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Prolonged anesthesia duration is associated with postoperative thyroid hormone reduction in pediatric surgical

Mengqin Shan1, Chaoyang Tong1,2, Xin Fu1

  • 1Department of Anesthesiology, Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, China.

Frontiers in Pediatrics
|May 1, 2026
PubMed

Insights

Longer anesthesia duration is a key risk factor for reduced thyroid hormones (TH) in pediatric surgical patients. This reduction, especially in cardiac surgery, is linked to longer hospital stays, impacting recovery.

Area of Science:

  • Pediatric Surgery
  • Endocrinology
  • Anesthesiology

Background:

  • Postoperative reduction in thyroid hormones (TH), particularly triiodothyronine (T3), is common in pediatric surgical patients but not well understood.
  • Factors influencing these hormonal changes and their clinical impact remain unclear.

Purpose of the Study:

  • Identify risk factors for postoperative TH reduction in pediatric surgical patients.
  • Analyze the association between anesthetic factors and perioperative TH changes.
  • Explore the relationship between postoperative TH reduction and clinical outcomes, especially in pediatric cardiac surgery.

Main Methods:

  • Retrospective analysis of 233 pediatric patients (0-18 years) undergoing surgery and anesthesia.
  • Categorization into low thyroid hormone (LTH) and non-LTH groups based on postoperative free T3 (FT3) and/or free thyroxine (FT4) levels.
  • Multivariable logistic and ridge regression for predictor identification; outcome analysis in cardiac surgery sub-cohort.

Main Results:

  • Postoperative LTH observed in 33.5% of patients.
  • Longer anesthesia duration emerged as a significant independent risk factor for LTH (OR=1.335, P<0.001), irrespective of surgery type or cardiopulmonary bypass (CPB) use.
  • Severe TH reduction in cardiac surgery patients was associated with longer postoperative hospital stays (P=0.035).

Conclusions:

  • Anesthesia duration is independently linked to postoperative TH reduction in children.
  • The degree of TH reduction in cardiac surgery correlates with prolonged hospitalization.
  • Findings suggest anesthesia duration as a modifiable risk factor for postoperative TH reduction, warranting further mechanistic investigation.
Abstract

Keywords:
anesthesiacardiac surgerylow T3 syndromepediatric surgeryretrospective studythyroid hormone

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