Evaluation of Positive Inotropic Drug Effects on Thyroid Hormone Levels after Open Heart Surgery

  • Umit Kervan
  • Anil Ozen
  • Utku Unal
  • Irfan Tasoglu
  • Mahmut Mustafa Ulas
  • Kumral Cagli
  • Alper Uzun
  • Hasmet Bardakci
  • Kerim Cagli

Abstract

Objective: The aim of this study was to examine the effects of positive inotropic drugs, including adrenaline, dopamine, and dobutamine on thyroid hormone levels following open heart surgery.

Methods: We analyzed free thyroid hormones (FT3 and FT4) and thyroid-stimulating hormones (TSH) in 200 consecutive patients undergoing open heart surgery. Patients were divided into 5 groups according to the inotropic drug administration as follows: Group A (n = 46) received dopamine alone; Group B (n = 40), dopamine and dobutamine; Group C (n = 36), dopamine, dobutamine, and adrenaline; Group D (n = 32), adrenaline alone; and Group E (n = 46), placebo. Procedural factors affecting thyroid hormones were recorded and included cardiopulmonary bypass (CPB) time, cross-clamping time, degree of hypothermia, and the duration and doses of positive inotropic drugs. Blood samples for hormone assays were collected before initiation of inotropic drug therapy (baseline) and postoperatively at 24, 72, and 120 hours after drug therapy.

Results: FT3, FT4, and TSH levels at baseline were similar in all groups. Although there was a trend showing very slight increases in thyroid hormone levels from baseline to the 24th, 72nd, and 120th postoperative hours after drug therapy, these changes were not significant, and there were also no significant differences between the groups. There was also no significant statistical difference in CPB time, cross-clamping time, degree of hypothermia, and duration and doses of positive inotropic drugs between groups.

Conclusion: Although thyroid hormone levels were affected by positive inotropic drug usage after open heart surgery, this effect was not significant and thyroid hormone levels remained within normal ranges.

References

Afandi B, Schussler GC, Arafeh AH, Boutros A, Yap MG, Finkelstein A. 2000. Selective consumption of thyroxine-binding globulin during cardiac bypass surgery. Metabolism 49:270-4.\nBennett-Guerrero E, Jimenez JL, White WD, D'Amico EB, Baldwin BI, Schwin DA. 1996. Cardiovascular effects of intravenous triiodothyronine in patients undergoing coronary artery bypass graft surgery. A randomized, double-blind, placebo-controlled trial. Duke T3 study group. JAMA 275:687-92.\nBettendorf M, Schmidt KG, Tiefenbacher U, Grulich-Henn J, Heinrich UE, Schönberg DK. 1997. Transient secondary hypothyroidism in children after cardiac surgery. Pediatr Res 41:375-9.\nButtrick P, Malhotra A, Factor S, Geenen D, Scheuer J. 1988. Effects of chronic dobutamine administration on hearts of normal and hypertensive rats. Circ Res 63:173-81.\nCerillo AG, Storti S, Mariani M, et al. 2005. The non-thyroidal illness syndrome after coronary artery bypass grafting: a 6-month follow-up study. Clin Chem Lab Med 43:289-93.\nCoiro V, Volpi R, Cataldo S, et al. 2000. Dopaminergic and cholinergic involvement in the inhibitory effect of dexamethasone on the TSH response to TRH. J Investig Med 48:133-6.\nDe Groot LJ. 1999. Dangerous dogmas in medicine: the nonthyroidal illness syndrome. J Clin Endocrinol Metab 84:151-64.\nEggum R, Ueland T, Mollnes TE, et al. 2010. Perfusion temperature, thyroid hormones and inflammation during pediatric cardiac surgery. Interact Cardiovasc Thorac Surg 10:76-80.\nHeinen E, Herrmann J, Lippe J, Dudek M, Krüskemper HL. 1983. Effect of dopamine and dobutamine on thyroid hormone concentration [in German]. Med Welt 34:696-9.\nHolland FW 2nd, Brown PS Jr, Weintraub BD, Clark RE. 1991. Cardiopulmonary bypass and thyroid function: a "euthyroid sick syndrome." Ann Thorac Surg 52:46-50.\nLee E, Chen P, Rao H, Lee J, Burmeister LA. 1999. Effect of acute high dose dobutamine administration on serum thyrotrophin (TSH). Clin Endocrinol (Oxf) 50:487-92.\nMitchell IM, Pollock JC, Jamieson MP, Donaghey SF, Paton RD, Logan RW. 1992. The effects of cardiopulmonary bypass on thyroid function in infants weighing less than five kilograms. J Thorac Cardiovasc Surg 103:800-5.\nReinhardt W, Mocker V, Jockenhövel F, et al. 1997. Influence of coronary artery bypass surgery on thyroid hormone parameters. Horm Res 47:1-8.\nRoth-Härer A, Lilienthal H, Bubser M, et al. 2001. Neurotransmitter concentrations and binding at dopamine receptors in rats after maternal exposure to 3,4,3,4-tetrachlorobiphenyl: the role of reduced thyroid hormone concentrations. Environ Toxicol Pharmacol 9:103-15.\nSaatvedt K, Lindberg H, Geiran OR, et al. 1998. Thyroid function during and after cardiopulmonary bypass in children. Acta Anaesthesiol Scand 42:1100-3.\nThrush DN, Austin D, Burdash N. 1995. Cardiopulmonary bypass temperature does not affect postoperative euthyroid sick syndrome? Chest 108:1541-5.\nVan den Berghe G, de Zegher F, Lauwers P. 1994. Dopamine and the sick euthyroid syndrome in critical illness. Clin Endocrinol (Oxf) 41:731-7.\nVan den Berghe G, de Zegher F. 1996. Anterior pituitary function during critical illness and dopamine treatment. Crit Care Med 24:1580-90.\nVander Salm TJ, Stahl RS. Early postoperative care. In: Edmunds LH, ed. Cardiac surgery in the adult. 1st ed. Philadelphia: The McGraw-Hill Companies; 1997: 339-67.\nVelissaris T, Tang AT, Wood PJ, Hett DA, Ohri S.K 2009. Thyroid function during coronary surgery with and without cardiopulmonary bypass. Eur J Cardiothorac Surg 36:148-54.\n
Published
2015-04-03
How to Cite
Kervan, U., Ozen, A., Unal, U., Tasoglu, I., Ulas, M., Cagli, K., Uzun, A., Bardakci, H., & Cagli, K. (2015). Evaluation of Positive Inotropic Drug Effects on Thyroid Hormone Levels after Open Heart Surgery. The Heart Surgery Forum, 16(2), E78-E82. https://doi.org/10.1532/HSF98.20121084
Section
Articles

Most read articles by the same author(s)