Coronary Bypass Surgery in Patients on Thyroxin Replacement Therapy

Syed, Akbar; Watidy, Ahmed F El; Akhlaque, N Bhat; Wahba, Ahmed H.; Oakley, Reida El; Imran, Kiyani; Bukhari, Emad; Fagih, Mohammed R Al

doi:10.1177/021849230201000203

Cited by 12 publications

(4 citation statements)

References 14 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…[15] There are still conflicting data regarding the safety of CABG in untreated patients. Some authors have reported no adverse effects in patients with untreated mild-to-moderate hypothyroidism undergoing cardiac surgery, [16][17][18] whereas some others have suggested adverse effects such as severe myxedema after cardiac surgery, leading to significant hemodynamic compromise. [19] Some reports have also shown that percutaneous transluminal coronary angioplasty (PTCA) can be a better choice before CABG in hypothyroid patients who have a higher incidence of complications, if there is no time to render them euthyroid.…”

Section: Discussionmentioning

confidence: 99%

Does thyroid dysfunction affect early mortality and morbidity after coronary artery bypass graft surgery?

Tarçın¹

2019

Cardiovasc Surg Int

View full text Add to dashboard Cite

This study aims to evaluate to effect of thyroid dysfunction on early mortality and morbidity in patients undergoing coronary artery bypass grafting (CABG). Patients and methods: Between April 2008 and December 2010, a total of 37 patients (20 females, 17 males; mean age 54.9±10.2 years; range, 26 to 76 years) with thyroid dysfunctions who underwent CABG and 11 patients (2 females, 9 males; mean age 46.9±15.5 years; range, 26 to 65 years) without thyroid dysfunction who underwent on-pump CABG as the control group were included in the study. Patients were divided into groups as overt and subclinical hypothyroidism, overt hyperthyroidism, and subclinical hyperthyroidism according to the thyroid function test results. The European System for Cardiac Operative Risk Evaluation (EuroSCORE) scores were evaluated and the Gensini severity scores were calculated according to coronary angiographies. All patients were followed for seven days after surgery. The duration of endotracheal intubation, inotropic support, cardiac complications, duration of stay in the intensive care unit (ICU) and hospital were recorded. Results: There were no statistically significant differences between the groups in terms of the duration of intubation, need of inotropic support, and duration of stay in the ICU and hospital. Arrhythmia was more frequent in the overt hyperthyroid group than in the overt hypothyroid group postoperatively. Thyroid-stimulating hormone (TSH) levels remained unchanged after surgery, whereas free T 3 decreased and free T 4 increased, which was compatible with postoperative euthyroid sick syndrome. The EuroSCORE scores were positively correlated with pre-and postoperative TSH levels, duration of intubation, and duration of ICU and hospital stay, but was negatively correlated with free T 3. Conclusion: Subclinical or overt thyroid dysfunctions do not seem to affect early mortality after CABG. However, overt hyperthyroidism is associated with postoperative arrhythmia complications. Euthyroid sick syndrome may also occur after surgery in certain cases. Pre-and postoperative TSH and free T 3 levels may be useful to identify mortality and morbidity risk in patients undergoing CABG.

show abstract

Section: Discussionmentioning

confidence: 99%

Does thyroid dysfunction affect early mortality and morbidity after coronary artery bypass graft surgery?

Tarçın¹

2019

Cardiovasc Surg Int

View full text Add to dashboard Cite

show abstract

“…Moreover, there is the suggestion that hypothyroid subjects operated upon for spine surgery may have a 1-day increase in length of stay that was even much longer if the patient had poorly controlled diabetes mellitus [21]. This finding stands in contrast with that of Syed and co-workers who found that there was no significant outcome difference in patients with elevated TSH on thyroid supplement who underwent coronary bypass surgery [22] and to Sherman et al who found no effect on outcomes in hypothyroid patients undergoing angioplasty [23]. More recent data add further confusion to the outcome of surgery on hypothyroid patients.…”

Section: Discussionmentioning

confidence: 93%

Hypothyroidism Prolongs Hospitalization Following Surgery

Villavicencio¹,

Mariash²

2019

IJCM

View full text Add to dashboard Cite

Objective: Each year 45 million surgical procedures are performed in the United States, and a significant number of these are performed on hypothyroid patients. Little guidance is available to determine the postoperative risk to these subjects. We hypothesized that new surgical techniques and modern anesthesia would lead to no differences in outcome between hypothyroid patients and euthyroid controls. Methods: We queried surgical databases in our health system for patients who underwent an operative procedure between January 1, 2010 and December 31, 2015 with a TSH > 10 mcU/mL or a FT4 < 0.6 ng/dL. Identified patients were matched to euthyroid controls selected for age, sex, surgical procedure, and search interval. Predicted length of hospital stay (LOS) was determined using the American College of Surgeons National Surgical Quality Improvement Program surgical risk calculator. Results: We identified 29 hypothyroid patients. The LOS was significantly longer for the hypothyroid patients compared to the predicted LOS (14.4 vs 6.7 days, P < 0.001). The LOS in the matched controls was not significantly different than their predicted LOS (9.6 vs 7.1 days, P = 0.11). Other complications were not different between the hypothyroid and control patients. Conclusions: In contrast to our initial hypothesis, hypothyroidism is associated with a 2-fold longer LOS following surgery. Hypothyroidism continues to place patients at increased surgical risk.

show abstract

“…The usual replacement dose can be administered on the day of surgery via the enteral route without the need for any additional supplementation or conversion to a parenteral route of administration. 38 There are no studies on the safety and efficacy of antithyroid medications (methimazole and propylthiouracil) in the perioperative period. To avoid the possible risk of thyroid storm in the perioperative period, these medications should be continued uninterrupted.…”

Section: Thyroid Medicationsmentioning

confidence: 99%

Preoperative Management of Endocrine, Hormonal, and Urologic Medications: Society for Perioperative Assessment and Quality Improvement (SPAQI) Consensus Statement

Pfeifer

Selzer

Mendez

et al. 2021

Mayo Clinic Proceedings

View full text Add to dashboard Cite

Perioperative medical management is challenging due to the rising complexity of patients presenting for surgical procedures. A key part of preoperative optimization is appropriate management of long-term medications, yet guidelines and consensus statements for perioperative medication management are lacking. Available resources utilize the recommendations derived from individual studies and do not include a multidisciplinary focus or formal consensus. The Society for Perioperative Assessment and Quality Improvement (SPAQI) identified a lack of authoritative clinical guidance as an opportunity to utilize its multidisciplinary membership to improve evidence-based perioperative care. SPAQI seeks to provide guidance on perioperative medication management that synthesizes available literature with expert consensus. The aim of this Consensus Statement is to provide practical guidance on the preoperative management of endocrine, hormonal, and urologic medications. A panel of experts with anesthesiology, perioperative medicine, hospital medicine, general internal medicine, and medical specialty experience was drawn together and identified the common medications in each of these categories. The authors then utilized a modified Delphi approach to critically review the literature and generate consensus recommendations.

show abstract

Coronary Bypass Surgery in Patients on Thyroxin Replacement Therapy

Cited by 12 publications

References 14 publications

Does thyroid dysfunction affect early mortality and morbidity after coronary artery bypass graft surgery?

Does thyroid dysfunction affect early mortality and morbidity after coronary artery bypass graft surgery?

Hypothyroidism Prolongs Hospitalization Following Surgery

Preoperative Management of Endocrine, Hormonal, and Urologic Medications: Society for Perioperative Assessment and Quality Improvement (SPAQI) Consensus Statement

Contact Info

Product

Resources

About