Thyroid hormone metabolism and level of illness severity in pediatric cardiac surgery patients

Allen, David B.; Dietrich, K.; Zimmerman, Jerry J.

doi:10.1016/s0022-3476(89)80601-8

“…A diferença no comportamento do FT4 e do TSH encontrado no nosso estudo e no de Borges e colaboradores 13 poderia ser o reflexo das múltiplas alterações que ocorrem nessa síndrome [23][24][25] .…”

Section: Discussionunclassified

Effect of Perinatal Asphyxia on Thyroid Hormones

Pereira¹,

Procianoy²

2001

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ResumoObjetivo: verificar o efeito da asfixia perinatal sobre os hormô-nios tireóideos.Métodos: foi realizado um estudo de caso-controle, no hospital de Clínicas de Porto Alegre, envolvendo 17 recém-nascidos a termo asfixiados (A) e 17 não-asfixiados (N), pareados conforme a cor, sexo, tipo de parto, idade gestacional e peso de nascimento. Foram coletados T4, T3, T4 livre, T3 reverso e TSH do sangue do cordão e do recém-nascido com 18 a 24 horas de vida, entre os que sofreram ou não asfixia perinatal.Resultados: no sangue de cordão, não houve diferença na dosagem dos hormônios tireóideos, com exceção do T3 reverso, que foi mais elevado no grupo que sofreu asfixia [mediana (percentis 25-75):A= 2(1,4-2); N= 1,41(1,13-1,92); p=0,037]. Com 18 a 24 horas de vida, foram significativamente menores no grupo de asfixiados, com exceção do T3 reverso, que foi semelhante entre os dois grupos [média ± DP: T4 A= 9,79 ± 2,59; N=14,68 ± 3,05; p<0,001/ mediana T3 A= 40,83(37,4-80,4); N= 164(56,96-222,5); P=0,003/ média ± DP T4 livre A=1,85 ± 0,92; N= 2,8 ± 0,74; p=0,004/ mediana T3 reverso A= 1,54(1,16-1,91); N= 1,31(0,87-2); p=0,507/ TSH A= 9,1(6,34-12,95); N=14,5(12,9-17,85); p=0,008].Conclusões: nossos dados sugerem que os níveis diminuídos de T4, T4 livre e T3 no recém-nascido asfixiado com 18 a 24 horas de vida são secundários aos níveis diminuídos de TSH. Além disso, os valores baixos de T3 e normais de T3 reverso podem refletir alteração no metabolismo periférico do T4.J Pediatr (Rio J) 2001; 77 (3): 175-78: hormônios da tireóide, asfixia perinatal, síndrome do doente eutireóideo. AbstractObjective: to verify the effect of perinatal asphyxia on thyroid hormone levels in term newborn infants.Methods: we carried out a case-control study with 17 term and asphyxiated (A) and 17 term and control (N) newborn infants at the Hospital de Clínicas de Porto Alegre. Patients were paired according to color of skin, sex, mode of delivery, gestational age, and weight at birth. We collected plasmatic T4, T3, free T4, reverse T3, and TSH of the umbilical cord after 18 to 24 hours of life and from asphyxiated and control newborn infants.Results: there were no differences in thyroid hormones of cord blood, with the exception of reverse T3, which was higher in A than in controls [median (percentile 25-75): A= 2(1.4-2); N= 1.41 (1.13-1.92); P=0.037)]. Thyroid hormone levels were lower in A than in controls on 18-24-hour after birth samples, except for reverse T3, which was similar in both groups [average ± SD: T4 A= 9.79 ± 2.59; N=14.68 ± 3.05; P<0.001; median T3 A= 40.83 (37.4-80.4); N= 164 (56.96-222.5); P=0.003; average ± SD: free T4 A=1.85 ± 0.92; N= 2.8 ± 0.74; P=0.004; median: reverse T3 A=1.54 (1.16-1.91); N=1.31(0.87-2); P=0.507; TSH A=9.1 (6.34-12.95); N=14.5(12.9-17.85); P=0.008].Conclusions: our data suggests that lower T4, free T4, and T3 levels are secondary to lower TSH levels in asphyxiated newborns; also, peripheral metabolism of T4 in asphyxiated infants can be altered due to low T3 and normal reverse T3 levels.J Pediatr (Rio...

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“…Alterações no metabolismo hormonal tireóideo devido a doenças de origem não-tireóidea são conhecidas como síndrome do doente eutireóideo [23][24][25] .…”

Section: Discussionunclassified

Efeitos da asfixia perinatal sobre os hormônios tireoidianos

Pereira¹,

Procianoy

²

2001

J. Pediatr. (Rio J.)

2

1

0

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ResumoObjetivo: verificar o efeito da asfixia perinatal sobre os hormô-nios tireóideos.Métodos: foi realizado um estudo de caso-controle, no hospital de Clínicas de Porto Alegre, envolvendo 17 recém-nascidos a termo asfixiados (A) e 17 não-asfixiados (N), pareados conforme a cor, sexo, tipo de parto, idade gestacional e peso de nascimento. Foram coletados T4, T3, T4 livre, T3 reverso e TSH do sangue do cordão e do recém-nascido com 18 a 24 horas de vida, entre os que sofreram ou não asfixia perinatal.Resultados: no sangue de cordão, não houve diferença na dosagem dos hormônios tireóideos, com exceção do T3 reverso, que foi mais elevado no grupo que sofreu asfixia [mediana (percentis 25-75):A= 2(1,4-2); N= 1,41(1,13-1,92); p=0,037]. Com 18 a 24 horas de vida, foram significativamente menores no grupo de asfixiados, com exceção do T3 reverso, que foi semelhante entre os dois grupos [média ± DP: T4 A= 9,79 ± 2,59; N=14,68 ± 3,05; p<0,001/ mediana T3 A= 40,83(37,4-80,4); N= 164(56,96-222,5); P=0,003/ média ± DP T4 livre A=1,85 ± 0,92; N= 2,8 ± 0,74; p=0,004/ mediana T3 reverso A= 1,54(1,16-1,91); N= 1,31(0,87-2); p=0,507/ TSH A= 9,1(6,34-12,95); N=14,5(12,9-17,85); p=0,008].Conclusões: nossos dados sugerem que os níveis diminuídos de T4, T4 livre e T3 no recém-nascido asfixiado com 18 a 24 horas de vida são secundários aos níveis diminuídos de TSH. Além disso, os valores baixos de T3 e normais de T3 reverso podem refletir alteração no metabolismo periférico do T4.J Pediatr (Rio J) 2001; 77 (3): 175-78: hormônios da tireóide, asfixia perinatal, síndrome do doente eutireóideo. AbstractObjective: to verify the effect of perinatal asphyxia on thyroid hormone levels in term newborn infants.Methods: we carried out a case-control study with 17 term and asphyxiated (A) and 17 term and control (N) newborn infants at the Hospital de Clínicas de Porto Alegre. Patients were paired according to color of skin, sex, mode of delivery, gestational age, and weight at birth. We collected plasmatic T4, T3, free T4, reverse T3, and TSH of the umbilical cord after 18 to 24 hours of life and from asphyxiated and control newborn infants.Results: there were no differences in thyroid hormones of cord blood, with the exception of reverse T3, which was higher in A than in controls [median (percentile 25-75): A= 2(1.4-2); N= 1.41 (1.13-1.92); P=0.037)]. Thyroid hormone levels were lower in A than in controls on 18-24-hour after birth samples, except for reverse T3, which was similar in both groups [average ± SD: T4 A= 9.79 ± 2.59; N=14.68 ± 3.05; P<0.001; median T3 A= 40.83 (37.4-80.4); N= 164 (56.96-222.5); P=0.003; average ± SD: free T4 A=1.85 ± 0.92; N= 2.8 ± 0.74; P=0.004; median: reverse T3 A=1.54 (1.16-1.91); N=1.31(0.87-2); P=0.507; TSH A=9.1 (6.34-12.95); N=14.5(12.9-17.85); P=0.008].Conclusions: our data suggests that lower T4, free T4, and T3 levels are secondary to lower TSH levels in asphyxiated newborns; also, peripheral metabolism of T4 in asphyxiated infants can be altered due to low T3 and normal reverse T3 levels.J Pediatr (Rio...

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“…In general, the postoperative state is associated with major changes in thyroid hormone economy and is char acterized by a decrease of outer ring deiodinase activity (5'deiodinase), leading to a decrease in serum T3 and increase in rT3 concentration and known as the low T3 syndrome or nonthyroidal illness (NTI) [1], Results ob tained after cardiac surgery with cardiopulmonary bypass (CPB) were rather conflicting [2][3][4][5][6][7][8][9]. Bremneret al [4] and Gôtzsche and Weeke [7] showed a significant fall of T3 and an increase in rT3 concentrations but no change in TSH during CPB.…”

Section: Introductionmentioning

confidence: 99%

Influence of Coronary Artery Bypass Surgery on Thyroid Hormone Parameters

Reinhardt¹,

Mocker²,

et al. 1997

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The postoperative period after cardiac surgery with cardiopulmonary bypass (CPB) is associated with a low T3 syndrome, i.e. low T3 and fT3 concentrations in the presence of normal T4 and TSH concentrations. So far, results from studies evaluating thyroid function during and after CPB are rather conflicting. We therefore evaluated prospectively thyroid function in 28 patients before, during and up to 3 days after coronary artery bypass surgery. We could demonstrate the most significant changes in thyroid hormone concentrations on day 1 after CPB (low T3 and fT3 concentrations, elevated rT3 concentrations in the presence of a significant fall of TSH). T3 fell from 1.93 to 0.6 nmol/l and fT3 from 5.5 to 1.42 pmol/l. Those patients with low cardiac output syndrome after surgery had significantly lower T3 concentrations than patients without this complication. Moreover, those patients, who already had significant lower T3 values prior to CPB, also demonstrated low T3 concentrations on day 1 after CPB. Cortisol usually has a suppressive effect on TSH secretion. However, the effect of cortisol on TSH in patients undergoing CPB seems to be not that important: those patients with high endogenous cortisol concentrations on day 1 after CPB had similar TSH values to those patients with only slightly elevated cortisol concentrations. Also, the application of high doses of catecholamines seems to have only minor effects on TSH secretion, because those patients requiring high doses of dopamine over a prolonged time period had essentially the same TSH values after CPB. Patients who had been exposed preoperatively to high doses of iodine did not demonstrate significantly different thyroid hormone concentrations. In conclusion: We could demonstrate that CPB induces a low T3 syndrome up to 3 days after surgery. Those patients with low T3 concentrations prior to surgery demonstrate postoperatively a more severe degree of nonthyroidal illness (NTI).Catecholamines and cortisol seem to have only minor effects on the TSH secretion after CPB. The influence of a previous iodine contamination is negligible.

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Thyroid hormone metabolism and level of illness severity in pediatric cardiac surgery patients

Cited by 36 publications

References 11 publications

Effect of Perinatal Asphyxia on Thyroid Hormones

Effect of Perinatal Asphyxia on Thyroid Hormones

Efeitos da asfixia perinatal sobre os hormônios tireoidianos

Influence of Coronary Artery Bypass Surgery on Thyroid Hormone Parameters

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