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Transient Secondary Hypothyroidism and Thyroid Hormone Replacement Therapy in Pediatric Postoperative Cardiopulmonary
Travis F D Souza1, Steven G Hoshal1, Ridwaan Albeiruti1
1College of Human Medicine, Michigan State University, Grand Rapids, MI, United States.
Insights
Pediatric heart surgery patients often develop temporary hypothyroidism after cardiopulmonary bypass (CPB). Current practices for managing this condition, including thyroid function tests (TFTs), lack consistency across major centers.
Area of Science:
- Pediatric Endocrinology
- Cardiothoracic Surgery
- Pediatric Cardiology
Background:
- Transient secondary hypothyroidism is a known complication in pediatric patients following cardiopulmonary bypass (CPB).
- Understanding current management strategies is crucial for optimizing patient outcomes.
Purpose of the Study:
- To assess current practices in the diagnosis and management of transient secondary hypothyroidism in pediatric patients post-CPB.
- To identify variations in thyroid function testing (TFT) and treatment protocols.
Main Methods:
- An electronic survey was distributed to 64 high-volume pediatric heart centers in the US and UK.
- A retrospective chart review was conducted at a Midwest referral center, analyzing data from pediatric patients (0-18 years) who underwent CPB between 2005-2015.
- Data collected included CPB details and Thyroid Function Test (TFT) orders.
Main Results:
- A low survey response rate (11.2%) was observed, with 129 providers completing the questionnaire.
- Only a small number of respondents routinely ordered TFTs (pre- and post-CPB or as indicated).
- Retrospective data showed limited preoperative (20/502) and postoperative (11/502) TFT testing, with only one provider using prophylactic thyroid hormone replacement.
Conclusions:
- There is a significant lack of standardized approaches for evaluating, diagnosing, and treating transient secondary hypothyroidism in pediatric CPB patients.
- Current practices reveal considerable variability in TFT ordering and thyroid hormone replacement therapy.
- Further research and guideline development are needed to ensure consistent care for these vulnerable patients.
Background:
To develop an understanding of current practices in the management of transient secondary hypothyroidism in pediatric postoperative cardiopulmonary bypass (CPB) patients.
Methods:
Electronic survey comprising a 10-item questionnaire was sent to sixty-four high volume pediatric heart centers in the United States and United Kingdom. Survey participants included cardiologists, intensivists, cardiothoracic surgeons, and advanced practice providers. A retrospective chart review was also performed at a large regional referral center in the Midwest on subjects 0-18 years old who underwent CPB from 2005-2015. Information obtained included a unique identifier, date of birth, age, procedure performed, CPB time, date of surgery and date and type of Thyroid Function Test (TFT) ordered.
Results:
1,153 individuals from 64 congenital heart centers were contacted via email to participate in the electronic survey. In the 3-month response window, 129 completed surveys were received from cardiologists (55%), intensivists (17%), surgeons (15%), "other" (8%), and advanced practice providers (5%). This yielded a response rate of 11.2%. Of the 129 respondents, only 10 providers routinely order TFTs prior to (n=7) and after (n=1) CPB or when clinically indicated (n=2). All 10 providers order thyroid stimulating hormone test, 7 order thyroxine, and 3 order triiodothyronine. Only 1 provider routinely treats children with prophylactic thyroid hormone replacement therapy after CPB. Our retrospective review included 502 CPB events with 442 unique patients. Of the events, 20 patients received preoperative TFT testing while 11 received postoperative testing.
Conclusions:
There is a general lack of uniformity in the evaluation, diagnosis, and treatment of transient secondary hypothyroidism in pediatric postoperative CPB patients.
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