Per‐ and postoperative changes in the concentration of serum thyreotropin under general anaesthesia, compared to general anaesthesia with epidural analgesia

Abstract

In 18 patients scheduled for lower intraabdominal surgery (hysterectomy), changes in thyreotropin (TSH) thyroxine (T4), triiodothyronine (T3) binding of thyroid hormones to plasma proteins (T3-uptake) and glucose in serum were evaluated. In eight patients afferent neurogenic impulses from the surgical area were blocked (Th4-S5) with bupivacaine 0.5% infused continuously into the epidural space from the start of the operation until 6 h postoperatively. All patients received general anaesthesia with thiopentone, pethidine, pancuronium and nitrous-oxide plus oxygen. The patients receiving epidural analgesia had no increase in plasma-TSH, compared to the other group, which had a significant (P less than 0.05) increase peroperatively. The patients receiving epidural analgesia were pain-free and the normal stress-induced increase in plasma-glucose was abolished. Concerning T3 we found a significant decrease in both groups and a steady level of T4- and T3-uptake without significant fluctuations. Thus it can be concluded that the effects of surgical trauma on plasma-TSH concentration are markedly similar to the effects of other anterior pituitary hormones, i.e. HGH, prolactin and ACTH.

Hyperthyroidism after surgery for primary hyperparathyroidism

“…During breast cancer surgery, T3 remained stable whereas a significant decrease was found on the first postoperative day. This result is in accordance with several papers describing the "sick-euthyroid or low-T3-syndrome" occurring following general as well as thyroid surgery and thus confirms that our control group reacted in an expected way [22,27,28,29].…”

“…Last, if the FT4/FT3 increase was solely due to a traumatic manipulation of the thyroid gland, TSH should rather be decreased and not increased as was the case. A transient peri-operative TSH increase followed by a decrease on the first postoperative day has also been observed by others [27,28].…”

Sex-dependent roles of prolactin and prolactin receptor in postoperative pain and hyperalgesia in mice

“…Surgical insults are associated with an activation of the anterior pituitary gland and increased serum levels of PRL in humans seen at 1-2 weeks and even longer (>2 weeks) after the insult (Noreng et al, 1987, Yardeni et al, 2007, Wu and Raja, 2011). Our results also show the systemic upregulation of endogenous PRL, but in addition show an upregulation locally at the site of the incision and in the lumbar spinal cord.…”

“…The response of the hypothalamic-pituitary-adrenal axis in humans to surgery is well documented (Noel et al, 1972, Anand, 1986, Reiner et al, 1987). Stress, surgical trauma and postoperative conditions activate the anterior pituitary gland in humans and elicit an increase in serum levels of prolactin (PRL), an important sex hormone (Noreng et al, 1987, Yardeni et al, 2007). Plasma PRL concentrations in humans remain increased for up to 1-2 weeks postoperatively with a gradual return to normal levels (Chernow et al, 1987).…”

Neuroendocrine mechanisms governing sex-differences in chronic pain involve prolactin receptor sensory neuron signaling

“…First, Prlr-mediated PRL effects are sex- and gonadal hormone-dependent in many tissues and cell types, including sensory neurons (Torner et al, 2001; Ben-Jonathan et al, 2008; Belugin et al, 2013; Patil et al, 2013a; Patil et al, 2019b; Patil et al, 2019a). Second, many clinical and preclinical studies show that endogenous release of PRL from both pituitary and extra-pituitary origins is induced by inflammation and tissue injury (Chernow et al, 1987; Noreng et al, 1987; BenJonathan et al, 1996; Yardeni et al, 2007; Scotland et al, 2011; Patil et al, 2013a). Third, PRL is an effective direct and/or indirect activator of immune cells, especially macrophages and T-cells (Matera et al, 2001; Savino et al, 2016; Tang et al, 2017).…”