Thyroid Hormone Treatment after Coronary-Artery Bypass Surgery

Klemperer, John D.; Klein, Irwin; Gómez, Maritza Díaz; Helm, Robert E.; Ojamaa, Kaie; Thomas, Susan J.; Isom, O. Wayne; Krieger, Karl H.

doi:10.1056/nejm199512073332302

Cited by 414 publications

(230 citation statements)

References 22 publications

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“…Indeed, although short-term i.v. administration of T3 to patients after cross-clamp removal during elective coronary bypass grafting has been shown to improve postoperative cardiac function (39,40), the pharmacological doses of T3 which resulted in supranormal serum T3 levels and the absence of an effect on outcome do not allow refutation of the postulated adaptive nature of thè acute' low-T3 syndrome.…”

Section: Changes In the Acute Phase Of Critical Illnessmentioning

confidence: 99%

Novel insights into the neuroendocrinology of critical illness

Berghe

2000

European Journal of Endocrinology

226

104

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An unexplained hallmark of prolonged critical illness is the fact that food does not prevent or reverse protein wasting, while fat is paradoxically accrued. This`wasting syndrome' often persists after the underlying disease has been resolved and thus perpetuates intensive care dependency. Although the crucial role of an intact hypothalamus±pituitary axis for homeostasis during stress is well recognized, the differences between the neuroendocrine changes observed in acute and prolonged critical illness were only recently described. Novel insights in this area are reviewed here.The initial endocrine stress response consists primarily of a peripheral inactivation of anabolic pathways while pituitary activity is essentially ampli®ed or maintained. These responses presumably provide the metabolic substrates and host defense required for survival and to delay anabolism, and thus should be considered as adaptive and bene®cial. Persistence of this acute stress response throughout the course of critical illness was hitherto assumed. This assumption has now been invalidated, since a uniformly reduced pulsatile secretion of ACTH, TSH, LH, prolactin (PRL) and GH has been observed in protracted critical illness, causing diminished stimulation of several target organs. Impaired pulsatile secretion of anterior pituitary hormones in the chronic phase of critical illness seems to have a hypothalamic rather than a pituitary origin, as administration of relevant releasing factors evoked immediate and pronounced pituitary hormone release. A reduced availability of TRH, one of the endogenous ligands of the GH-releasing peptide (GHRP) receptor (such as the recently discovered ghrelin) and, in very long-stay critically ill men, also of GHRH, appear to be involved. This hypothesis was further explored by investigating the effects of continuous i.v. infusion of GHRH, GHRP, TRH and their combinations for several days. Pulsatile secretion of GH, TSH and PRL was re-ampli®ed by relevant combinations of releasing factors which also substantially increased circulating levels of IGF-I, GH-dependent binding proteins, thyroxine and tri-iodothyronine (T3) while avoiding a rise in reverse T3. Active feedback-inhibition loops prevented overstimulation of target organs and metabolic improvement was noted with the combined infusion of GHRP and TRH. Whether this novel endocrine strategy will also enhance clinical recovery from critical illness remains to be explored.

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Section: Changes In the Acute Phase Of Critical Illnessmentioning

confidence: 99%

Novel insights into the neuroendocrinology of critical illness

Berghe

2000

European Journal of Endocrinology

226

104

View full text Add to dashboard Cite

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“…Patients undergoing coronary bypass surgery (Holland et al 1991, Klemperer et al 1995 and patients with congestive heart failure (Hamilton 1993, Hamilton & Stevenson 1996 may show typical changes in serum thyroid hormone parameters -low serum T 3 , high serum reverse T 3 and normal T 4 and thyrotropin (TSH) concentrations -known as the euthyroid sick syndrome (Docter et al 1993). Whether or not this condition should be treated remains a matter of debate (Klemperer et al 1995, Utiger 1995, Camacho & Dwarkanathan 1999.…”

Section: Introductionmentioning

confidence: 99%

“…Whether or not this condition should be treated remains a matter of debate (Klemperer et al 1995, Utiger 1995, Camacho & Dwarkanathan 1999. However, during the past 5-10 years, clinical studies have explored the possibility of improving heart function using treatment with T 3 or T 4 (Moruzzi et al 1996, Chowdhury et al 1999, Mullis-Jansson et al 1999, both in children with congenital heart disease and in elderly patients with congestive heart failure.…”

Section: Introductionmentioning

confidence: 99%

Uptake of triiodothyronine and triiodothyroacetic acid in neonatal rat cardiomyocytes: effects of metabolites and analogs

Verhoeven¹,

Putten²,

Hennemann³

et al. 2002

Journal of Endocrinology

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Cellular and nuclear uptake of [125 I]tri-iodothyronine (T 3 ) and [125 I]triiodothyroacetic acid (Triac) were compared in cardiomyocytes of 2-3 day old rats, and the effect of thyroid hormone analogs on cellular T 3 uptake was measured. Cells (5-10 10 5 per well) were cultured in DMEM-M199 with 5% horse serum and 5% FCS. Incubations were performed for from 15 min to 24 h at 37 C in the same medium, 0·5% BSA and [125 I]T 3 (100 pM), or [ 125 I]Triac (240 pM). Expressed as % dose, T 3 uptake was five times Triac uptake, but expressed as fmol/pM free hormone, Triac uptake was at least 30% (P<0·001) greater than T 3 uptake, whereas the relative nuclear binding of the two tracers was comparable. The 15 min uptake of [ 125

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“…The need of thyroid hormone replacement in the patients with NTIS is controversial. The administration of T4 or T3 does not affect the prognosis of seriously sick patients [12][13][14] , but it has been proposed that the thyroid hormone replacement may be beneficial in some patients 2 …”

mentioning

confidence: 99%

Nonthyroidal illness syndrome in patients with subarachnoid hemorrhage due to intracranial aneurysm

Casulari

Mangieri

Naves³

et al. 2004

Arq. Neuro-Psiquiatr.

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-We have previously reported that subarachnoid hemorrhage due to ruptured intracranial aneurysm (SH) is associated with changes in the hormonal profile in the first 24 hours after the event. We proposed that the hormonal changes observed are due to the intense stress to which the patients are exposed. However, the thyroidal hormonal profile is indicative of the presence of a nonthyroidal illness syndrome (NTIS). In this paper, we examined whether the change in the thyroid hormone profile is compatible with a NTIS. Two groups of patients were included in the study: A) 30 patients with SH (21 females and 9 males; 41.7±11.4 years) and B) a control group including 25 patients with benign diseases of the spine (BDS) (lumbar disc hernia or stable spinal trauma) (8 females and 17 males; 41.3±14.2 years). In a subgroup of eight patients of each group serum triiodothyronine (T3) and reverse T3 levels were measured. The blood samples were obtained between 8:00 and 9:00 AM. The following results were obtained: The SH group had smaller serum T3 and free T4 levels than the BDS group (p<0.05): T3 (ng/mL): SH = 58.7±1.1 and BDS = 74.5±13.9; free T4 (ng/dL): SH = 0.9±0.2 and BDS = 1.1±0.3. There was no significant difference in the serum levels of total thyroxine (T4) and thyroid-stimulating hormone (TSH) between the two groups: T4 (µg/dL): SH = 6.9±1.1 and BDS = 7.4±2.1; TSH (µUI/mL): SH = 1.5±0.8 and BDS = 1.8±1,0. In the sample of eight patients of each group we had the following results: T3 (ng/mL): SH = 66.8±3.8 and BDS = 77.2±1.1 (p <0.05); reverse T3 (ng/dL): SH = 32.8±8 and BDS = 24.7±2.2 (NS); T3/ reverse T3 ratio: SH = 2.6±0.3 and BDS = 3.3±0.4 (NS). Thyreoglobulin and microsomal antibodies were not detectable, except in one patient in the SH group. In conclusion, the SH patients present serum levels of T3 and free T4 significantly lower than that of BDS patients; the thyroidal hormone profile suggests that SH patients have developed the nonthyroidal illness syndrome.KEY WORDS: cerebral aneurysm, euthyroid sick syndrome, nonthyroidal illness syndrome, subarachnoid hemorrhage, thyroid hormones. Sindrome da doença não tiroideana em pacientes com hemorragia subaracnoidea devida a aneurisma cerebralRESUMO -Nós apresentamos previamente que a hemorragia subaracnoidea devido à ruptura de aneurisma intracraniano (SH) está associada com alterações no perfil hormonal nas primeiras 24 horas após o evento. Nós propusemos que as alterações hormonais observadas são devidas ao intenso estresse ao qual os pacientes estão expostos. Contudo, o perfil hormonal tireoidiano é indicativo da presença da síndrome da doença não tireoidiana (NTIS). Neste trabalho, examinamos se as alterações no perfil dos hormônios tireoidianos são compatíveis com a NTIS. Dois grupos de pacientes foram incluídos no estudo: A) 30 pacientes com SH (21 mulheres e 9 homens; 41,7±11,4 anos) e B) um grupo controle incluindo 25 pacientes com doenças benignas da coluna (BDS) (hérnia de disco lombar ou estável trauma da coluna) (8 mulheres e 17 homens; 41,3±14...

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Thyroid Hormone Treatment after Coronary-Artery Bypass Surgery

Abstract: Raising serum triiodothyronine concentrations in patients undergoing coronary-artery bypass surgery increases cardiac output and lowers systemic vascular resistance, but does not change outcome or alter the need for standard postoperative therapy.

Cited by 414 publications

References 22 publications

Novel insights into the neuroendocrinology of critical illness

Novel insights into the neuroendocrinology of critical illness

Uptake of triiodothyronine and triiodothyroacetic acid in neonatal rat cardiomyocytes: effects of metabolites and analogs

Nonthyroidal illness syndrome in patients with subarachnoid hemorrhage due to intracranial aneurysm

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