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Hormonal changes in brain dead patients.

D J Powner1, A Hendrich, R G Lagler

  • 1Department of Medicine, Indiana University School of Medicine, Indianapolis.

Critical Care Medicine
|July 1, 1990
PubMed
Summary
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Serum hormone levels in neurologically impaired patients do not indicate a need for thyroid hormone replacement therapy before organ donation. Elevated lactate levels in these patients remain unexplained and do not suggest hypothyroidism.

Area of Science:

  • Endocrinology
  • Nephrology
  • Critical Care Medicine

Background:

  • Neurologically impaired patients often undergo organ donation evaluations.
  • Hormonal changes in these patients may impact organ viability and donor management.

Purpose of the Study:

  • To investigate serum thyroid hormone, cortisol, insulin, and lactate levels in neurologically impaired patients.
  • To determine if these levels indicate a need for hormone replacement therapy before organ removal for donation.

Main Methods:

  • Monitored serum levels of free thyroxine (fT4), thyroid-stimulating hormone (TSH), reverse T3 (rT3), cortisol, insulin, and lactate.
  • Evaluated 30 neurologically impaired patients (Glasgow Coma Score < 7), including 16 before and after brain death and 14 without brain death.

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Main Results:

  • Most patients exhibited low fT3, normal fT4, and normal/high rT3, consistent with euthyroid sick syndrome.
  • Cortisol, insulin, and lactate levels were normal or high.
  • No correlation found between low thyroid hormones and elevated lactate or vasopressor requirements.
  • No significant hormonal or lactate changes occurred post-brain death.

Conclusions:

  • Observed hormonal profiles do not support thyroid hormone replacement in brain-dead organ donors.
  • Elevated lactate levels in this context are unexplained and do not justify a diagnosis of hypothyroidism.
  • Hormone levels do not necessitate intervention before organ procurement in these patients.