Perioperative Thyroid Hormone Kinetics in Patients Undergoing Major Oral and Maxillofacial Operations

Saranteas, Theodosios; Tachmintzis, Annete; Katsikeris, Nick; Lykoudis, Eustathios; Mourouzis, Iordanis; Anteriotis, Dimitrios; Alexopoulos, C.; Dimakopoulou, A.; Dimitriou, V.; Pantos, C.; Tesseromatis, C.

doi:10.1016/j.joms.2005.12.067

Cited by 8 publications

(6 citation statements)

References 29 publications

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“…Several factors may contribute to the observed decrease in circulating thyroid hormone levels. In healthy adult humans the biological half-life of TSH is less than 1 h, while T3 is 24 h and T4 is 5–7 d. Although thyroid hormone levels are acutely altered in the setting of surgical and psychological stress, very little is known about the kinetics of thyroid hormone in acute settings [16–18]. As such, the biological half-life of key thyroid hormones following severe trauma is unknown.…”

Section: Discussionmentioning

confidence: 99%

Altered thyroid function in severely injured patients

Grill

Strong

Sonnad

et al. 2013

Journal of Surgical Research

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Background Hemorrhagic shock profoundly affects the neuroendocrine profile of trauma patients, and we hypothesized that massive resuscitation would negatively impact thyroid function. Methods A prospective, observational study investigating thyroid function in hypotensive trauma patients (systolic blood pressure <90 mm Hg × 2) who survived >48 h was conducted at a Level I center over a 6-mo period. Blood samples for thyroid function were collected at time of presentation to the trauma bay and serially for 48 h. Collected data included demographics, injury data, vital signs, transfusion needs, crystalloid use, and vasopressor requirements. Patients receiving >5 units packed red blood cells (PRBC) within 12 h were compared with those receiving ≥ 5 units. Results Patients who required >5 units of PRBC/12 h had significantly lower total and free T4 levels on initial presentation, and levels remained significantly depressed over the next 48 h when compared with patients who required a less aggressive resuscitative effort. T3 values were markedly suppressed during the initial 48 h post trauma in all patients, but were significantly lower in patients requiring >5 units PRBC. TSH levels remained within the normal range for all time points. Lower trauma admission T4 levels were associated with the need for greater crystalloid resuscitation within the first 24 h. Conclusion Measurements of thyroid function are significantly altered in severely injured patients on initial presentation, and low T4 levels predict the need for large resuscitation. Further research investigating the profile and impact of thyroid function in trauma patients during resuscitation and recovery is warranted.

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Section: Discussionmentioning

confidence: 99%

Altered thyroid function in severely injured patients

Grill

Strong

Sonnad

et al. 2013

Journal of Surgical Research

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“…The authors of the study suggested a possible association between low postoperative levels of thyroid hormones and increased levels of S100B. 60 Neurone-specific enolase NSE is a dimeric enzyme that catalyses the conversion of 2-phospho-D-glycerate to phosphoenolpyruvate in the glycolytic pathway and is found in neurones and neuroendocrine cells. The subunits a and g present in NSE are specific for neurones.…”

Section: S100b In Non-cardiac Surgerymentioning

confidence: 99%

Neurological biomarkers in the perioperative period

Cata

Abdelmalak

Farag

2011

British Journal of Anaesthesia

101

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The rapid detection and evaluation of patients presenting with perioperative neurological dysfunction is of great clinical relevance. Biomarkers have been defined as biological molecules that can be used as an indicator of new onset or progression of a biological process or effect of treatment. Biomarkers have become increasingly important in this setting to supplement other modalities of diagnosis such as EEG, sensory- or motor-evoked potential, transcranial Doppler, near-infrared spectroscopy, or imaging methods. A number of neuro-proteins have been identified and are currently under investigation for potential to provide insights into injury severity, outcome, and the ability to monitor cellular damage and molecular events that occur during neurological injury. S100B is a protein released by glial cells and is considered a marker of blood-brain barrier dysfunction. Clinical studies in patients undergoing cardiac and non-cardiac surgery indicate that serum levels of S100B are increased intraoperatively and after operation. The neurone-specific enolase has also been extensively investigated as a potential marker of neuronal injury in the context of cardiac and non-cardiac surgery. A third biomarker of interest is the Tau protein, which has been linked to neurodegenerative disorders. Tau appears to be more specific than the previous two biomarkers since it is only found in the central nervous system. The metalloproteinase and ubiquitin C terminal hydroxylase-L1 (UCH-L1) are the most recently researched markers; however, their usefulness is still unclear. This review presents a comprehensive overview of S100B, neuronal-specific enolase, metalloproteinases, and UCH-L1 in the perioperative period.

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“…[8][9][10][11] To further complicate the issue, upon exposure to anaesthetics both increases and decreases of thyroid hormones have been found. 3,[12][13][14][15][16] These diverse results may be due to differences in the study set-up and/or in the study populations, the presence of surgical stress and the varying degrees of surgical stimulation.…”

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confidence: 99%

The differential impact of volatile and intravenous anaesthetics on stress response in the swine

Kostopanagiotou¹,

Kalimeris²,

Christodoulaki³

et al. 2010

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OBjEcTIVE: To compare the effects of various anaesthetics on stress response in the presence and absence of surgical stimulation. DESIGN: Twenty-nine pigs scheduled to undergo surgical central vein catheter placement were randomly allocated to receive only sedation with ketamine-midazolam (group SHAM, n=5) or general anaesthesia with either propofol 8 mg/kg/h (group PROP, n=8), sevoflurane 1.0 MAc (group SEVO, n=8) or desflurane 1.0 MAc (group DESF, n=8). Following surgery, anaesthesia was maintained for a total period of 4 hours. Thyroid hormones, noradrenaline, cortisol, corticotrophin (AcTH), β-endorphin, interleukin-1β and -6 and tumor necrosis factor-α were determined by appropriate methodology after premedication (t0), after surgical procedure (t1) and at the end of 4h (t2). RESULTS: At t1 AcTH and β-endorphin increased in all groups, thyroxin in groups SEVO, DESF and PROP, noradrenaline in group SEVO and cortisol in the SHAM and PROP groups. At t2 cortisol and AcTH levels were lower in the PROP compared to SEVO group. Serum cytokines were not significantly altered in either group. cONcLUSIONS: The choice of the general anaesthetic did not affect thyroid hormones levels in either the presence or absence of surgical stimulus. In the presence of surgical stimulation, sevoflurane resulted in higher noradrenaline levels and in higher activity of the AcTH-cortisol axis compared to propofol.

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Perioperative Thyroid Hormone Kinetics in Patients Undergoing Major Oral and Maxillofacial Operations

Cited by 8 publications

References 29 publications

Altered thyroid function in severely injured patients

Altered thyroid function in severely injured patients

Neurological biomarkers in the perioperative period

The differential impact of volatile and intravenous anaesthetics on stress response in the swine

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