The non-thyroidal illness syndrome after coronary artery bypass grafting: a 6-month follow-up study
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Alfredo Giuseppe Cerillo
Abstract
The non-thyroidal illness syndrome (NTIS) is considered a transient and completely reversible phenomenon, but it has been shown that it may last for several days postoperatively after coronary artery bypass grafting (CABG) surgery. This study was undertaken to assess thyroid function 6 months after uncomplicated CABG. The thyroid profile was evaluated in 40 consecutive patients undergoing CABG preoperatively, at 0, 12, 48, and 120h postoperatively, and at 6-month follow-up. Triiodothyronine (T 3), free T 3 (FT 3), free thyroxine (FT 4) and thyroid stimulating hormone (TSH) were assayed using a microparticle enzyme immunoassay. T 4 and total serum thyroid hormone-binding capacity (T-uptake) were measured on the same samples using a fluorescence polarization immunoassay. Patients with severe systemic illness and patients treated with amiodarone were excluded. All patients were euthyroid at admission. Mean age was 67.4±9.0years. There were 31 (77.5%) men. Typical NTIS was observed in all patients, and the FT 3 concentration was still reduced by postoperative day 5 (p<0.0001). At 6-month follow-up, all patients were free from cardiac symptoms, and no new cardiac events were recorded. The thyroid profile was normal in 35 patients (87.5%). One patient (4.5%) had developed overt hypothyroidism. Two patients had isolated low T 3 and FT 3 levels with normal TSH. Two patients had moderately increased FT 3 levels with suppressed TSH. In most uncomplicated patients, thyroid function returns to normal 6months after CABG. However, we observed significant alterations of the thyroid profile in 5 out of 40 patients. Further studies are needed to define the long-term consequences of postoperative NTIS.
References
1 Klemperer JD. Thyroid hormone and cardiac surgery. Thyroid 2002; 12: 517–21. 10.1089/105072502760143917Search in Google Scholar
2 Afandi B, Schussler GC, Arafeh AH, Boutros A, Yap MG, Finkelstein A. Selective consumption of thyroxine-binding globulin during cardiac bypass surgery. Metabolism 2000; 49: 270–4. 10.1016/S0026-0495(00)91611-1Search in Google Scholar
3 De Groot LJ. Dangerous dogmas in medicine: the non-thyroidal illness syndrome. J Clin Endocrinol Metab 1999; 84: 151–64. 10.1210/jcem.84.1.5364Search in Google Scholar
4 Utiger RD. Altered thyroid function in nonthyroidal illness and surgery: to treat or not to treat? N Engl J Med 1995; 333: 1562–3. 10.1056/NEJM199512073332310Search in Google Scholar
5 Cerillo AG, Sabatino L, Bevilacqua S, Farneti PA, Scarlattini M, Forini F, et al. Nonthyroidal illness syndrome in off-pump coronary artery bypass grafting. Ann Thorac Surg 2003; 75: 82–7. 10.1016/S0003-4975(02)03919-XSearch in Google Scholar
6 Sabatino L, Cerillo AG, Ripoli A, Pilo A, Glauber M, Iervasi G. Is the low tri-iodothyronine state a crucial factor in determining the outcome of coronary artery bypass patients? Evidence from a clinical pilot study. J Endocrinol 2002; 175: 577–86. 10.1677/joe.0.1750577Search in Google Scholar
7 Thrush DN, Austin D, Burdash N. Cardiopulmonary bypass temperature does not affect postoperative euthyroid sick syndrome? Chest 1995; 108: 1541–5. 10.1378/chest.108.6.1541Search in Google Scholar
8 Surks MI, Sievert R. Drugs and thyroid function. N Engl J Med 1995; 333: 1688–94. 10.1056/NEJM199512213332507Search in Google Scholar
9 Wilke TJ. Estimation of the free thyroid hormone concentrations in the clinical laboratory. Clin Chem 1986; 32: 585–92. 10.1093/clinchem/32.4.585Search in Google Scholar
10 Cerillo AG, Bevilacqua S, Storti S, Mariani M, Kallushi E, Ripoli A, et al. Free triiodothyronine: a novel predictor of postoperative atrial fibrillation. Eur J Cardiothorac Surg 2003; 23: 552–9. 10.1016/S1010-7940(03)00396-8Search in Google Scholar
11 Hamilton MA, Stevenson LW, Fonarow GC, Steimle A, Goldhaber JI, Child JS, et al. Safety and hemodynamic effects of intravenous triiodothyronine in advanced congestive heart failure. Am J Cardiol 1998; 81: 443–7. 10.1016/S0002-9149(97)00950-8Search in Google Scholar
12 Iervasi G, Pingitore A, Landi P, Raciti M, Ripoli A, Scarlattini M, et al. Low-T3 syndrome: a strong prognostic predictor of death in patients with heart disease. Circulation 2003; 107: 708–13. 10.1161/01.CIR.0000048124.64204.3FSearch in Google Scholar
13 Hamilton MA. Prevalence and clinical implications of abnormal thyroid hormone metabolism in advanced heart failure. Ann Thorac Surg 1993; 56: S48–S53. 10.1016/0003-4975(93)90554-USearch in Google Scholar
©2005 by Walter de Gruyter Berlin New York
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