Anaesthesia, Not Surgical Stress, Induces Increases in Serum Concentrations of Reverse Triiodothyronine and Thyroxine during Surgery

Chikenji, Tohru; Mizutani, Masakazu; Kitsukawa, Yukio

doi:10.1055/s-0029-1210955

Cited by 21 publications

(17 citation statements)

References 3 publications

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“…Ether anaesthesia reportedly induces decreased serum T 3 and T 4 over time (Huang et al 1991). In contrast, serum T 3 and T 4 actually increased intra-operatively and immediately postoperatively in humans, which was attributed not to surgical trauma but to inhalational anaesthetics (Chikenji et al 1990); our data support these latter reports. It has also been reported that enflurane anaesthesia causes the most significant increase in free and total thyroxine in a short period (Wang and Chen 1997).…”

Section: Discussionsupporting

confidence: 86%

Comparison between emulsified isoflurane and propofol/isoflurane combination on plasma thyroid hormones, insulin, glucose, and glucagon in dogs

Jiang

Lin

et al. 2014

Acta Vet. Brno

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It is important to determine the varying effects of anaesthesia agents on the endocrine function. In this study, the effects of emulsified isoflurane and propofol-isoflurane on the endocrine function were compared in dogs. Sixteen dogs were randomly divided into two groups: one group (G1) of dogs were induced with intravenous 5 mg/kg propofol and maintained with inhaled 2-2.5% inspiratory isoflurane in 100% oxygen; second group (G2) of dogs were induced with intravenous 1 ml/kg emulsified isoflurane and maintained with intravenous 8 ml/kg/h emulsified isoflurane. Blood samples to determine the endocrine function were collected prior to induction of anaesthesia and at 15 min, 30 min, 60 min, 2 h, 6 h, and 24 h after drug administration. Serum triiodothyronine and tetraiodothyronine concentrations in G1 increased significantly (P < 0.05) at 15 min and were higher than in G2. Serum insulin at 15 min and 30 min were significantly (P < 0.05) higher in both G1 and G2. Serum insulin in G1 was higher after anaesthesia than in G2. Serum glucagon decreased at 15 min, 30 min, and 60 min, without significant changes (P > 0.05). Serum glucose increased at 15 min and 30 min after anesthesia, and was significantly higher in G1 than in G2 (P < 0.05) at 60 min. In conclusion, both emulsified isoflurane and propofol-isoflurane anaesthesia affected triiodothyronine, tetraiodothyronine, and insulin in dogs, but emulsified isoflurane anaesthesia had a minimal effect on triiodothyronine and tetraiodothyronine. With its less deleterious effect on the endocrine function, emulsified isoflurane may be more suitable for canine anaesthesia.

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Section: Discussionsupporting

confidence: 86%

Comparison between emulsified isoflurane and propofol/isoflurane combination on plasma thyroid hormones, insulin, glucose, and glucagon in dogs

Jiang

Lin

et al. 2014

Acta Vet. Brno

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“…2,4,[7][8][9] Those with significant illness before surgery are reported to have the changes typical of nonthyroidal illness pre-operatively, including decreased T 3 and elevated rT 3 , that worsened after surgery. 3,4 Because the current study used healthy dogs, the magnitude of the changes in hormones noted may be greater in dogs with pre-existing illness.…”

Section: Discussionmentioning

confidence: 99%

Influence of Isoflurane General Anesthesia or Anesthesia and Surgery on Thyroid Function Tests in Dogs

Wood

Panciera

Berry

et al. 2008

Journal of Veterinary Internal Medicine

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Background: Anesthesia and surgery affect thyroid function tests in humans but have not been studied in dogs. Hypothesis: Anesthesia and anesthesia with surgery will affect thyroid function tests in dogs. Animals: Fifteen euthyroid dogs. Methods: Prospective, controlled, interventional study. Dogs were assigned to one of 3 groups: control, general anesthesia, and general anesthesia plus abdominal exploratory surgery. Dogs in the anesthesia and surgery groups were premedicated with acepromazine and morphine, induced with propofol, and maintained on isoflurane. Samples for measurement of serum thyroxine (T 4 ), free T 4 (fT 4 ) by equilibrium dialysis, triiodothyronine (T 3 ), reverse T 3 (rT 3 ), and thyroid-stimulating hormone concentrations were collected from each dog immediately before premedication, at multiple times during anesthesia, surgery, 4, 8, 12, 24, 36, and 48 hours after anesthesia, once daily for an additional 5 days, and once 14 days after anesthesia. Sampling was performed at identical times in the control group.Results: Serum T 4 decreased significantly from baseline in the surgery and anesthesia groups compared with the control group at 0.33 (P 5 0.043) and 1 hour (P 5 0.018), and 2 (P 5 0.031) and 4 hours (P 5 0.037), respectively, then increased significantly in the surgery group compared with the control group at 24 hours (P 5 0.005). Serum T 3 decreased significantly from baseline in the anesthesia group compared with the control group at 1 hour (P 5 0.034). Serum rT 3 increased significantly from baseline in the surgery group compared with the control and anesthesia groups at 8 (P 5 0.026) and 24 hours (P 5 0.0001) and anesthesia group at 8, 12, 24, and 36 hours (P 5 0.004, P 5 0.016, P 5 0.004, and P 5 0.014, respectively). Serum fT 4 increased significantly from baseline in the surgery group compared to the control at 24 hours (P 5 0.006) and at day 7 (P 5 0.037) and anesthesia group at 48 hours (P 5 0.023).Conclusions and Clinical Importance: Surgery and anesthesia have a significant effect on thyroid function tests in dogs.

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“…1,42,46 The clinical significance of T4 in critical illness remains less clear, and findings regarding postoperative changes in T4 concentrations have been inconsistent, given that it was reported that T4 concentrations may increase, 15 decrease, 48 or remain unchanged 43 after surgery. The postoperative increase in free T4 concentrations found in our study could be due to 1) suppressed conversion of T3 from T4 leading to a build-up of T4; 2) impaired entry of free T4 into cells in patients with low T3 syndrome; 37 and 3) increased release of T4 from thyroid gland stores together with impaired function of thyroid-binding globulin previously described in relation to certain anesthetics, such as isoflurane and enflurane, that are widely used in neurosurgery.…”

Section: 4348mentioning

confidence: 99%

Low triiodothyronine syndrome as a predictor of poor outcomes in patients undergoing brain tumor surgery: a pilot study

Bunevičius

Deltuva

Tamašauskas³

et al. 2013

JNS

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Object A low triiodothyronine (T3) state is highly prevalent and is associated with a poor prognosis in critically ill patients. The authors investigated, in patients undergoing brain tumor surgery, the direct association of a perioperative low T3 syndrome with clinical outcomes and also with symptoms of depression and anxiety. Methods Ninety consecutive patients (71% women, median age 55 years), on admission for brain tumor surgery, were evaluated for sociodemographic and clinical characteristics. Their thyroid function profile was assessed on the morning of brain tumor surgery and on the morning after brain tumor surgery. Patients with free T3 concentrations of 3.1 pmol/L or less were considered to have low T3 syndrome. The patients were evaluated for symptoms of depression and anxiety using the Hospital Anxiety and Depression Scale (HADS) before and after surgery and for clinical outcomes using the Glasgow Outcome Scale (GOS) at discharge. Results After brain tumor surgery, free T3 concentrations decreased (p < 0.001) and the proportion of patients with low T3 levels increased from 38% to 54% (p = 0.02). Lower preoperative (rho = 0.30, p = 0.004) and postoperative (rho = 0.33, p = 0.002) free T3 concentrations correlated with low GOS scores at discharge. Preoperative low T3 syndrome (OR 5.49, 95% CI 1.27–23.69, p = 0.02) and postoperative low T3 syndrome (OR 8.73, 95% CI 1.49–51.21, p = 0.02) both increased risk for unfavorable clinical outcomes (GOS scores < 5) at discharge, after adjusting for age, sex, histological diagnosis of brain tumor, preoperative functional impairment, previous treatment for brain tumor, and depressive symptoms. Preoperative low T3 syndrome increased the risk for preoperative (HADS-depression subscale score ≥ 11; OR 4.12, 95% CI 1.16–14.58, p = 0.03) but not postoperative depressive symptoms independently from sociodemographic and clinical factors. Conclusions Low T3 syndrome is a strong independent predictor of unfavorable clinical outcomes and depressive symptoms, and its diagnosis and preoperative management should be considered in patients undergoing neurosurgery for the treatment of brain tumors.

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Anaesthesia, Not Surgical Stress, Induces Increases in Serum Concentrations of Reverse Triiodothyronine and Thyroxine during Surgery

Cited by 21 publications

References 3 publications

Comparison between emulsified isoflurane and propofol/isoflurane combination on plasma thyroid hormones, insulin, glucose, and glucagon in dogs

Comparison between emulsified isoflurane and propofol/isoflurane combination on plasma thyroid hormones, insulin, glucose, and glucagon in dogs

Influence of Isoflurane General Anesthesia or Anesthesia and Surgery on Thyroid Function Tests in Dogs

Low triiodothyronine syndrome as a predictor of poor outcomes in patients undergoing brain tumor surgery: a pilot study

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