Changes of perioperative thyroid hormone in adult patients undergoing cardiac surgery under cardiopulmonary bypass_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

ZENG Ling ¹ , XIANG Yuping ¹ , LUO Tianhui ¹ , LIN Min ¹ , LIU Lu ¹ ,  QIAN Yongjun ²

1. Department of Thoracic Surgery ICU, West China Hospital, West China School of Nursing, Sichuan University, Chengdu, 610041, P.R.China;
2. Department of Cardiovascular Surgery, National Clinical Research Center for Geriatrics, West China Hospital, Sichuan University, Chengdu, 610041, P.R.China;

Corresponding author：

QIAN Yongjun, Email: qianyongjun@scu.edu.cn

Keywords：

Cardiac surgery; cardiopulmonary bypass; thyroid hormone; perioperation

DOI：

10.7507/1007-4848.202001048

Video：

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Objective To analyze the changes of perioperative thyroid hormone in patients undergoing cardiac surgery under cardiopulmonary bypass, and to provide guidance for postoperative cardiac management.Methods The clinical data of 72 patients receiving cardiac surgery under cardiopulmonary bypass in our hospital from January to May 2019 were collected, including 35 males and 37 females, aged 19-72 (52.35±10.40) years. The changes of thyroid hormones before operation, 2 hours and 24 hours after operation were analyzed.Results There was a statistical difference in thyroid stimulating hormone (TSH), triiodothyronine (T3), tetraiodothyronine (T4) and free tetraiodothyronine (FT4) between postoperative 2 hours and preoperation (P<0.05). There was a statistical difference in TSH, T3, free triiodothyronine (FT3), T4 and FT4 between postoperative 24 hours and preoperation (P<0.05). There was a statistical difference in TSH, T3, FT3 and T4 between postoperative 24 hours and 2 hours (P<0.05). Postoperatively T3 and FT3 decreased, TSH increased and then decreased while T4 and FT4 were within the normal range. Repeated measures analysis of variance showed a statistical difference of time effect in TSH, T3, FT3, T4 and FT4.Conclusion Patients with cardiac surgery under cardiopulmonary bypass have different thyroid hormones postoperatively compared with preoperatively. T3 and FT3 decrease, TSH increases and then decreases, while T4 and FT4 are in the normal range. The results require further large-scale, multi-center, high-quality clinical studies to be confirmed.

Citation： ZENG Ling, XIANG Yuping, LUO Tianhui, LIN Min, LIU Lu, QIAN Yongjun. Changes of perioperative thyroid hormone in adult patients undergoing cardiac surgery under cardiopulmonary bypass. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2020, 27(9): 1055-1058. doi: 10.7507/1007-4848.202001048 Copy

1.	Razvi S, Jabbar A, Pingitore A, <italic>et al</italic>. Thyroid hormones and cardiovascular function and diseases. J Am Coll Cardiol, 2018, 71(16): 1781-1796.
2.	Park YJ, Yoon JW, Kim KI, <italic>et al</italic>. Subclinical hypothyroidism might increase the risk of transient atrial fibrillation after coronary artery bypass grafting. Ann Thorac Surg, 2009, 87(6): 1846-1852.
3.	刘海贝, 谭灵灿, 阳垚鑫, 等. 术前甲状腺功能减退对中老年患者体外循环下心脏手术术后认知功能障碍影响的前瞻性队列研究. 中国胸心血管外科临床杂志, 2019, 26(2): 152-157.
4.	Talwar S, Khadgawat R, Sandeep JA, <italic>et al</italic>. Cardiopulmonary bypass and serum thyroid hormone profile in pediatric patients with congenital heart disease. Congenit Heart Dis, 2012, 7(5): 433-440.
5.	罗俊. 体外循环心脏手术对10 kg以下婴幼儿甲状腺激素的影响. 天津医科大学, 2008.
6.	童媛媛, 刘晋萍. 体外循环对小儿内分泌系统的影响. 中国体外循环杂志, 2018, 16(1): 48-52, 55.
7.	贾克刚, 韩雪晶, 刘利祥. 体外循环心脏手术前后甲状腺激素水平的变化. 检验医学, 2008, 23(5): 469-471.
8.	高嵩, 严洁, 许红阳, 等. 不同体外循环时间对心脏外科手术患者血清甲状腺激素水平的影响. 山东医药, 2017, 57(22): 40-41.
9.	Jia K, Han X, Liu L. Changes of thyroid hormone level in patients with cardiac surgery under cardiopulmonary bypass. Lab Medicine, 2008, 23(5): 469-471.
10.	Chen QQ, Tong J, Yan YS, <italic>et al</italic>. Relationship between early spontaneous cardioversion of atrial fibrillation and thyroid hormone metabolism after mitral replacement in patients with rheumatic heart disease. Nan Fang Yi Ke Da Xue Xue Bao, 2010, 30(11): 2548-2550.
11.	Velissaris T, Tang AT, Wood PJ, <italic>et al</italic>. Thyroid function during coronary surgery with and without cardiopulmonary bypass. Eur J Cardiothorac Surg, 2009, 36(1): 148-154.
12.	Danzi S, Klein I. Thyroid hormone and the cardiovascular system. Med Clin North Am, 2012, 96(2): 257-268.
13.	Iervasi G, Nicolini G. Thyroid hormone and cardiovascular system: from basic concepts to clinical application. Intern Emerg Med, 2013, 8(Suppl 1): S71-S74.
14.	Skelton CL. The heart and hyperthyroidism. N Engl J Med, 1982, 307(19): 1206-1208.
15.	Cappola AR, Fried LP, Arnold AM, <italic>et al</italic>. Thyroid status, cardiovascular risk, and mortality in older adults. JAMA, 2006, 295(9): 1033-1041.
16.	Collet TH, Gussekloo J, Bauer DC, <italic>et al</italic>. Subclinical hyperthyroidism and the risk of coronary heart disease and mortality. Arch Intern Med, 2012, 172(10): 799-809.
17.	Marks SD, Haines C, Rebeyka IM, <italic>et al</italic>. Hypothalamic-pituitary-thyroid axis changes in children after cardiac surgery. J Clin Endocrinol Metab, 2009, 94(8): 2781-2786.
18.	Farwell AP. Nonthyroidal illness syndrome. Curr Opin Endocrinol Diabetes Obes, 2013, 20(5): 478-484.
19.	Cerillo AG, Storti S, Kallushi E, <italic>et al</italic>. 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(6): 2089-2095.
20.	Magalhães AP, Gus M, Silva LB, <italic>et al</italic>. Oral triiodothyronine for the prevention of thyroid hormone reduction in adult valvular cardiac surgery. Braz J Med Biol Res, 2006, 39(7): 969-978.
21.	Choi YS, Shim JK, Song JW, <italic>et al</italic>. Efficacy of perioperative oral triiodothyronine replacement therapy in patients undergoing off-pump coronary artery bypass grafting. J Cardiothorac Vasc Anesth, 2013, 27(6): 1218-1223.
22.	Sabatino L, Balzan S, Kusmic C, <italic>et al</italic>. Modification of gene expression profiling related to renin-angiotensin system in an ischemia/reperfusion rat model after T3 infusion. Mol Cell Biochem, 2018, 449(1-2): 277-283.

1. Razvi S, Jabbar A, Pingitore A, <italic>et al</italic>. Thyroid hormones and cardiovascular function and diseases. J Am Coll Cardiol, 2018, 71(16): 1781-1796.
2. Park YJ, Yoon JW, Kim KI, <italic>et al</italic>. Subclinical hypothyroidism might increase the risk of transient atrial fibrillation after coronary artery bypass grafting. Ann Thorac Surg, 2009, 87(6): 1846-1852.
3. 刘海贝, 谭灵灿, 阳垚鑫, 等. 术前甲状腺功能减退对中老年患者体外循环下心脏手术术后认知功能障碍影响的前瞻性队列研究. 中国胸心血管外科临床杂志, 2019, 26(2): 152-157.
4. Talwar S, Khadgawat R, Sandeep JA, <italic>et al</italic>. Cardiopulmonary bypass and serum thyroid hormone profile in pediatric patients with congenital heart disease. Congenit Heart Dis, 2012, 7(5): 433-440.
5. 罗俊. 体外循环心脏手术对10 kg以下婴幼儿甲状腺激素的影响. 天津医科大学, 2008.
6. 童媛媛, 刘晋萍. 体外循环对小儿内分泌系统的影响. 中国体外循环杂志, 2018, 16(1): 48-52, 55.
7. 贾克刚, 韩雪晶, 刘利祥. 体外循环心脏手术前后甲状腺激素水平的变化. 检验医学, 2008, 23(5): 469-471.
8. 高嵩, 严洁, 许红阳, 等. 不同体外循环时间对心脏外科手术患者血清甲状腺激素水平的影响. 山东医药, 2017, 57(22): 40-41.
9. Jia K, Han X, Liu L. Changes of thyroid hormone level in patients with cardiac surgery under cardiopulmonary bypass. Lab Medicine, 2008, 23(5): 469-471.
10. Chen QQ, Tong J, Yan YS, <italic>et al</italic>. Relationship between early spontaneous cardioversion of atrial fibrillation and thyroid hormone metabolism after mitral replacement in patients with rheumatic heart disease. Nan Fang Yi Ke Da Xue Xue Bao, 2010, 30(11): 2548-2550.
11. Velissaris T, Tang AT, Wood PJ, <italic>et al</italic>. Thyroid function during coronary surgery with and without cardiopulmonary bypass. Eur J Cardiothorac Surg, 2009, 36(1): 148-154.
12. Danzi S, Klein I. Thyroid hormone and the cardiovascular system. Med Clin North Am, 2012, 96(2): 257-268.
13. Iervasi G, Nicolini G. Thyroid hormone and cardiovascular system: from basic concepts to clinical application. Intern Emerg Med, 2013, 8(Suppl 1): S71-S74.
14. Skelton CL. The heart and hyperthyroidism. N Engl J Med, 1982, 307(19): 1206-1208.
15. Cappola AR, Fried LP, Arnold AM, <italic>et al</italic>. Thyroid status, cardiovascular risk, and mortality in older adults. JAMA, 2006, 295(9): 1033-1041.
16. Collet TH, Gussekloo J, Bauer DC, <italic>et al</italic>. Subclinical hyperthyroidism and the risk of coronary heart disease and mortality. Arch Intern Med, 2012, 172(10): 799-809.
17. Marks SD, Haines C, Rebeyka IM, <italic>et al</italic>. Hypothalamic-pituitary-thyroid axis changes in children after cardiac surgery. J Clin Endocrinol Metab, 2009, 94(8): 2781-2786.
18. Farwell AP. Nonthyroidal illness syndrome. Curr Opin Endocrinol Diabetes Obes, 2013, 20(5): 478-484.
19. Cerillo AG, Storti S, Kallushi E, <italic>et al</italic>. 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(6): 2089-2095.
20. Magalhães AP, Gus M, Silva LB, <italic>et al</italic>. Oral triiodothyronine for the prevention of thyroid hormone reduction in adult valvular cardiac surgery. Braz J Med Biol Res, 2006, 39(7): 969-978.
21. Choi YS, Shim JK, Song JW, <italic>et al</italic>. Efficacy of perioperative oral triiodothyronine replacement therapy in patients undergoing off-pump coronary artery bypass grafting. J Cardiothorac Vasc Anesth, 2013, 27(6): 1218-1223.
22. Sabatino L, Balzan S, Kusmic C, <italic>et al</italic>. Modification of gene expression profiling related to renin-angiotensin system in an ischemia/reperfusion rat model after T3 infusion. Mol Cell Biochem, 2018, 449(1-2): 277-283.

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