Engin GURCU, Ahmet YÜKSEL, Yusuf VELİOĞLU, Isik Senkaya SİGNAK

The effects of thyroid hormones levels on prognosis after pediatric heart surgery

In this study, we aimed to evaluate the effects of thyroid hormone levels on the prognosis of patients who underwent congenital heart surgery under cardiopulmonary bypass. A total of 40 children who underwent congenital heart surgery were enrolled to this prospective study. The patients were divided into two groups according to the presence or absence of postoperative low cardiac output state. Plasma free thyroxine, free triiodothyronine and thyroid stimulating hormone levels were measured preoperatively and at 24 and 48 hours postoperatively. Postoperative low cardiac output state was observed in five patients (12.5 %). Preoperative free thyroxine levels were significantly higher in the low cardiac output state group (p=0.021). Postoperative free triiodothyronine and free thyroxine levels were significantly lower, and lactate levels, inotropic index were significantly higher in the low cardiac output state group. Duration of mechanical ventilation, intensive care unit stay, operation and cardiopulmonary bypass were significantly higher in the low cardiac output state group. Four patients (10 %) died in the early postoperative period, and all of them were in the low cardiac output state group. Our findings showed that the occurrence of low cardiac output state after congenital heart surgery was associated with the high levels of preoperative free thyroxine and the reduction in percentage of free triiodothyronine and free thyroxine levels at the 24th and 48th hours postoperatively.

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Ootaki Y, Yamaguchi M, Yoshimura N, et al. Vascular endothelial growth factor in children with congenital heart disease. Ann Thorac Surg. 2003;75:1523-6.

Wernovsky G, Wypij D, Jonas RA, et al. Postoperative course and hemodynamic profile after the arterial switch operation in neonates and infants: A comparison of low-flow cardiopulmonary bypass and circulatory arrest. Circulation. 1995;92:2226-35.

Kumar G, Parvathi U Iyer. Management of perioperative low cardiac output state without extracorporeal life support: What is feasible? Ann Pediatr Cardiol. 2010;3:147-58.

Yoldas H, Karagoz I, Ogun MN, et al. Novel mortality markers for critically ill patients. J Intensive Care Med. 2018;1:885066617753389.

Shore S, Nelson D, Pearl J, at al. Usefulness of corticosteroid therapy in decreasing epinephrine requirements in critically Ill infants with congenital heart disease. Am J Cardiol. 2001;88:591-4.

Gaies MG, Gurney JG, Yen AH, at al. Vasoactive-inotropic score as a predictor of morbidity and mortality in infants after cardiopulmonary bypass. Pediatr Crit Care Med. 2010;11:234-8.

Jones TH, Hunter SM, Price A, et al. Should thyroid function be assessed before cardiopulmonary bypass operations? Ann Thorac Surg. 1994;58:434-6.

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;7:433-40.

Marks SD, Haines C, Rebeyka IM, et al. Hypothalamic-pituitary-thyroid axis changes in children after cardiac surgery. J Clin Endocrinol Metab. 2009;94:2781-6.

Börner U, Klimak M, Schoengen H, et al. The influence of various anesthetics on the release and metabolism of thyroid hormones: Results of two clinical studies. Anesth Analg. 1995;81:612-8.

Oyama T, Shibata S, Matsuki A, et al. Thyroxine distribution during halothane anesthesiain man. Anesth Analg. 1969;48:715-9.

Lyerly HK. The thyroid gland physiology. Textbook of surgery Sabiston DC. 14th edition. Philadelphia: WB Sounders CO; 1991. p: 560-8.

Bird CG, Hayward I, Howells TH, et al. Cardiac arrythmias during thyroid surgery. Anaesthesia. 1969;24:180-9.

Bostancı N. Tiroid ve paratiroid hastalıkları. Endokrinoloji II. İstanbul: Bozak Matbaası, 1979.

The Merck of diagnosis and therapy. Section 2, Chapter 8. Thyroid disorders; 2011.

Greenspan FS, Gardner DG. Basic and clinical endocrinology. 8. edition. Norwalk: McGraw-Hill Companies; 2001. p: 902-8.

Plumpton K, Haas NA. Identifying infants at risk of marked thyroid suppression post-cardiopulmonary bypass. Intensive Care Med. 2005;31:581-7.

McMahon CK, Klein I, Ojamaa K. Interleukin-6 and thyroid hormone metabolism in pediatric cardiac surgery patients. Thyroid. 2003;13:301-4.

Baysal A, Saşmazel A, Yıldırım Aİ, et al. The effects of thyroid hormones and interleukin-8 levels on prognosis after congenital heart surgery. Turk Kardiyol Dern Ars. 2010;38:537-43.

Bartkowski R, Wojtalik M, Korman E, et al. Thyroid hormones levels in infants during and after cardiopulmonary bypass with ultrafiltration. Eur J Cardiothorac Surg. 2002;22:879-84.

Bettendorf M, Schmidt KG, Grulich-Henn J, et al. Triiodothyronine treatment in children after cardiac surgery: a double-blind, randomised, placebocontrolled study. Lancet. 2000;356:529-34.