The Effect of Oral Triiodothyronine in Outcome of Pediatric Congenital Cardiac Surgery
Journal of Cellular & Molecular Anesthesia,
Vol. 5 No. 3 (2020),
19 Mehr 2020
,
Page 150-156
https://doi.org/10.22037/jcma.v5i3.30272
Abstract
Background: Cardiac surgery especially in small children is associated with a marked decrease in thyroid hormone levels consistent with the phenomenon referred to as Sick Euthyroid Syndrome (SES). The purpose of the present study was to determine if oral triiodothyronine could reduce the length of ICU stay, vasoactive inotropic score (VIS), and promote ejection fraction in infants and children undergoing cardiac surgery with CPB. Materials and Methods: In a double-blind clinical trial, one hundred and twenty children aged 6 to 60 months and scheduled for different types of cardiac surgery with CPB, were randomized into two groups to receive either 2 mcg/Kg triiodothyronine (trial group) or 5% dextrose water (placebo group), immediately after anesthesia and 24 hours after surgery. The perioperative serum thyroid hormone levels and hemodynamic variables were determined. The intubation time, ICU stay length, ICU inotropic use, and cardiac ejection fraction was recorded. Results: The basic demographic data were comparable in two groups. No significant side effects or adverse reactions were seen due to hormone therapy. Intubation time, ICU stay, and VIS values were significantly shorter between the two groups. Conclusion: In children undergoing cardiac surgery with CPB, perioperative oral small-dose triiodothyronine therapy could improve clinical indices of perioperative care.- Triiodothyronine
- Intubation time
- Congenital Cardiac Surgery
- ICU Stay
How to Cite
References
Klein I, Ojamaa K. Thyroid hormone and the cardiovascular system. N Engl J Med. 2001;344(7):501-9.
Kahaly GJ, Dillmann WH. Thyroid hormone action in the heart. Endocr Rev. 2005;26(5):704-28.
Gomberg-Maitland M, Frishman WH. Thyroid hormone and cardiovascular disease. Am Heart J. 1998;135(2 Pt 1):187-96.
Plumpton K, Haas NA. Identifying infants at risk of marked thyroid suppression post-cardiopulmonary bypass. Intensive Care Med. 2005;31(4):581-7.
Bettendorf M, Schmidt KG, Tiefenbacher U, Grulich-Henn J, Heinrich UE, Schönberg DK. Transient secondary hypothyroidism in children after cardiac surgery. Pediatr Res. 1997;41(3):375-9.
Bartkowski R, Wojtalik M, Korman E, Sharma G, Henschke J, Mrówczyński W. Thyroid hormones levels in infants during and after cardiopulmonary bypass with ultrafiltration. Eur J Cardiothorac Surg. 2002;22(6):879-84.
Dimmick S, Badawi N, Randell T. Thyroid hormone supplementation for the prevention of morbidity and mortality in infants undergoing cardiac surgery. The Cochrane database of systematic reviews. 2004(3):Cd004220.
Ross OC, Petros A. The sick euthyroid syndrome in paediatric cardiac surgery patients. Intensive Care Med. 2001;27(7):1124-32.
Saatvedt K, Lindberg H, Geiran OR, Fiane A, Seem E, Michelsen S, et al. Thyroid function during and after cardiopulmonary bypass in children. Acta Anaesthesiol Scand. 1998;42(9):1100-3.
Talwar S, Khadgawat R, Sandeep JA, Sreenivas V, Choudhary SK, Gupta N, et al. Cardiopulmonary bypass and serum thyroid hormone profile in pediatric patients with congenital heart disease. Congenit Heart Dis. 2012;7(5):433-40.
Zhang JQ, Yang QY, Xue FS, Zhang W, Yang GZ, Liao X, et al. Preoperative oral thyroid hormones to prevent euthyroid sick syndrome and attenuate myocardial ischemia-reperfusion injury after cardiac surgery with cardiopulmonary bypass in children: A randomized, double-blind, placebo-controlled trial. Medicine (Baltimore). 2018;97(36):e12100.
Marwali EM, Caesa P, Darmaputri S, Sani AA, Roebiono PS, Fakhri D, et al. Oral Triiodothyronine Supplementation Decreases Low Cardiac Output Syndrome After Pediatric Cardiac Surgery. Pediatr Cardiol. 2019;40(6):1238-46.
Radman M, Portman MA. Thyroid Hormone in the Pediatric Intensive Care Unit. J Pediatr Intensive Care. 2016;5(4):154-61.
Choi YS, Shim JK, Song JW, Song Y, Yang SY, Kwak YL. Efficacy of perioperative oral triiodothyronine replacement therapy in patients undergoing off-pump coronary artery bypass grafting. J Cardiothorac Vasc Anesth. 2013;27(6):1218-23.
Choi YS, Kwak YL, Kim JC, Chun DH, Hong SW, Shim JK. Peri-operative oral triiodothyronine replacement therapy to prevent postoperative low triiodothyronine state following valvular heart surgery. Anaesthesia. 2009;64(8):871-7.
Marwali EM, Boom CE, Sakidjan I, Santoso A, Fakhri D, Kartini A, et al. Oral triiodothyronine normalizes triiodothyronine levels after surgery for pediatric congenital heart disease*. Pediatr Crit Care Med. 2013;14(7):701-8.
Dagan O, Vidne B, Josefsberg Z, Phillip M, Strich D, Erez E. Relationship between changes in thyroid hormone level and severity of the postoperative course in neonates undergoing open-heart surgery. Paediatr Anaesth. 2006;16(5):538-42.
Haas NA, Camphausen CK, Kececioglu D. Clinical review: thyroid hormone replacement in children after cardiac surgery--is it worth a try? Crit Care. 2006;10(3):213.
Palace MR. Perioperative Management of Thyroid Dysfunction. Health Serv Insights. 2017;10:1178632916689677.
Chatzitomaris A, Hoermann R, Midgley JE, Hering S, Urban A, Dietrich B, et al. Thyroid Allostasis-Adaptive Responses of Thyrotropic Feedback Control to Conditions of Strain, Stress, and Developmental Programming. Front Endocrinol (Lausanne). 2017;8:163.
Talwar S, Bhoje A, Khadagawat R, Chaturvedi P, Sreenivas V, Makhija N, et al. Oral thyroxin supplementation in infants undergoing cardiac surgery: A double-blind placebo-controlled randomized clinical trial. J Thorac Cardiovasc Surg. 2018;156(3):1209-17.e3.
Mackie AS, Booth KL, Newburger JW, Gauvreau K, Huang SA, Laussen PC, et al. A randomized, double-blind, placebo-controlled pilot trial of triiodothyronine in neonatal heart surgery. J Thorac Cardiovasc Surg. 2005;130(3):810-6.
Langouche L, Jacobs A, Van den Berghe G. Nonthyroidal Illness Syndrome Across the Ages. J Endocr Soc. 2019;3(12):2313-25.
Jacobs A, Derese I, Vander Perre S, van Puffelen E, Verstraete S, Pauwels L, et al. Non-Thyroidal Illness Syndrome in Critically Ill Children: Prognostic Value and Impact of Nutritional Management. Thyroid. 2019;29(4):480-92.
Portman MA, Slee A, Olson AK, Cohen G, Karl T, Tong E, et al. Triiodothyronine Supplementation in Infants and Children Undergoing Cardiopulmonary Bypass (TRICC): a multicenter placebo-controlled randomized trial: age analysis. Circulation. 2010;122(11 Suppl):S224-33.
- Abstract Viewed: 171 times
- PDF Downloaded: 136 times