Peri‐operative oral triiodothyronine replacement therapy to prevent postoperative low triiodothyronine state following valvular heart surgery

Abstract

Summary This study evaluated the effect of oral triiodothyronine (T3) replacement therapy, starting on the day of the surgery, on thyroid hormone concentrations and clinical outcome in high‐risk patients undergoing valvular heart surgery. Fifty patients were randomly allocated to either T3 or placebo. In the treatment (T3) group patients received 20 μg of oral or nasogastric T3 every 12 h starting just before induction of anaesthesia and until the first day after surgery. T3 concentrations were significantly higher in the T3 group than the placebo group from 1 to 36 h after removal of the aortic cross clamp. The number of patients requiring vasopressin after discontinuing cardiopulmonary bypass was significantly greater in the placebo group than the T3 group. Significantly fewer patients required vasopressors in the T3 group on the first day after surgery.

Thyroid function in critically ill patients

“…Only a few, rather small, RTCs have assessed the effects of treatment with thyroid hormones in patients with NTIS. These trials report results obtained in a large range of patient groups—eg, patients with acute renal failure, 29 burn injury, 24 and cardiac surgery, 23,25–27 and those in the ICU with low T 4 concentrations. 28 Furthermore, the age of the study population varies greatly in these studies, 23–29 ranging from premature newborns to children and adults.…”

Low free triiodothyronine levels in mexican pediatric population with congenital heart disease after cardiac surgery undergoing cardiopulmonary bypass.

“…However, due to the high cost of intravenous treatment, research is still going on to find the best way to deliver the hormone. [16][17][18] In conclusion, in our population the prevalence of PLFT3 in children undergoing congenital heart surgery with CPB, is slightly more frequent than the one informed elsewhere.…”

Low cardiac output syndrome in cardiac surgery

“…Более того, 7 пациентам из группы плацебо потребовалась установка одного из устройств вспомогательного кровообращения, в группе трийодтиронина таких пациентов не оказалось [91]. В двух других исследованиях, где были представлены пациенты, которым выполнялось коронарное шунтирование на работающем сердце и оперативное вмешательство на клапанах сердца, достоверных преимуществ трийодтиронина выявлено не было [92,93]. Таким образом, необходимо дальнейшее исследование трийодтиронина в условиях сердечно-сосудистой хирургии.…”