Brazilian Journal of Anesthesiology
https://bjan-sba.org/article/doi/10.1590/S0034-70942004000300006
Brazilian Journal of Anesthesiology
Scientific Article

Aspectos da função tireóidea em lactentes submetidos à cirurgia cardíaca com circulação extracorpórea

Thyroid function profile in infants submitted to cardiac surgery with cardiopulmonary bypass

Paula Maria da Cruz; Carmem Narvaes Bello; Miguel Lorenzo Barbero Marcial; José Otávio Costa Auler Júnior

http://dx.doi.org/10.1590/S0034-70942004000300006 Braz J Anesthesiol, vol.54, n3, p.325-334, 2004
PDF Português
PDF English
Downloads: 0
Views: 712

Resumo

JUSTIFICATIVA E OBJETIVOS: A cirurgia cardíaca com circulação extracorpórea (CEC) relaciona-se à doença eutireóidea ou à depressão do eixo hipotálamo-hipofisário-tireóideo. O estado hemodinâmico incomum imposto pela CEC é responsável por diversas alterações endócrino-metabólicas, acarretando complexa resposta inflamatória sistêmica. Esta investigação teve como objetivo analisar o comportamento da triiodotironina (T3), tetraiodotironina (T4) e tireotrofina (TSH) em lactentes submetidos à cirurgia cardíaca com CEC. MÉTODO: Foram estudados 15 lactentes. As amostras de sangue para pesquisa de T3, T4 e TSH foram obtidas em 4 momentos designados: M1 - após a indução da anestesia; M2 - após o final da cirurgia; M3 - 6 horas após o final da cirurgia e M4 - 24 horas após o M1. Para complementar esta investigação, foram estudadas as variações dos seguintes parâmetros: pressão arterial média (PAM), temperatura sangüínea central (ºC), atributos da oxigenação tecidual e do equilíbrio ácido-base (M1, CEC, M2, M3 e M4). RESULTADOS: As médias de idade, peso, altura e superfície corpórea dos pacientes foram 3,9 meses; 4,708 kg; 0,65 m e 0,3 m², respectivamente. As concentrações plasmáticas de T3 (p < 0,0001), T4 (p < 0,0001) e TSH (p = 0,0021) variaram significativamente durante o período estudado, sendo que as de T3 declinaram progressivamente. As menores taxas de T3 e T4 coincidiram com as maiores de Ht e Hb, descartando os efeitos da hemodiluição. As maiores concentrações séricas de TSH demonstraram a provável reação do eixo hipotálamo-hipofisário-tireóideo aos efeitos da hipotermia e da absorção maciça pelo iodo (uso tópico de soluções anti-sépticas). Foram identificados aspectos da "Síndrome do T3 baixo" em todos os momentos estudados. CONCLUSÕES: Foram observadas alterações nas concentrações séricas de T3, T4 e TSH em lactentes submetidos à cirurgia cardíaca com circulação extracorpórea.

Palavras-chave

ANESTESIA, CIRURGIA, HORMÔNIOS

Abstract

BACKGROUND AND OBJECTIVES: Cardiac surgery with cardiopulmonary bypass (CPB) is related to euthyroid disease or hypothalamic-pituitary-thyroid system depression. Abnormal hemodynamic status induced by CPB is responsible for several endocrine-metabolic changes, triggering complex systemic inflammatory response. This study aimed at evaluating triiodothyronine (T3), tetraiodothyronine (T4) and thyrotrophin (TSH) behavior in infants submitted to cardiac surgery with CPB. METHODS: Participated in this study 15 infants. Blood samples for T3, T4 and TSH evaluation were collected in four moments: M1 - after anesthetic induction; M2 - at surgery completion; M3 - six hours after surgery completion; M4 - 24 hours after M1. To complete this study the following parameters were evaluated: mean blood pressure (MBP), central blood temperature (ºC), tissue oxygenation and acid-base attributes (M1, CPB, M2, M3 and M4). RESULTS: The patients' means aged, weigh, height and body surface were 3.9 months; 4.708 kg; 0.65 m and 0.3 m² respectivety. Plasma T3 (p < 0.0001), T4 (p < 0.0001) and TSH (p = 0.0021) concentrations have significantly varied throughout the study with T3 concentrations progressively decreasing. Lowest T3 and T4 values were coincident with highest Ht and Hb values, discarding hemodilution effects. Highest serum TSH concentrations have shown a possible hypothalamic-pituitary-thyroid system reaction to hypothermia and of massive iodine absorption (topic use of antiseptic solutions). "Low T3 Syndrome" aspects were identified in all studied moments. CONCLUSIONS: There have been changes in serum T3, T4 and TSH concentrations in infants submitted to cardiac surgery with cardiopulmonary bypass.

Keywords

ANESTHESIA, HORMONES, SURGERY

References

Butler J, Rocker GM, Westaby S. Inflammatory response to cardiopulmonary bypass. Ann Thorac Surg. 1993;55:552-559.

Richmand DA, Molitch ME, O'Donnel TF. Altered thyroid hormone levels in bacterial sepsis: role of nutritional adequacy. Metabolism. 1980;29:936-942.

Kaptein EM, Weiner JM, Robinson WJ. Relationship of altered thyroid hormone indices to survival in nonthyroidall illnesses. Clin Endocrinol. 1982;16:565-574.

Hamilton MA, Stevenson LW, Luu M. Altered thyroid hormone metabolism in advanced heart failure. J Am Coll Cardiol. 1990;16:91-95.

Chopra IJ, Hershman JM, Pardridge WM. Thyroid function in nonthyroidall illnesses. Ann Intern Med. 1983;98:946-957.

Mitchell IM, Pollock JC, Jamieson MP. The effects of cardiopulmonary bypass on thyroid function in infants weighing less than five kilograms. J Thorac Cardiovasc Surg. 1992;103:800-805.

Moore R. Preoperative Evaluation and Preparation of the Pediatric Patient with Cardiac Disease. Pediatric Cardiac Anesthesia. 1998:95-122.

Kern FH, Schulman SR, Lawson DS. Extracorporeal Circulation and Circulatory Assist Devices in the Pediatric Patient. Pediatric Cardiac Anesthesia. 1998:219-957.

Zuckerberg AL, Deutschman CS, Caballero B. Nutricional and Metabolism in the Critically ill Child with Heart Disease. Critical Heart Disease in Infants and Children. 1995:415-436.

Mitchell IM. Liver function after cardiopulmonary bypass in children. J Thorac Cardiovasc Surg. 1995;110:284-286.

Bartalena L. Recent achievements in studies on thyroid hormone-binding proteins. Endocr Rev. 1990;11:47-64.

Degroot LJ, Larsen PR, Hennemann G. Effects of Drugs, Disease, and other Agents on Thyroid Function; the Nonthyroidal Illness Syndrome. The Thyroid and its Diseases. 1996:137-187.

Wartofsky L, Burman KD. Alterations in thyroid function in patients with systemic illness: the "euthyroid sick syndrome". Endocr Rev. 1982;3:164-217.

Newnham HH, Hamblin PS, Long F. Effect of oral furosemide on diagnostic indices of thyroid function. Clin Endocrinol. 1987;26:423-431.

Smerdely P, Lim A, Boyages SC. Topical iodine-containing antiseptics and neonatal hypothyroidism in very-low-birthweight infants. Lancet. 1989;2:661-664.

Brogan TV, Bratton SL, Lynn AM. Thyroid function in infants following cardiac surgery: comparative effects of iodinated and noniodinated topical antiseptics. Crit Care Med. 1997;25:1583-1587.

Bettendorf M, Schmidt KG, Tiefenbacher U. Transient secondary hypothyroidism in children after cardiac surgery. Pediatr Res. 1997;41:375-379.

Mitchell IM, Pollock JC, Jamieson MP. Transcutaneous iodine absorption in infants undergoing cardiac operation. Ann Thorac Surg. 1991;52:1138-1140.

Majerus PW, Broze Jr GJ, Mitetich JP. Drogas Anticoagulantes, Trombolíticas e Anti-Plaquetárias. As Bases Farmacológicas da Terapêutica. 1991:874-888.

Mitchell IM. Thyroid function after cardiopulmonary bypass in neonates. Ann Thorac Surg. 1995;60:745-747.

Cooper DK, Novitzky D. Invited letter concerning: Changes in plasma-free thyroid hormones during cardiopulmonary bypass. J Thorac Cardiovasc Surg. 1992;104:526-527.

Tahirovic HF. Thyroid hormones changes in infants and children with metabolic acidosis. J Endocrinol Invest. 1991;14:723-726.

Saatvedt K, Lindberg H. Depressed thyroid function following paediatric cardiopulmonary bypass: association with interleukin-6 release?. Scand J Thorac Cardiovasc Surg. 1996;30:61-64.

Savaris N. Resposta imunoinflamatória à circulação extracorpórea: estado atual. Rev Bras Anestesiol. 1998;48:126-136.

van der Poll T, Romijn JA, Wiersinga WM. Tumor necrosis factor: a putative mediator of the sick euthyroid syndrome in man. J Clin Endocrinol Metab. 1990;71:1567-1572.

Taylor KM, Wright GS, Bremner WF. Anterior pituitary response to thyrotrophin-releasing hormone during open-heart surgery. Cardiovasc Res. 1978;12:114-119.

Taylor KM, Wright GS, Bain WH. Comparative studies of pulsatile and nonpulsatile flow during cardiopulmonary bypass: III - Response of anterior pituitary gland to thyrotropin-releasing hormone. J Thorac Cardiovasc Surg. 1978;75:579-584.

Reinhardt W, Mocker V, Jockenhovel F. Influence of coronary artery bypass surgery on thyroid hormone parameters. Horm Res. 1997;47:1-8.

Mainwaring RD, Lamberti JJ, Billman GF. Suppression of the pituitary thyroid axis after cardiopulmonary bypass in the neonate. Ann Thorac Surg. 1994;58:1078-1082.

Mainwaring RD, Lamberti JJ, Carter Jr TL. Reduction in triiodothyronine levels following modified Fontan procedure. J Card Surg. 1994;9:322-331.

Holland FW, Brown Jr PS, Weintraub BD. Cardiopulmonary bypass and thyroid function: a "euthyroid sick syndrome". Ann Thorac Surg. 1991;52:46-50.

Hesslink Jr RL, D'Alesandro MM, Armstrong DW. Human cold air habituation is independent of thyroxine and thyrotropin. J Appl Physiol. 1992;72:2134-2139.

Hefco E, Krulich L, Illner P. Effect of acute exposure to cold on the activity of the hypothalamic-pituitary-thyroid system. Endocrinology. 1975;97:1185-1195.

Rondeel JM, de Greef WJ, Hop WC. Effect of cold exposure on the hypothalamic release of thyrotropin-releasing hormone and catecholamines. Neuroendocrinology. 1991;54:477-481.

Rondeel JM, Klootwijk W, Linkels E. Regulation of thyrotropin-releasing hormone in the posterior pituitary. Neuroendocrinology. 1995;61:421-429.

Wilber JF, Baum D. Elevation of plasma TSH during surgical hypothermia. J Clin Endocrinol Metab. 1970;31:372-375.

Gordon CM, Rowitch DH, Mitchell ML. Topical iodine and neonatal hypothyroidism. Arch Pediatr Adolesc Med. 1995;149:1336-1339.

5dd7e6640e8825c96413f289 rba Articles
Links & Downloads
2352-2291 (Electronic) 0104-0014 (Printed)
Braz J Anesthesiol ©2024 All rights reserved.

Braz J Anesthesiol

Share this page
Page Sections