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Thyroid hormone treatment after coronary-artery bypass surgery
J D Klemperer1, I Klein, M Gomez
1Department of Cardiothoracic Surgery, New York Hospital-Cornell University Medical College, New York 10021, USA.
The New England Journal of Medicine
|December 7, 1995
Summary
Perioperative triiodothyronine (liothyronine sodium) administration improved cardiac output and reduced systemic vascular resistance in high-risk bypass surgery patients. However, it did not alter postoperative outcomes or the need for standard therapies.
Area of Science:
- Cardiology
- Endocrinology
- Cardiovascular Surgery
Background:
- Thyroid hormone significantly impacts cardiovascular function.
- Cardiopulmonary bypass can cause a transient decrease in triiodothyronine levels, potentially leading to hemodynamic instability.
- This study investigated the effects of perioperative triiodothyronine supplementation in patients undergoing coronary artery bypass surgery.
Purpose of the Study:
- To determine if perioperative administration of triiodothyronine (liothyronine sodium) improves cardiovascular performance in high-risk patients undergoing coronary-artery bypass surgery.
- To assess the impact of triiodothyronine on hemodynamic parameters and the need for supportive therapies post-surgery.
Main Methods:
- A randomized controlled trial involving 142 patients with coronary artery disease and reduced left ventricular function.
- Patients received either intravenous triiodothyronine or a placebo during and after cardiopulmonary bypass.
- Hemodynamic responses and need for inotropic or vasodilator drugs were monitored.
Main Results:
- Serum triiodothyronine levels decreased by 40% during cardiopulmonary bypass.
- Triiodothyronine administration resulted in supranormal concentrations, significantly higher than placebo.
- Patients receiving triiodothyronine showed a higher cardiac index (P = 0.007) and lower systemic vascular resistance (P = 0.003) postoperatively.
Conclusions:
- Perioperative triiodothyronine supplementation effectively increases cardiac output and decreases systemic vascular resistance in patients undergoing coronary-artery bypass surgery.
- Despite hemodynamic improvements, triiodothyronine did not significantly alter perioperative outcomes, including arrhythmia incidence, need for supportive drugs, or mortality/morbidity.
- The findings suggest a potential role for triiodothyronine in managing hemodynamic function but not in altering overall clinical outcomes.