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Intensive Care Medicine
Published in: Intensive Care Medicine 4/2005

01-04-2005 | Neonatal and Pediatric Intensive Care

Identifying infants at risk of marked thyroid suppression post-cardiopulmonary bypass

Authors: Kevin Plumpton, Nikolaus A. Haas

Published in: Intensive Care Medicine | Issue 4/2005

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Abstract

Objective

The clinical benefit of tri-iodothyrinone (T3) replacement following congenital heart surgery with cardiopulmonary bypass (CPB) is not clear in unselected cohorts of children. Infants with more marked thyroid hormone suppression or prolonged post-CPB recovery may benefit from T3 replacement. This study aimed to identify infants at risk of more marked suppression by examining the relationship between organ support parameters during CPB and post-operative thyroid hormone levels.

Design and setting

Prospective observational study in a tertary referral centre for congenital heart surgery.

Patients

36 infants less than 12 months of age were recruited following CPB.

Measurements and results

Thyroid hormone levels were measured on admission to the intensive care unit and on post-operative days 1 and 2. Increasing CPB time was associated with decreasing admission free T3 and thyroid-stimulating hormone. Younger, smaller infants had lower admission levels of free T3 on univariant analysis. Infants who continued to require ventilation 48 h after admission to the ICU had a mean free T3 level on post-operative day 2 that was 0.9 pmol/l lower than in those who had been extubated.

Conclusions

Prospective studies of T3 replacement in selected young infants (less than 3 months) with long CPB time (greater than 120 min) during congenital heart surgery are warranted.
Literature
1.
Bettendorf M, Schmidt KG, Tiefenbacher U, Grulich-Henn J, Heinrich UE, Schonberg DK (1997) Transient secondary hypothyroidism in children after cardiac surgery. Pediatr Res 41:375–379
2.
Bartkowski R, Wojtalik M, Korman E, Sharma G, Henschke J, Mrowczynski W (2002) Thyroid hormones levels in infants during and after cardiopulmonary bypass with ultrafiltration. Eur J Cardiothorac Surg 22:879–884CrossRef
3.
Murzi B, Iervasi G, Masini S, Moschetti R, Vanini V, Zucchelli G, Biagini A (1995) Thyroid hormones homeostasis in pediatric patients during and after cardiopulmonary bypass. Ann Thorac Surg 59:481–485CrossRefPubMed
4.
Portman MA, Fearneyhough C, Ning XH, Duncan BW, Rosenthal GL, Lupinetti FM (2000) Triiodothyronine repletion in infants during cardiopulmonary bypass for congenital heart disease. J Thorac Cardiovasc Surg 120:604–608CrossRefPubMed
5.
Ross OC, Petros A (2001) The sick euthyroid syndrome in paediatric cardiac surgery patients. Intensive Care Med 27:1124–1132CrossRef
6.
Brogan TV, Bratton SL, Lynn AM (1997) Thyroid function in infants following cardiac surgery: comparative effects of iodinated and noniodinated topical antiseptics. Crit Care Med 25:1583–1587CrossRef
7.
Ririe DG, Butterworth JF, Hines M, Hammon JW Jr, Zaloga GP (1998) Effects of cardiopulmonary bypass and deep hypothermic circulatory arrest on the thyroid axis during and after repair of congenital heart defects: preservation by deep hypothermia? Anesth Analg 87:543–548CrossRef
8.
Docter R, Krenning EP, de Jong M, Hennemann G (1993) The sick euthyroid syndrome: changes in thyroid hormone serum parameters and hormone metabolism. Clin Endocrinol (Oxf) 39:499–518
9.
Van den Berghe G, de Zegher F, Lauwers P (1994) Dopamine suppresses pituitary function in infants and children. Crit Care Med 22:1747–1753
10.
McMahon CK, Klein I, Ojamaa K (2003) Interleukin-6 and thyroid hormone metabolism in pediatric cardiac surgery patients. Thyroid 13:301–304CrossRef
11.
Allen DB, Dietrich KA, Zimmerman JJ (1989) Thyroid hormone metabolism and level of illness severity in pediatric cardiac surgery patients. J Pediatr 114:59–62
12.
Bettendorf M, Schmidt KG, Grulich-Henn J, Ulmer HE, Heinrich UE (2000) Tri-iodothyronine treatment in children after cardiac surgery: a double-blind, randomised, placebo-controlled study. Lancet 356:529–534CrossRefPubMed
13.
Mainwaring RD, Healy RM, Meier FA, Nelson JC, Norwood WI (2001) Reduction in levels of triiodothyronine following the first stage of the Norwood reconstruction for hypoplastic left heart syndrome. Cardiol Young 11:295–300
14.
LaFranchi S (2004) Hypothyroidism. In: Jenson HB (ed) Nelson textbook of pediatrics. Saunders, Philadelphia, pp 1872–1879
15.
Newman CM, Price A, Davies DW, Gray TA, Weetman AP (1998) Amiodarone and the thyroid: a practical guide to the management of thyroid dysfunction induced by amiodarone therapy. Heart 79:121–127PubMed
16.
Slater A, Shann F, Pearson G (2003) PIM2: a revised version of the Paediatric Index of Mortality. Intensive Care Med 29:278–285PubMed
17.
Nicholson JF, Pesce MA (2004) Laboratory medicine, drug therapy, and reference tables In: Jenson HB (ed) Nelson textbook of pediatrics. Saunders, Philadelphia, pp 2398–2421
18.
Saatvedt K, Lindberg H, Geiran OR, Fiane A, Seem E, Michelsen S, Pedersen T, Hagve TA (1998) Thyroid function during and after cardiopulmonary bypass in children. Acta Anaesthesiol Scand 42:1100–1103PubMed
19.
De Groot LJ (1999) Dangerous dogmas in medicine: the nonthyroidal illness syndrome. J Clin Endocrinol Metab 84:151–164CrossRef
20.
Robuschi G, Medici D, Fesani F, Barboso G, Montermini M, d’Amato L, Gardini E, Borciani E, Dall’Aglio E, Salvi M et al (1986) Cardiopulmonary bypass: a low T4 and T3 syndrome with blunted thyrotropin (TSH) response to thyrotropin-releasing hormone (TRH). Horm Res 23:151–158
21.
Holland FW 2nd, Brown PS Jr, Weintraub BD, Clark RE (1991) Cardiopulmonary bypass and thyroid function: a “euthyroid sick syndrome.” Ann Thorac Surg 52:46–50
22.
Mainwaring RD, Lamberti JJ, Carter TL Jr, Nelson JC (1994) Reduction in triiodothyronine levels following modified Fontan procedure. J Card Surg 9:322–331
23.
Mainwaring RD, Lamberti JJ, Billman GF, Nelson JC (1994) Suppression of the pituitary thyroid axis after cardiopulmonary bypass in the neonate. Ann Thorac Surg 58:1078–1082
24.
Chopra IJ (1997) Euthyroid sick syndrome: is it a misnomer? J Clin Endocrinol Metab 82:329–334CrossRef
25.
Utiger RD (1995) Altered thyroid function in nonthyroidal illness and surgery. To treat or not to treat? N Engl J Med 333:1562–1563CrossRef
26.
Mullis-Jansson SL, Argenziano M, Corwin S, Homma S, Weinberg AD, Williams M, Rose EA, Smith CR (1999) A randomized double-blind study of the effect of triiodothyronine on cardiac function and morbidity after coronary bypass surgery. J Thorac Cardiovasc Surg 117:1128–1134
27.
Novitzky D, Fontanet H, Snyder M, Coblio N, Smith D, Parsonnet V (1996) Impact of triiodothyronine on the survival of high-risk patients undergoing open heart surgery. Cardiology 87:509–515
28.
Klemperer JD, Klein I, Gomez M, Helm RE, Ojamaa K, Thomas SJ, Isom OW, Krieger K (1995) Thyroid hormone treatment after coronary-artery bypass surgery. N Engl J Med 333:1522–1527CrossRef
29.
Biswas S, Buffery J, Enoch H, Bland M, Markiewicz M, Walters D (2003) Pulmonary effects of triiodothyronine (T3) and hydrocortisone (HC) supplementation in preterm infants less than 30 weeks gestation: results of the THORN trial-thyroid hormone replacement in neonates. Pediatr Res 53:48–56CrossRef
30.
Osborn DA (2001) Thyroid hormones for preventing neurodevelopmental impairment in preterm infants. Cochrane Database Syst Rev CD001070
31.
Hamilton MA (1993) Prevalence and clinical implications of abnormal thyroid hormone metabolism in advanced heart failure. Ann Thorac Surg 56:S48–S52
32.
Behrman RE, Kliegman R, Jenson HB (2004) Nelson textbook of pediatrics, 17th edn. Saunders, Philadelphia
33.
Van den Berghe G, de Zegher F, Lauwers P (1994) Dopamine and the sick euthyroid syndrome in critical illness. Clin Endocrinol (Oxf) 41:731–737
34.
Leebaw WF, Lee LA, Woolf PD (1978) Dopamine affects basal and augmented pituitary hormone secretion. J Clin Endocrinol Metab 47:480–487
Metadata
Title
Identifying infants at risk of marked thyroid suppression post-cardiopulmonary bypass
Authors
Kevin Plumpton
Nikolaus A. Haas
Publication date
01-04-2005
Publisher
Springer-Verlag
Published in
Intensive Care Medicine / Issue 4/2005
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI
https://doi.org/10.1007/s00134-004-2549-1

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