Influence of Age on the Endocrine-Metabolic Response to Surgery

Blichert-Toft, M; Christensen, Vibeke Brix; Engquist, A.; Fog-Møller, F.; Kehlet, Henrik; Madsen, S. Nistrup; Skovsted, L.; Thode, J.; Ølgaard, Klaus

doi:10.1097/00132586-198012000-00052

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“…One important advantage of the kinetic methods is that the patient is intact and presumably in steady state, but it is difficult to evaluate the effects of the anaesthesia and surgical trauma on the directly measured secretion rates. Conflicting data have been reported about T4, T3, and rT3 serum concen¬ trations during anaesthesia, abdominal or thyroid surgery (Adami et al 1978;Hooper et al 1978;Blichert-Toft et al 1979;Tevaarwerk & Boyd 1979;Gheri et al 1981), but these changes should not be due to altered thyroid secretion rates, as the effect on T3 was opposite to that on rT3 (Hagenfeldt et al 1979). We found no changes due to anaesthesia but small though significant changes in the peripheral hormone concentrations in many patients initally during surgery.…”

Section: Discussionmentioning

confidence: 99%

Secretion rates of thyroxine, triiodothyronine, and reverse triiodothyronine in man during surgery

Tegler¹,

Gillquist²,

Lindvall³

et al. 1982

Acta Endocrinologica

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The secretion rates of T4, T3, and rT3 were studied in experiments of short duration by a new method based on determinations of the hormone difference across the thyroid combined with simultaneous electromagnetic thyroid blood flowmetry during surgery in 70 euthyroid patients. The secretion rate of T3 was similar in normal thyroid tissue and nodular goitre, but those of T4 and rT3 were lower in nodular goitre and solitary adenoma (P < 0.05). In 61 patients with normal thyroid tissue or nodular goitre the secretion rates during surgery (mean \ m=+-\ sem) were for T4 222 \ m=+-\ 28 nmol/day, for T3 27.4 \m=+-\ 3.1nmol/ day, and for rT3 3.5 \ m=+-\ 0.5 nmol/day. In relation to the individual T4 secretion rate, the secretion rate of T3 was 12.5 \m=+-\3.0% and that of rT3 1.2 \ m=+-\0.9%.In these short-term experiments we found a secretion rate for T4 during operation about 50% greater than in earlier long-term kinetic studies, but which tallied with a recent report using a 4-compartment model. For T3 and rT3 it was 2\p=n-\3times greater than earlier estimates. The secretion was estimated to be 50% of the total production rate for T3 and 6% for rT3. If proportional adjustment were performed to yield a T4 secretion of about 130 nmol/day, T3 and rT3 secretion rates would still be greater than earlier reported.No method as yet exists for measuring directly the rate of thyroid hormone secretion in man (Chopra 1978). Indirect measurement of production rates of thyroid hormones has been achieved with radionucleides using different compartment models (Sterling et al. 1954;DiStefano & Fisher 1979). However, the methods for separation of iodothyronines other than T4 have been criticized (Aickin et al. 1977;Rudolph et al. 1978); and it is difficult by kinetic methods to distinguish secretion from extraglandular conversion of the hormones.In animals the secretion rates of thyroid hor¬ mones have been estimated as the product of the arteriovenous hormone difference and the thyroid blood flow (Mowbray & Peart 1960;Falconer 1967). Application of this method to man should avoid some of the problems in compartment models. Hormone differences across the thyroid may be measured during surgery (Tegler et al. 1976) and a method for thyroid flowmetry has recently been reported (Tegler et al. 1981). Our aim was therefore to study the secretion rates of T4, T3, and rT3 in man by a direct method using hormone differences across the thyroid gland and simultaneous electromagnetic blood flowmetry.Material and Methods PatientsTen men and 21 women, aged 57 (33-78) years (mean and range), with normal thyroid tissue in the lobe studied were admitted for surgery for hyperparathyroidism (n = 25), unilateral adenoma, nodular goitre or follicular carcinoma (n = 6). All lobes studied were macroscopically normal; and 15 randomly chosen were histologically normal. All patients were euthyroid on the basis of clinical findings and serum concentrations of T4, T3, and thyrotrophin (Odell et al. 1965).Thirty euthyroid subjects, 5 men and 25 women aged 56 (26 -...

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Section: Discussionmentioning

confidence: 99%