Oral and intravenous thyroxine (T4) achieve comparable serum levels for hormonal resuscitation protocol in organ donors: a randomized double-blinded study

Abstract

Oral and intravenous thyroxine (T4) achieve comparable serum levels for hormonal resuscitation protocol in organ donors: a randomized double-blinded study La voie orale permet d'obtenir des taux sériques de thyroxine (T4) comparables à la voie intraveineuse dans le cadre d'un protocole de réanimation hormonale chez les donneurs d'organes: une étude randomisée à double insu Abstract Background Thyroxine (T4) administration is advocated in the management of organ donors; however, the bioavailability of oral thyroxine is unknown in this patient population. Objective The primary objective of this study was to compare the percentage of the study time (from study drug administration to organ procurement) that patients in the oral vs the intravenous group required inotropic support. Secondary objectives included plasma levels of T3 and T4 and number of organs donated following oral vs intravenous T4 administration. Design Randomized double-blinded study. Setting Adult medical-surgical intensive care unit. Patients Thirty-two adult solid organ donors. Interventions Patients were randomized to receive either an oral or intravenous dose of T4 (2 lgÁkg -1 ). All patients received an oral and intravenous study drug preparation, one of which was a placebo. The study was double-blinded, and randomization occurred in blocks of four and six. Measurements The number and duration of inotropic/ vasopressor therapies and free serum levels of T3 and T4 were determined hourly until procurement. Main results Following T4 administration, all patients remained on inotropic/vasopressor therapy for the same mean (SD) duration [93 (3)%] of the study period. There was a similar and gradual decrease in the number and dosages of inotropes/vasopressors required in both groups. There was no difference in T3 or T4 levels between groups. Oral bioavailability of T4 was 93% of the intravenous group at six hours and 91% overall. At six hours, the mean area under the curve for T4 was similar between the intravenous group [92.2 (33)

Oral thyroxin supplementation in infants undergoing cardiac surgery: A double-blind placebo-controlled randomized clinical trial

“…18 Previous studies have shown decreased requirement of inotropes with the use intravenous thyroid hormone preparations. 21 In our observation, the inotropic requirement was higher in the placebo group.…”

Bioavailability of Orally Administered Drugs in Critically Ill Patients

“…The authors have found that thyroxine appears to be well absorbed in this population. 66 Given the moderate level evidence, unadjusted doses of thyroxine may be appropriate for solid organ donors in the ICU.…”

Outcome Measures in Solid Organ Donor Management Research - a Systematic Review

“…Donor sex information is available for n=2669 donors in total (20 studies) with 1596 (59.8%) male and 1073 (40.2%) female donors. Some individual studies, however, had groups more heavily skewed towards male donors 12,17,[24][25][26] . Donor ethnicity was reported by three studies only 16,17,27 , with two further studies reporting the percentage of Afro-American donors in the two groups 28,29 .…”