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Effects of triiodothyronine supplementation following modified Fontan procedure

Published online by Cambridge University Press:  19 August 2008

Richard D. Mainwaring ,
John J. Lamberti ,
Jerald C. Nelson ,
Glenn F. Billman ,
Thomas L. Carter  and
Kenneth H. Schell
Richard D. Mainwaring*
Affiliation:
Divisions of Cardiac Surgery, Pathology, and PharmacyChildren's Hospital and Health Center, San Diego, California, USA
John J. Lamberti
Affiliation:
Divisions of Cardiac Surgery, Pathology, and PharmacyChildren's Hospital and Health Center, San Diego, California, USA
Jerald C. Nelson
Affiliation:
Divisions of Cardiac Surgery, Pathology, and PharmacyChildren's Hospital and Health Center, San Diego, California, USA
Glenn F. Billman
Affiliation:
Nichols Institute, San Juan Capistrano, California, USA
Thomas L. Carter
Affiliation:
Divisions of Cardiac Surgery, Pathology, and PharmacyChildren's Hospital and Health Center, San Diego, California, USA
Kenneth H. Schell
Affiliation:
Divisions of Cardiac Surgery, Pathology, and PharmacyChildren's Hospital and Health Center, San Diego, California, USA
*
Richard D. Mainwaring, M.D. 3030 Children's Way, Suite 310, San Diego, CA 92123. Fax: (619) 974-8032
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Abstract

Patients undergoing the modified Fontan procedure may develop low cardiac output postoperatively. Since thyroid hormone has important effects on cardiovascular function, the present study was undertaken to evaluate the influence of triiodothyronine supplementation. Ten consecutive patients under-going the Fontan procedure were administered intravenous triiodothyronine (0.4 mcg per kg) following surgery. Clinical outcome and thyroid hormone profiles were assessed and then compared to a previous series of patients undergoing the Fontan procedure who had not received triiodothyronine supplementation. Both groups initially demonstrated marked decreases in serum free triiodothyronine levels. The group which received triiodothyronine supplementation demonstrated a more rapid return of serum triiodothyronine levels to baseline [259±17 vs 121±15 pg/dl (p<0.05) on the fifth postoperative day and 336±18 vs 178±12 pg/dl (p<0.05) on the eighth day]. In addition, patients receiving supplemental triiodothyronine demonstrated more rapid recovery of total triiodothyronine, free thyroxine, total thyroxine and thyroglobulin levels. The group which received triiodothyronine supplementation had a shorter length of hospital stay [9±2 vs 14±3 (p<0.05)] as compared to patients who did not receive exogenous triiodothyronine. The results of this study demonstrate that triiodothyronine supplementation aids in the recovery of thyroid hormone levels following Fontan procedure. This endocrinologic finding correlated with improved clinical outcome.

Keywords

TriiodothyronineFontaneuthyroid sick syndrome
Type
Original Articles
Information
Cardiology in the Young , Volume 7 , Issue 2 , April 1997 , pp. 194 - 200
Copyright
Copyright © Cambridge University Press 1997

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References

1.Dillmann, WH. Cardiac Function in Thyroid Disease: Clinical Features and Management Considerations. Ann Thor Surg 1993; 56: S9–15.CrossRefGoogle ScholarPubMed
2.Klein, I. Thyroid Hormone and The Cardiovascular System. Am J Med 1990; 88: 631–637.CrossRefGoogle ScholarPubMed
3.Sypniewski, E. Comparative Pharmacology of The Thyroid Hormones. Ann Thor Surg 1993; 56: S2–8.CrossRefGoogle ScholarPubMed
4.Paschen, U, Muller, MJ, Darup, J, Kalmar, P, Seitz, HJ. Alteration in Thyroid Hormone Concentration during and after Coronary Bypass Operation. Annales d'Endocrinologie (Paris) 1983; 44: 239–242.Google ScholarPubMed
5.Chu, S, Huang, T, Shu, R, Wang, S, Wang, C. Thyroid Hormone Changes After Cardiovascular Surgery and Clinical Implications. Ann of Thor Surg 1991; 52: 791–796.CrossRefGoogle ScholarPubMed
6.Holland, FW II, Brown, PS Jr, Clark, RE. Acute Severe Post-ischemic Myocardial Depression Reversed by Triiodothyronine. Ann Thor Surg 1992; 54: 301–305.CrossRefGoogle Scholar
7.Novitzky, D, Cooper, DKC, Swanepoel, A. Inotropic Effect of Triiodothyronine in Low Cardiac Output Following Cardioplegic Arrest and Cardiopulmonary Bypass: An Initial Experience in Patients Undergoing Open-heart Surgery. Eur J Cardio-Thorac Surg 1989; 3: 140–145.CrossRefGoogle ScholarPubMed
8.de Vivie, ER and Rupprath, G. Long Term Results After Fontan Procedure and Its Modifications. J Thorac Cardiovasc Surg 1986; 91: 690–697.CrossRefGoogle ScholarPubMed
9.Franklin, WH and Norwood, WI. Management of Complications Related to the Fontan Procedure. Complications in Cardiothoracic Surgery; 1991, Waldhausen and Orringer, Mosby Yearbook, 202–211.Google Scholar
10.Mainwaring, RD, Lamberti, JJ, Carter, TL Jr, Nelson, JC. Reduction in Triiodothyronine Levels Following Modified Fontan Procedure. J Card Surg 1994; 9: 322–331.CrossRefGoogle ScholarPubMed
11.Larsen, PR. Triiodothyronine: Review of Recent Studies of Its Pathology and Pathophysiology in Man. Metabolism 1972; 21: 1073–1092.CrossRefGoogle Scholar
12.Sterling, K and Brenner, MA. Free Thyroxine in Human Serum: Simplified Measurement with the Aid of Magnesium Precipitation. J Clin Invest 1996; 45: 153–163.Google Scholar
13.Chopra, IJ. A Radioimmunoassay for Measurement of Thyroxine in Unextracted Serum. J Clin Endocrinol Metab 1972; 34: 938.CrossRefGoogle ScholarPubMed
14.Nelson, JC and Tomei, RT. Direct Determination of Free Thyroxine in Undiluted Serum by Equilibrium Dialysis/Radionimmunoassay. Clin Chem 1988; 34: 1737–1744.CrossRefGoogle Scholar
15.Spencer, C, LoPresti, JS, Patel, A, Guttler, RB, Eigen, A, Shen, D, Gray, D, Nicoloff, JT. Applications of a Ne Chemiluminometric Thyrotropin Assay to Subnormal Measurement. J Clin Endocrinol Metab 1990; 70: 453–460.CrossRefGoogle Scholar
16.Van Herle, AJ, Uller, RP, Matthews, NL, Brown, J. Radioimmunoassy for Measurement of Thyroglobulin in Human Serum. J Clin Invest 1973; 52: 1320–1327.CrossRefGoogle Scholar
17.Morkin, E, Flink, IL, Goldman, S. Biochemical and Physiologic Effects of Thyroid Hormone in Cardiac Performance. Prog Cardiovasc Dis 1983; 25: 435–464.CrossRefGoogle ScholarPubMed
18.Samuels, HH, Furman, BM, Horowitz, ZD, Ye, ZS. Regulation of Gene Expression by Thyroid Hormone. J Clin Invest 1988; 81: 957–967.CrossRefGoogle ScholarPubMed
19.Dillmann, WH. Biochemical Basis of Thyroid Hormone Action in the Heart. Am J Med 1990; 88: 626–630.CrossRefGoogle ScholarPubMed
20.Larsen, PR and Ingbar, SH. The Thyroid Gland in William's Textbook of Endocrinology, 8th Ed.Wilson, JD and Foster, DW. WB Saunders Company, Philadelphia, PA, 1992, 365–374.Google Scholar
21.Wartofsky, L and Burman, KD. Alterations in Thyroid Function in Patients with Systemic Illness: The “euthyroid sick syndrome.” Endocr Rev 1982; 3: 164–217.CrossRefGoogle ScholarPubMed
22.Hermus, RM, Sweep, CGJ, Vandermeer, MJM, Ross, HA, Smals, AGH, Benraad, TJ, Kloppenborg, PWC. Continuous Infusion of Interleukin-1b Induces a Non-thyroidal Illness Syndrome in the Rat. Endocrinology 1992; 131: 2139–2146.CrossRefGoogle Scholar