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

Mainwaring, Richard D.; Healy, Regina M.; Meier, Frederick A.; Nelson, Jerald C.; Norwood, William I.

doi:10.1017/s1047951101000324

Cited by 15 publications

(13 citation statements)

References 14 publications

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“…The TSH recovered back to preoperative levels by POD 4 with a possible rise above preoperative levels starting on POD 7. FT4 and arguably RT3 both recovered to preoperative levels, but TT3, FT3I, and T3U showed no evidence of recovery by POD 7. Several smaller studies in children undergoing cardiac surgery similarly showed the presence of NTIS [33,[47][48][49][50][51][52][53][54][55][56][57]. As mentioned previously, Zucker et al [33] followed 27 children of which 18 underwent cardiac surgery.…”

Section: Ntis In Childrenmentioning

confidence: 86%

“…In other studies, Mainwaring has attempted to differentiate a thyroid response among the various types of congenital cardiac malformations. In one study, he followed the thyroid function in 14 newborns, aged 1-12 days old, all with hypoplastic left heart syndrome undergoing first stage Norwood reconstruction [52]. These children all had decreases in FT3 and TT3 levels starting with the initiation of CPB and reaching a nadir at 24 h after surgery.…”

Section: Ntis In Childrenmentioning

confidence: 99%

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Nonthyroidal illness syndrome in children

Marks

2009

Endocr

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Neuroendocrine changes in the hypothalamic-pituitary-thyroid axis during critical illness result in nonthyroidal illness syndrome (NTIS) characterized by abnormal thyrotropin (TSH) and thyroid hormone levels. Studies looking at the natural history of neuroendocrine changes during critical illness have revealed the presence of NTIS. NTIS has been described in a variety of patient settings. Many studies have tried to uncover the pathophysiology behind NTIS and several theories are proposed. Whether NTIS requires treatment or intervention is still controversial and the results of the treatment studies are arguably mixed. Whether implicitly stated or not, the underlying purpose of all the natural history, pathophysiology, or treatment studies is to determine whether NTIS is adaptive or maladaptive. Some studies have illustrated a correlation between illness severity and the degree of NTIS but a cause and effect relationship is still elusive. The human studies can be divided between those with either adult or pediatric subjects, with much less data available in the latter. This review examines the available literature on NTIS with an emphasis on the pediatric literature.

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Section: Ntis In Childrenmentioning

confidence: 86%

Section: Ntis In Childrenmentioning

confidence: 99%

Nonthyroidal illness syndrome in children

Marks

2009

Endocr

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“…In addition, the T3 infusion was associated with a reduced need for postoperative intensive care (6). Studies have also found a significant decrease in the levels of free and total T3 in the postoperative period following stage 1 reconstruction for hypoplastic left heart syndrome (19) and the Fontan procedure (20). T3 supplementation has also been shown to increase heart rate without concomitant decrease in systemic blood pressure in infants after cardiopulmonary bypass, suggesting that repletion improves myocardial oxygen consumption (7).…”

Section: Discussionmentioning

confidence: 99%

The effect of a thyroid hormone infusion on vasopressor support in critically ill children with cessation of neurologic function

Zuppa

Nadkarni

Davis

et al. 2004

Critical Care Medicine

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“…After CPB, serum thyroid hormone levels are depressed (100). Because of the known effects of thyroid hormone on ventricular function, several studies have evaluated the role of thyroid replacement therapy in children after cardiac surgery (101)(102)(103)(104).…”

Section: Other Strategies For Improving Circulatory Functionmentioning

confidence: 99%

Management of the postoperative pediatric cardiac surgical patient

Bronicki

Chang

2011

Critical Care Medicine

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The practice of pediatric cardiac intensive care has evolved considerably over the last several years. These efforts are the result of a collaborative effort from all subspecialties involved in the care of pediatric patients with congenital heart disease. Discoveries and innovations that are representative of this effort include the extension of cerebral oximetry from the operating room into the critical care setting; mechanical circulatory devices designed for pediatric patients; and surgery in very low birth weight neonates. Advances such as these impact postoperative management and make the field of pediatric cardiac intensive care an exciting, demanding, and evolving discipline, necessitating the ongoing commitment of various disciplines to pursue a greater understanding of disease processes and how to best go about treating them.

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

Abstract: The data demonstrate significant decreases in levels of free and total triiodothyronine during the early postoperative period. These changes in levels of thyroid hormone may have adverse effects on cardiac function during this phase of recovery.

Cited by 15 publications

References 14 publications

Nonthyroidal illness syndrome in children

Nonthyroidal illness syndrome in children

The effect of a thyroid hormone infusion on vasopressor support in critically ill children with cessation of neurologic function

Management of the postoperative pediatric cardiac surgical patient

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