting (CABG). Patients and methods: Between April 2008 and December 2010, a total of 37 patients (20 females, 17 males; mean age 54.9±10.2 years; range, 26 to 76 years) with thyroid dysfunctions who underwent CABG and 11 patients (2 females, 9 males; mean age 46.9±15.5 years; range, 26 to 65 years) without thyroid dysfunction who underwent on-pump CABG as the control group were included in the study. Patients were divided into groups as overt and subclinical hypothyroidism, overt hyperthyroidism, and subclinical hyperthyroidism according to the thyroid function test results. The European System for Cardiac Operative Risk Evaluation (EuroSCORE) scores were evaluated and the Gensini severity scores were calculated according to coronary angiographies. All patients were followed for seven days after surgery. The duration of endotracheal intubation, inotropic support, cardiac complications, duration of stay in the intensive care unit (ICU) and hospital were recorded. Results: There were no statistically significant differences between the groups in terms of the duration of intubation, need of inotropic support, and duration of stay in the ICU and hospital. Arrhythmia was more frequent in the overt hyperthyroid group than in the overt hypothyroid group postoperatively. Thyroid-stimulating hormone (TSH) levels remained unchanged after surgery, whereas free T 3 decreased and free T 4 increased, which was compatible with postoperative euthyroid sick syndrome. The EuroSCORE scores were positively correlated with pre-and postoperative TSH levels, duration of intubation, and duration of ICU and hospital stay, but was negatively correlated with free T 3. Conclusion: Subclinical or overt thyroid dysfunctions do not seem to affect early mortality after CABG. However, overt hyperthyroidism is associated with postoperative arrhythmia complications. Euthyroid sick syndrome may also occur after surgery in certain cases. Pre-and postoperative TSH and free T 3 levels may be useful to identify mortality and morbidity risk in patients undergoing CABG.

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Section: Discussionmentioning

confidence: 98%

Does thyroid dysfunction affect early mortality and morbidity after coronary artery bypass graft surgery?

Tarçın¹

2019

Cardiovasc Surg Int

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“…A significant reduction in plasma FT 3 , which was known to have an inotropic effect, had been documented in patients undergoing open-heart procedures (152,153). Our observations of the effect of T 3 administration to brain-dead organ donors suggested that the reduction in circulating FT 3 levels was responsible for a deterioration of cardiac function in patients following cardiopulmonary bypass (CPB).…”

Section: Studies On the Effects Of T 3 Following Myocardial Ischemia mentioning

confidence: 55%

A review of studies relating to thyroid hormone therapy in brain-dead organ donors

Novitzky²,

Wn³

et al. 2009

Front Biosci

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An acute decrease in cardiac performance can result from a reduced free triiodothyronine (FT3) level following (i) brain death (euthyroid sick syndrome), (ii) a period of cardiopulmonary bypass, and possibly (iii) regional or global myocardial ischemia. The two major pathophysiologic effects of brain death are (i) vascular injury associated with the hemodynamic consequences of the autonomic 'storm', and (ii) a generalized inhibition of mitochondrial function, which results in diminished organ function from the loss of energy stores from a rapid loss of circulating FT3. Deterioration of donor organ function can be reversed by hormonal replacement therapy, in which T3 plays a critical role. This results in (i) an increased number of organs being functionally acceptable, and (ii) increased early and intermediate graft survival. Cardiopulmonary bypass is associated with a reduction in the circulating level of FT3, and this can be associated with deterioration in cardiac function. The administration of T3 at the time of discontinuation of cardiopulmonary bypass reverses this state. In patients undergoing heart transplantation, T3 therapy to both donor and recipient is beneficial.

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“…In the current study, levels of free triiodothyronine in the serum decreased by more than three-fifths. This magnitude of depletion is sufficient to influence cardiac performance, 19 and it may have an adverse contribution in those patients recovering from their initial reconstructive surgery.…”

Section: Discussionmentioning

confidence: 99%

Reduction in levels of triidothyronine following the first stage of the Norwood reconstruction for hypoplastic left heart syndrome

et al. 2001

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Hypothalamo-pituitary-thyroid axis function during cardiopulmonary bypass

Cited by 94 publications

References 19 publications

Does thyroid dysfunction affect early mortality and morbidity after coronary artery bypass graft surgery?

Does thyroid dysfunction affect early mortality and morbidity after coronary artery bypass graft surgery?

A review of studies relating to thyroid hormone therapy in brain-dead organ donors

Reduction in levels of triidothyronine following the first stage of the Norwood reconstruction for hypoplastic left heart syndrome

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