Abstract
Normal thyroid function is vital for growth and nervous system myelinization. The number of myocardial β-adrenergic receptors and the rate of synthesis and use of myocardial high-energy phosphates are thyroid hormone dependent. Abnormal thyroid function may occur after cardiac surgery; we therefore assessed perioperative thyroid hormone secretion in children. 82 patients (age range 2 days to 16 years) with congenital heart disease were studied before and after surgery (day 1, 3, 5, 7). Plasma TSH, T3, T4, fT4, TG and urinary iodine excretion were measured. Results are expressed as mean ± SEM. Statistical analysis was performed by ANOVA (preoperative vs. postoperative) and a general linear models procedure (SAS).
There was also a significant fall of fT4 and TG. T3/T4 ratio remained unchanged. Plasma hormone values failed to reach preoperative values within 7 days. This effect was statistically independent of age, cardiopulmonary bypass and iodine contamination. TSH(R=0.43), T3(R=0.74), T4(R=0.56), fT4(R=0.42), TG(R=0.42)were significantly lower in dopamine treated patients compared to children not receiving dopamine infusion. We conclude, that secondary hypothyroidism was present in all patients. T3 replacement therapy has to be strongly considered in pediatric patients after cardiac surgery, especially when treated with dopamine. T3 may serve as a positive inotropic agent and reduce inotropic support (catecholamines). Whether this therapy will influence the postoperative intensive care course of these patients in general and will reduce recovery time from surgery is under investigation.
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Bettendorf, M., Tiefenbacher, U., Schmidt-Ott, S. et al. SECONDARY HYPOTHYROIDISM IN PEDIATRIC CARDIAC SURGERY PATIENTS. Pediatr Res 33 (Suppl 5), S91 (1993). https://doi.org/10.1203/00006450-199305001-00528
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DOI: https://doi.org/10.1203/00006450-199305001-00528