Low T3 syndrome and cardiac surgery_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

 ZHANG Jingchao , ZHANG Dingkai , GUO Longhui , HAO Shuang , YU Xinyi

Department of Cardiovascular surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, P.R.China;

Corresponding author：

ZHANG Jingchao, Email: Zhangjingchao126@126.com

Keywords：

Low T3 syndrome; cardiac surgery; triiodothyrosine

DOI：

10.7507/1007-4848.201811002

Video：

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Abstract Full text Figures/Tables Video References Cited by

The non-thyroidal illness syndrome always occurs in the post-operative period following cardiac surgery in adults and children. Low T3 syndrome is the most common one. This abnormal thyroid hormone metabolism can significantly affect the stability of hemodynamics and the recovery of cardiac function after operation.There remains debate about the potential benefits of the treatment of the non-thyroidal illness syndrome with thyroid hormone supplementation. In this paper, the clinical manifestations and related intervention measures of low T3 syndrome in various heart operations were reviewed through previous clinical experiments.

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2. Girvent M, Maestro S, Hernandez R, et al. Euthyroid sick syndrome, associated endocrine abnormalities, and outcome in elderly patients undergoing emergency operation. Surg, 1998, 123: 560-567.
3. Schilling JU, Zimmermann T, Albrecht S, et al. Low T3 syndrome in multiple trauma patients–a phenomenon or important pathogenetic factor? (German). Med Klin, (Munich), 1999, 94(Suppl 3): 66-69.
4. Schulte C, Reinhardt W, Beelen D, et al. Low T3-syndrome and nutritional status as prognostic factors in patients undergoing bone marrow transplantation. Bone Marrow Transplant, 1998, 22: 1171-8.
5. Umpierrez GE: Euthyroid sick syndrome. Umpierrez GE: Euthyroid sick syndrome. South Med J, 2002, 95: 506-513.
6. Fliers E, Bianco AC, Langouche L, et al. Thyroid function in critically ill patients. Lancet Diabetes Endocrinol, 2015, 3: 816-825.
7. Klein I, Ojamaa K. Thyroid hormone and the cardiovascular system. N Engl J Med, 2001, 344: 501-509.
8. Pingitore A, Landi P, Taddei MC, et al. Triiodothyronine levels for risk stratification of patients with chronic heart failure. Am J Med, 2005, 118: 132-136.
9. Debaveye Y, Ellger B, Mebis L, et al. Regulation of tissue iodothyronine deiodinase activity in a model of prolonged critical illness. Thyroid, 2008, 18(5): 551-560.
10. Bremner WF, Taylor KM, Baird S, et al. Hypothalamo–pituitary–thyroid axis function during cardiopulmonary bypass. J Thorac Cardiovasc Surg, 1978, 75: 392-399.
11. Holland FW, Brown PS Jr, Weintraub BD, et al. Cardiopulmonary bypass and thyroid function: A “euthyroid sick syndrome. ”. Ann Thorac Surg, 1991, 52: 46-50.
12. Robuschi G, Medici D, Fesani F, et al. Cardiopulmonary bypass: A low T4 and T3 syndrome with blunted thyrotropin (TSH) response to thyrotropic-releasing hormone (TRH). Horm Res, 1986, 23: 151-158.
13. Bartalena L, Brogioni S, Grasso L, et al. Relationship of the increased serum interleukin-6 concentration to changes in thyroid function in nonthyroidal illness. J Endocrinol Invest, 1994, 17: 269-274.
14. Cerillo AG, Sabatino L, Bevilacqua S, et al. Nonthyroidal illness syndrome in off-pump coronary artery bypass grafting. Ann Thorac Surg, 2003, 75: 82-87.
15. Velissaris T, Tang ATM, Wood PJ, et al. Thyroid function during coronary surgery with and without cardiopulmonary bypass. Eur J CardioThorac Surg, 2009, 36: 148-154.
16. Mebis L, Van den Berghe G. Thyroid axis function and dysfunction in critical illness. Best Pract Res Clin Endocrinol Metab, 2011, 25: 745-757.
17. Lee S, Farwell AP. Euthyroid sick syndrome. Compr Physiol, 2016, 6: 1071-1080.
18. Mitchell IM, Pollock JCS, Jamieson MPG, et al. The effects of cardiopulmonary bypass on thyroid function in infants weighing less than five kilograms. J Thorac Cardiovasc Surg, 1992, 103: 800-805.
19. Mainwaring RD, Lamberti JJ, Billman GF, et al. Suppression of the pituitary thyroid axis after cardiopulmonary bypass in the neonate. Ann Thorac Surg, 1994, 58(4): 1078-1082.
20. Mainwaring RD, Lamberti JJ, Carter TL Jr, et al. Reduction in triiodothyronine levels following modified Fontan procedure. J Card Surg, 1994, 9: 322-331.
21. Plumpton K, Haas NA. Identifying infants at risk of marked thyroid suppression post-cardiopulmonary bypass. Intensive Care Med, 2005, 31: 581-587.
22. Ririe DG, Butterworth JF, Hines M, et al. 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, 1998, 87: 543-548.
23. Novitzky D, Cooper DK, Barton CI, et al. Triiodothyronine as an inotropic agent after open heart surgery. J Thorac Cardiovasc Surg, 1989, 98: 972-977.
24. Klemperer JD, Klein I, Gomez M, et al. Thyroid hormone treatment after coronary-artery bypass surgery. N Engl J Med, 1995, 333: 1522-1527.
25. Spratt DI, Frohnauer M, Cyr-Alves H, et al. Physiological effects of nonthyroidal illness syndrome in patients after cardiac surgery. Am J Physiol Endocrinol Metab, 2007, 293: E310-315.
26. Bennett-Guerrero E, Jimenez JL, White WD, et al. Cardiovascular effects of intravenous triiodothyronine in patients undergoing coronary artery bypass graft surgery. A randomized, double-blind, placebo-controlled trial. Duke T3 Study Group. JAMA, 1996, 275: 687-692.
27. Cerillo AG, Storti S, Kallushi E, et al. The low triiodothyronine syndrome: A strong predictor of low cardiac output and death in patients undergoing coronary artery bypass grafting. Ann Thorac Surg, 2014, 97: 2089-2095.
28. Choi YS, Kwak YL, Kim JC, et al. Peri-operative oral triiodothyronine replacement therapy to prevent postoperative low triiodothyronine state following valvular heart surgery. Anaesthesia, 2009, 64: 871-877.
29. Klemperer JD, Klein IL, Ojamaa K, et al. Triiodothyronine therapy lowers the incidence of atrial fibrillation after cardiac operations. Ann Thorac Surg, 1996, 61: 1323-1327.
30. Mullis-Janson SL, Argenziano M, Corwin S, et al. A randomized double-blind study of the effect of triiodothyronine on cardiac function and morbidity after coronary bypass surg. J Thorac Cardiovasc Surg, 1999, 117: 1128-1234.
31. Cerillo AG, Bevilacqua S, Storti S, et al. Free triiodothyronine: a novel predictor of postoperative atrial fibrillation. Eur J Cardiothorac Surg, 2003, 24: 487-492.
32. Park YJ, Yoon JW, Kim KI, et al. Subclinical hypothyroidism might increase the risk of transient atrial fibrillation after coronary artery bypass grafting. Ann Thorac Surg, 2009, 87: 1846-1852.
33. Dietrich JW, Müller P, Schiedat F, et al. “Nonthyroidal illness syndrome in cardiac illness involves elevated concentrations of 3,5-diiodothyronine and correlates with atrial remodeling. ”. Eur Tyroid J, 2015, 4(2): 129-137.
34. Teiger E, Menasche P, Mansier P, et al. Triiodothyronine therapy in open-heart surgery: from hope to disappointment. Eur Heart J, 1993, 14: 629-633.
35. Guden M, Akpinar B, Sagðbaþ E, et al. Effects of intravenous triiodothyronine during coronary artery bypass surgery. Asian Cardiovasc Thorac Ann, 2002, 10: 219-222.
36. Magalhaes AP, Gus M, Silva LB, et al. Oral triiodothyronine for the prevention of thyroid hormone reduction in adult valvular cardiac surgery. Braz J Med Biol Res, 2006, 39: 969-978.
37. Bettendorf M, Schmidt KG, Tiefenbascher U, et al. Transient secondary hypothyroidism in children after cardiac surgery. Pediatr Res, 1997, 41: 375-379.
38. Mainwaring RD, Lamberti JJ, Carter TL, et al. Reduction in triiodothyronine levels following modified fontan procedure. J Card Surg, 1994, 9: 322-331.
39. Babazadeh K, Tabib A, Eshraghi P, et al. Non-thyroidal illness syndrome and cardiopulmonary bypass in children with congenital heart disease. Caspian J Intern Med, 2014, 5: 235-242.
40. Talwar S, Khadgawat R, Sandeep JA, et al. Cardiopulmonary bypass and serum thyroid hormone profile in pediatric patients with congenital heart disease. Congenit Heart Dis, 2012, 7: 433-440.
41. Dagan O, Vidne B, Josefsberg Z, et al. Relationship between changes in thyroid hormone level and severity of the postoperative course in neonates undergoing open-heart surgery. Paediatr Anaesth, 2006, 16: 538-542.
42. Bettendorf M, Schmidt KG, Grulich-Henn J, et al. Triiodothyronine treatment in children after cardiac surgery: a double-blind, randomised, placebo-controlled study. Lancet, 2000, 356: 529-534.
43. Mackie AS, Booth KL, Newburger JW, et al. A randomized, double-blind, placebo-controlled pilot trial of triiodothyronine in neonatal heart surgery. J Thorac Cardiovasc Surg, 2005, 130: 810-816.
44. Mainwaring RD, Capparelli B, Schell K, et al. Pharmacokinetic evaluation of triidothyronine supplementation in children after modified fontan procedure. Circulation, 2000, 101: 1423-1429.
45. Marwali EM, Boom CE, Sakidjan I, et al. Oral triiodothyronine normalizes triiodothyronine levels after surgery for pediatric congenital heart disease. Pediatr Crit Care Med, 2013, 14: 701-708.
46. Eva M, Marwali MD, Cindy E., et al Oral Triiodothyronine for infants and children undergoing cardiopulmonary bypass. Ann Thorac Surg, 2017, 104(2): 688-695.
47. Zhang JQ, Yang QY, Xue FS, 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.
48. Guisasola MC, Desco MM, Gonzalez FS, et al. Heat shock proteins, end effectors of myocardium ischemic preconditioning. Cell Stress Chaperones, 2006, 11: 250-258.
49. Pasqua T, Filice E, Mazza R, et al. Cardiac and hepatic role of rAtHSP70: basal effects and protection against ischemic and sepsis conditions. J Cell Mol Med, 2015, 19: 1492-1503.
50. Chen HB, Zhang XC, Cheng YF, et al. Association of heat shock protein 70 expression with rat myocardial cell damage during heat stress in vitro and in vivo. Genet Mol Res, 2015, 14: 1994-2005.
51. Yadav HN, Singh M, Sharma PL. Pharmacological inhibition of GSK-3b produces late phase of cardioprotection in hyperlipidemic rat: possible involvement of HSP 72. Mol Cell Biochem, 2012, 369: 227-233.
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