Cardiopulmonary bypass and thyroid function: A “euthyroid sick syndrome”

Holland, Fred W.; Brown, Paul S.; Weintraub, Bruce D.; Clark, Richard E.

doi:10.1016/0003-4975(91)91416-s

Cited by 174 publications

(78 citation statements)

References 20 publications

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“…6 Patients with normal thyroid function after cardiac surgery have been reported to have a low cardiac output and elevated systemic vascular resistance, similar to that observed in hypothyroid patients, and approximately 50-75% of patients are in a 'euthyroid-sick' state for 1-4 days after surgery. 7 In the present case, perioperative changes in FT3 and FT4 levels were minimal, and the lowest levels of serum thyroid hormone were found on postoperative day 3. Levels gradually increased to within the normal range in 3 weeks without any events associated with hyperthyroidism or hypothyroidism.…”

Section: Discussionsupporting

confidence: 41%

Combined Cardiac Surgery and Total Thyroidectomy

et al. 1999

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yperthyroid patients have hypertrophic hearts associated with reversible cardiomyopathy and can present with angina symptoms even in the absence of coronary artery disease. 1 Medical therapy for hyperthyroidism is currently the first choice of treatment in Japan and surgical treatment is rare except in certain patients. To the best of our knowledge, reports of combined cardiac surgery and thyroidectomy have rarely been published. 2 It is important to control the levels of thyroid hormone to prevent perioperative thyrothoxicosis in patients with hyperthyroidism. Case ReportA 65-year-old woman was admitted to hospital because of effort angina. She complained of palpitation and sweating for the 3 years prior to admission, and she had a history of rheumatoid arthritis and idiopathic thrombocytopenic purpura treated with prednisolone. There was also some history of cerebrovascular and ischemic heart disease in her family. A coronary angiogram and cardiac catheterization revealed ischemic heart disease and mild aortic stenosis. Laboratory studies revealed a hyperthyroid state: serum free triiodothyronine (FT3), free thyroxine (FT4), and thyroid-stimulating hormone (TSH) levels were, respectively, 8.39 pg/ml (normal range 2.47-4.34), 4.35 ng/dl (normal range 0.97-1.97), and less than 0.1 U/ml (normal range 0.4-5.0). Treatment for Graves' disease was initiated with methimazole combined with a -blocking agent. FT3 and FT4 levels then fell within the normal range. However, liver dysfunction had occurred within a few weeks due to the methimazole. Therefore, propylthiouracil was administered instead. However, the hepatoxicity still continued.Radioiodine instead of antithyroid drugs was administered. She was then discharged without any symptoms and in a euthyroid state. One year after the start of radioiodine administration, she experienced unstable angina with palpitation and sweating. FT3, FT4 and TSH levels were, respectively, 5.54 pg/ml, 2.37 ng/dl, and less than 0.1 U/ml. A second coronary angiogram revealed progressive ischemic heart disease with left main trunk disease and 2-vessel disease, and cardiac catheterization showed aortic stenosis with 34 mmHg of mean transvalvular pressure gradient and 0.7 cm 2 of estimated aortic valve area. Combined coronary artery bypass grafting (CABG), aortic valve replacement (AVR), and total thyroidectomy were recommended. In preparation for the surgery, a 50-mg daily dose of potassium iodine was initiated 17 days beforehand, in order to maintain thyroid function in the euthyroid or hypothyroid state. Thyroid hormone levels were gradually decreased to within the normal range by 10 days after the start of iodine administration, and then tended to increase again. Just before surgery, FT3, FT4, and TSH levels were, respectively, 3.88 pg/ml, 1.27 ng/dl, and less than 0.1 U/ml (Fig 1).During the induction of anesthesia, 20 mg of betametazone and a high dose of fentanyl were administered to prevent thyrotoxicosis and cardiac depression. Cardiac surgery through a median sternotomy was perfo...

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Section: Discussionsupporting

confidence: 41%

Combined Cardiac Surgery and Total Thyroidectomy

et al. 1999

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“…The low T3 state has been described in starvation (4), sepsis (5), surgery (6), myocardial infarction and heart failure (7,8), cardiopulmonary bypass (9), bone marrow transplantation (10) and any other severe illness (11).…”

Section: Introductionmentioning

confidence: 99%

Low triiodothyronine (T3) state: a predictor of outcome in respiratory failure? Results of a clinical pilot study

Scoscia¹,

Baglioni²,

Eslami³

et al. 2004

European Journal of Endocrinology

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Background and aim: Various low triiodothyronine (T3) states have been described in severe nonthyroidal diseases and associated with a poor prognosis in cardiovascular disease patients. We assessed thyroid function in patients with severe respiratory failure from pulmonary disorders, and needing invasive or noninvasive mechanical ventilation, in order to evaluate the prognostic value of nonthyroidal illness syndrome. Methods: We studied 32 consecutive patients with acute or acute-on-chronic respiratory failure. Measured variables upon admission included APACHE II score, the ratio of the partial pressure of oxygen in arterial blood to the fraction of oxygen in inspired gas (PaO 2 /FiO 2 ), and plasma levels of free T3 (fT3) and free thyroxine (fT4), and TSH levels. Thyroid function was further evaluated at discharge. Results: Plasma levels of fT3 were below normal in 17 patients (53%). Plasma fT3 was correlated with PaO 2 /FiO 2 (P , 0.001), and with APACHE II score (P ¼ 0.003). In four patients (12.5%) who died, fT3 levels were significantly lower (P ¼ 0.002) than in patients who survived. In univariate logistic regression analysis, fT3 was the only factor significantly associated with an increased risk of death (odds ratio, 64.23; 95% confidence interval, 1.78 -2316.86, P ¼ 0.023). Normalization of thyroid function was observed at discharge with a significant correlation between the percent increase in both fT3 and PaO 2 /FiO 2 (P ¼ 0.015). P values were calculated using Spearman's Correlation Coefficient. Conclusion: Our preliminary data suggest that the low T3 state is a predictor of outcome in pulmonary patients with respiratory failure.

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“…It has been assigned to this standard of hormonal variation, the concept of euthyroid syndrome. The most important pathophysiological mechanism in the occurrence of this profile is the thyroid hormone molecule reduced conversion of T4 to T3 the active component [12][13][14]. Taylor et al [15] have argued, since the late 70s of last century, that some aspects inherent to CPB may contribute to the changes of the thyroid hormone profile, such as hemodilution, hypothermia, and nonpulsatile flow.…”

Section: Fig 3 -Comparison Between Two Moments For Total T3 Free T3mentioning

confidence: 99%

Revascularização miocárdica com circulação extracorpórea; aspectos bioquímicos, hormonais e celulares

Gabriel¹,

Locali²,

Matsuoka³

et al. 2011

Rev Bras Cir Cardiovasc

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Revascularização miocárdica com circulação extracorpórea; aspectos bioquímicos, hormonais e celularesOn-pump coronary artery bypass graft surgery: biochemical, hormonal and cellular features This study was carried out at Federal University of São Paulo, Discipline of Cardiovascular Surgery, São Paulo, SP, Brazil. Methods: Eighteen patients underwent on-pump CABG surgery. Mean time of CPB was 80.3 minutes. Hormonal, biochemical and cellular measurements were taken in some time points -preoperatively, immediately after coming off CPB, 24 and 48 hours postoperatively. Friedman and Wilcoxon tests were applied based on significance level of 5%.Results: There was activation and significant elevation of total leukocytes and neutrophils count over CPB, remaining this way up to 48 hours postoperatively. Total platelets count, in turn, was marked by relevant reduction immediately after coming off CPB as well as in two postoperative time points. Serum levels of total proteins and albumin, immediately after coming off CPB and also in two postoperative time points, were significantly decreased comparing with preoperative status. There was remarkable reduction of total T3, free T3 and total T4 particularly up to first 24 hours postoperatively.Conclusion: In on-pump CABG surgery, inflammatory effects encompass activation of total leukocytes, neutrophils and platelets, reduction of serum level of total proteins and albumin and decreased thyroid hormones levels, especially within first postoperative 24 hours.

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Cardiopulmonary bypass and thyroid function: A “euthyroid sick syndrome”

Cited by 174 publications

References 20 publications

Combined Cardiac Surgery and Total Thyroidectomy

Combined Cardiac Surgery and Total Thyroidectomy

Low triiodothyronine (T3) state: a predictor of outcome in respiratory failure? Results of a clinical pilot study

Revascularização miocárdica com circulação extracorpórea; aspectos bioquímicos, hormonais e celulares

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