Efficacy of Perioperative Oral Triiodothyronine Replacement Therapy in Patients Undergoing Off-Pump Coronary Artery Bypass Grafting

Choi, Yong Seon; Shim, Jæ Kwang; Song, Jong Wook; Song, Young Goo; Kwak, Young Lan

doi:10.1053/j.jvca.2013.01.027

Cited by 20 publications

(12 citation statements)

References 28 publications

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“…Such differences may explain the ongoing controversy about whether patients with NTIS should be treated to improve the outcome of critical illness. In patients undergoing cardiac surgery, treatment with T3 either did or did not improve postoperative cardiac function [29–31], but patient-centered clinical outcomes were never affected [31–34]. Furthermore, T3 treatment did not affect mortality in patients suffering from acute burn injury [35].…”

Section: Ntis In Critically Ill Adults Treated In the Intensive Camentioning

confidence: 99%

Nonthyroidal Illness Syndrome Across the Ages

Langouche

Jacobs

Berghe

2019

Journal of the Endocrine Society

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In conditions of acute illness, patients present with reduced plasma T3 concentrations without a concomitant rise in TSH. In contrast, plasma concentrations of the inactive hormone rT3 increase, whereas plasma concentrations of T4 remain low-normal. This constellation of changes, referred to as nonthyroidal illness syndrome (NTIS), is present across all ages, from preterm neonates and over-term critically ill infants and children to critically ill adults. Although the severity of illness strongly correlates with the severity of the NTIS phenotype, the causality of this association remains debated, and pathophysiological mechanisms remain incompletely understood. In the acute phase of illness, NTIS appears to be caused predominantly by an increased peripheral inactivation of thyroid hormones, in which reduced nutritional intake plays a role. Current evidence suggests that these acute peripheral changes are part of a beneficial adaptation of the body to reduce expenditure of energy and to activate the innate immune response, which is important for survival. In contrast, in more severely ill and prolonged critically ill patients, an additional central suppression of the thyroid hormone axis alters and further aggravates the NTIS phenotype. Recent studies suggest that this central suppression may not be adaptive. Whether treatment of this central component of NTIS in prolonged critically ill patients, with the use of hypothalamic releasing factors, improves outcome remains to be investigated in large randomized control trials.

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Section: Ntis In Critically Ill Adults Treated In the Intensive Camentioning

confidence: 99%

Nonthyroidal Illness Syndrome Across the Ages

Langouche

Jacobs

Berghe

2019

Journal of the Endocrine Society

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“…In addition to the studies of Cerillo et al and Velissaris et al that found thyroid hormone changes during OPCAB comparable to those after CPB and consistent with the ESS, a posterior trial by Choi et al 24 found no differences between groups on haemodynamic variables and outcomes after T3 administration in adults undergoing elective OPCAB. Therefore, research would be needed to clarify these observations pertaining to OPCAB.…”

Section: ‘Gaps In Knowledge’ and Proposed Future Study Directionsmentioning

confidence: 78%

Euthyroid sick syndrome in paediatric and adult patients requiring extracorporeal circulatory support and the role of thyroid hormone supplementation: a review

Nistal-Nuño

2020

Perfusion

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Non-thyroid disorders may modify thyroid hormone metabolism, resulting in an ‘euthyroid sick syndrome’. Studies determining the association of cardiopulmonary bypass to thyroid function showed changes in line with this euthyroid sick syndrome. In some cases, cardiovascular dysfunction after cardiac surgery with cardiopulmonary bypass is comparable to that noticed in hypothyroidism associated with low cardiac output and elevated systemic vascular resistance. Numerous lines of research have proposed that triiodothyronine can behave acutely as a positive inotropic and vasodilator agent. The aim of this review is to present an update on the current literature about in what clinical situations the use of thyroid supplementation during the perioperative period of extracorporeal circulation in the adult and paediatric populations may impact outcome to any appreciable degree. The contribution of thyroid function in patients undergoing a ventricular assist device implantation is additionally reviewed and future study directions are proposed. This is a narrative review, where the search strategy consisted on retrieving the articles through an extensive literature search performed using electronic databases from January 1978 up to September 2019. All controlled trials randomly allocating to perioperative thyroid hormone administration in children and adults undergoing extracorporeal circulation for cardiac surgery were considered. Thyroid hormone supplementation may be recommended particularly in selected paediatric sub-populations. There is currently no firm evidence regarding the benefits of routine use of thyroid hormone administration in cardiac adult patients. Further studies are required to assess the beneficial effect of thyroid hormone on patients with end-stage heart failure supported by ventricular assist devices.

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“…In previous studies, perioperative oral thyroid hormone therapy in adult and pediatric patients undergoing cardiac surgery with CPB often used levothyroxine (Euthyrox), [ 11 – 13 ] which is a synthetic tetraiodothyronine sodium that can be transformed into T 3 by deiodination in liver. [ 17 ] Considering that postoperative decline of serum T 3 and T 4 is common in children undergoing cardiac surgery with CPB, [ 3 , 4 , 7 , 15 ] oral preparation of thyroid hormones used in this study is thyroid tablet including T 3 and T 4 .…”

Section: Discussionmentioning

confidence: 99%

“…[ 10 ] The available evidence also indicates that perioperative oral T 3 therapy can significantly attenuate the postoperative decline in serum T 3 level or maintain total and free serum T 3 levels within normal limits in adult and pediatric patients undergoing cardiac surgery. [ 11 – 13 ] Given that oral administration is a safe, convenient and feasible route of perioperative medication, we speculate that preoperative oral thyroid hormone therapy can not only increase therapeutic controllability, but also may provide a protection against myocardial IRI and prevent the occurrence of ESS after cardiac surgery. However, there has been no study to determine the preventive efficacy of preoperative oral thyroid hormone therapy on postoperative ESS and myocardial IRI in pediatric patients undergoing cardiac surgery with CPB.…”

Section: Introductionmentioning

confidence: 99%

Preoperative oral thyroid hormones to prevent euthyroid sick syndrome and attenuate myocardial ischemia-reperfusion injury after cardiac surgery with cardiopulmonary bypass in children

Zhang¹,

Yang

Xue

et al. 2018

Medicine

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Background:Both euthyroid sick syndrome and myocardial ischemia-reperfusion injury are common and have been significantly associated with morbidity and mortality after pediatric cardiac surgery with cardiopulmonary bypass. This single-center, prospective, double-blind, randomized placebo-controlled clinical pilot trial was designed to assess if preoperative oral thyroid hormone therapy could prevent the occurrence of euthyroid sick syndrome (ESS) and attenuate myocardial ischemia-reperfusion injury (IRI) after cardiac surgery with cardiopulmonary bypass (CPB) in children.Methods:Forty children aged 3 to 12 year, scheduled for elective congenital heart disease repair surgery with CPB, were randomized into 2 groups of equal size to receive the following treatments in a double-blind manner: placebo (control group) and thyroid tablet 0.4 mg/kg (trial group) taken orally once a day for 4 days before surgery. The perioperative serum thyroid hormone levels and hemodynamic variables were determined. The extubation time, duration of intensive care unit (ICU) stay, and use of inotropic drugs in the ICU were recorded. The myocardial expressions of heat shock protein 70 (HSP70), myosin heavy chain (MHC) mRNA, and thyroid hormone receptor (TR) mRNA were detected. The serum creatine kinase-MB (CK-MB) activity and troponin I (TnI) positive ratio at 24 hour after surgery were assessed.Results:There were no significant differences in hemodynamic variables at all observed points, extubation time, and duration of ICU stay between groups. As compared with baselines on administration, serum triiodothyronine (T3) and free T3 (FT3) levels on the first, second, and fourth postoperative day, and serum thyrotropic-stimulating hormone (TSH), tetraiodothyronine (T4), and free T4 (FT4) levels on the first postoperative day were significantly decreased in the 2 groups. Serum T3, FT3, and T4 levels on the first and second postoperative day, and serum FT4 level on the first postoperative day were significantly higher in the trial group than in control group. As compared with the control group, the number of patients requiring inotropic drugs in the ICU, serum CK-MB activity, serum positive TnI ratio, and myocardial expression of MHCβ mRNA were significantly decreased, and myocardial expressions of both HSP70 and MHCα mRNA were significantly increased in the trial group.Conclusions:In children undergoing cardiac surgery with CPB, preoperative oral small-dose thyroid hormone therapy reduces severity of postoperative ESS and provides a protection against myocardial IRI by increasing HSP70 and MHCα expression.

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Efficacy of Perioperative Oral Triiodothyronine Replacement Therapy in Patients Undergoing Off-Pump Coronary Artery Bypass Grafting

Cited by 20 publications

References 28 publications

Nonthyroidal Illness Syndrome Across the Ages

Nonthyroidal Illness Syndrome Across the Ages

Euthyroid sick syndrome in paediatric and adult patients requiring extracorporeal circulatory support and the role of thyroid hormone supplementation: a review

Preoperative oral thyroid hormones to prevent euthyroid sick syndrome and attenuate myocardial ischemia-reperfusion injury after cardiac surgery with cardiopulmonary bypass in children

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