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The Annals of Thoracic Surgery, Vol 52, 46-50, Copyright © 1991 by The Society of Thoracic Surgeons
FW Holland 2d, PS Brown Jr, BD Weintraub and RE Clark
The purpose of this prospective study was to define the effect of
cardiopulmonary bypass on the concentrations of thyroid hormones and
metabolites. Blood samples were obtained from 14 patients preoperatively,
at specific times throughout cardiopulmonary bypass, and serially to 24
hours postoperatively. Thyroid-stimulating hormone, thyroid-binding
globulin, total thyroxine, triiodothyronine (T3), and reverse T3, an
inactive metabolite of thyroxine, were measured by radioimmunoassay. Free
T3 was assayed by equilibrium dialysis. Values of total T3 and free T3, the
active hormone, were significantly depressed (75% and 50%, respectively) up
to 24 hours after bypass (p less than 0.05). Reverse T3 demonstrated a
greater than fourfold rise at 8 and 24 hours postoperatively (p less than
0.05). Thyroid-binding globulin was decreased at all sampling times (p less
than 0.05). Thyroid-stimulating hormone, thyroxine, and free thyroxine
levels remained within normal ranges at all sampling times. These results
indicate that cardiopulmonary bypass simulates the "euthyroid sick
syndrome" as seen in severely burned patients and critically ill patients,
which is characterized by depression of T3 and free T3 concentrations with
a concomitant increase in reverse T3 levels and normal concentrations of
thyroid-stimulating hormone, thyroxine, and free thyroxine. The hemodynamic
effects of primary hypothyroidism are well established. These data provide
further support for investigational trials of intravenous administration of
T3 in the prevention or treatment of low cardiac output syndrome after
cardiopulmonary bypass.
ARTICLES
Cardiopulmonary bypass and thyroid function: a "euthyroid sick syndrome"
Surgery Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland.
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