Cardiovascular effects of intravenous triiodothyronine in patients undergoing coronary artery bypass graft surgery. A randomized, double-blind, placebo- controlled trial. Duke T3 study group

E. Bennett-Guerrero, J. L. Jimenez, W. D. White, E. B. D'Amico, B. I. Baldwin and D. A. Schwinn
Department of Anesthesiology, Duke University Medical Center, Durham, NC, USA.

OBJECTIVE: To test the hypothesis that triiodothyronine (T(3)) administration improves hemodynamic variables and decreases inotropic drug requirements in cardiac surgery patients. DESIGN: Prospective, randomized, double-blind, placebo-controlled trial. SETTING: Tertiary care medical center. PATIENTS: A total of 211 patients undergoing coronary artery surgery at high risk for requiring inotropic drug support. INTERVENTION: At release of aortic cross-clamp, patients were randomized to an intravenous infusion of T(3) (0.8 microg/kg followed by 0.12 microg.kg(-1).h(-1) for 6 hours), dopamine (positive control, 5 microg.kg(-1).min(-1) for 6 hours) or placebo. MAIN OUTCOME MEASURES: Perioperative hemodynamic variables, inotropic support requirements, and serum T(3) concentrations. RESULTS: Mean+/-SEM free T(3) serum concentrations decreased significantly during cardiopulmonary bypass in all groups (from 0.0035+/-0.0001 nmol/L [0.23+/-0.01 ng/dL] to 0.001+/-0.0001 nmol/L [0.7+/- 0.00 ng/dL]; P=.001) and increased to 0.0133+/-0.0004 nmol/L [0.87+/-0.03 ng/dL] (twice normal range; P<.001) following initiation of intravenous T(3). Intravenous T(3) did not change hemodynamic variables or inotropic drug requirements; however, heart rate increased (P<.001), and a trend toward decreased use of inotropic agents was demonstrated in the dopamine group. CONCLUSIONS: Triiodothyronine administration prevents decreases in serum thyroid hormone concentrations associated with cardiopulmonary bypass. Intravenous T(3) does not have dramatic effects on hemodynamic variables in this setting as has been previously suggested. Although mild effects on myocardial performance may exist, we cannot recommend at this time the routine use of intravenous T(3) as an inotropic agent in patients undergoing coronary artery bypass graft surgery.

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Physiological effects of nonthyroidal illness syndrome in patients after cardiac surgery
Spratt et al.
Am. J. Physiol. Endocrinol. Metab. 2007;293:E310-E315.
ABSTRACT | FULL TEXT  

Acute Effects of Triiodothyronine on Endothelial Function in Human Subjects
Napoli et al.
J. Clin. Endocrinol. Metab. 2007;92:250-254.
ABSTRACT | FULL TEXT  

Medical management to optimize donor organ potential: review of the literature: [Traitement medical pour optimaliser le potentiel de don d'organe : une revue documentaire].
Kutsogiannis et al.
Canadian J. Anesthesia 2006;53:820-830.
ABSTRACT | FULL TEXT  

Does perioperative thyroxine have a role during adult cardiac surgery?
Ronald and Dunning
ICVTS 2006;5:166-178.
ABSTRACT | FULL TEXT  

Severe Hypothyroidism After Coronary Artery Bypass Grafting
Sarma et al.
Ann. Thorac. Surg. 2005;80:714-716.
ABSTRACT | FULL TEXT  

Thyroid Hormone Action in the Heart
Kahaly and Dillmann
Endocr. Rev. 2005;26:704-728.
ABSTRACT | FULL TEXT  

Meta-Analysis: Low-Dose Dopamine Increases Urine Output but Does Not Prevent Renal Dysfunction or Death
Friedrich et al.
ANN INTERN MED 2005;142:510-524.
ABSTRACT | FULL TEXT  

Endocrine Changes in Critical Illness
Nylen and Muller
J Intensive Care Med 2004;19:67-82.
ABSTRACT  

Interventions in heart and thyroid surgery: can they be safely combined?
Abboud et al.
Eur. J. Cardiothorac. Surg. 2003;24:712-715.
ABSTRACT | FULL TEXT  

Postoperative Care of Cardiac Surgical Patients
Salenger et al.
Card Surg Adult 2003;2:439-469.
FULL TEXT  

Severe Myxedema After Cardiopulmonary Bypass
O'Connor et al.
Anesth. Analg. 2003;96:62-64.
ABSTRACT | FULL TEXT  

Effects of Intravenous Triiodothyronine During Coronary Artery Bypass Surgery
Guden et al.
Asian Cardiovasc. Thorac. Ann. 2002;10:219-222.
ABSTRACT | FULL TEXT  

Coronary Bypass Surgery in Patients on Thyroxin Replacement Therapy
Syed et al.
Asian Cardiovasc. Thorac. Ann. 2002;10:107-110.
ABSTRACT | FULL TEXT  

Biochemistry, Cellular and Molecular Biology, and Physiological Roles of the Iodothyronine Selenodeiodinases
Bianco et al.
Endocr. Rev. 2002;23:38-89.
ABSTRACT | FULL TEXT  

Thyroid Hormone and the Cardiovascular System
Klein and Ojamaa
NEJM 2001;344:501-509.
FULL TEXT  

Cellular and molecular therapeutic targets for treatment of contractile dysfunction after cardioplegic arrest
Spinale
Ann. Thorac. Surg. 1999;68:1934-1941.
ABSTRACT | FULL TEXT  

Fast track recovery of elderly coronary bypass surgery patients
Lee et al.
Ann. Thorac. Surg. 1999;68:437-441.
ABSTRACT | FULL TEXT  

A RANDOMIZED DOUBLE-BLIND STUDY OF THE EFFECT OF TRIIODOTHYRONINE ON CARDIAC FUNCTION AND MORBIDITY AFTER CORONARY BYPASS SURGERY
Mullis-Jansson et al.
J. Thorac. Cardiovasc. Surg. 1999;117:1128-1135.
ABSTRACT | FULL TEXT  

Triiodothyronine-Enhanced Left Ventricular Function After Ischemic Injury
Dyke
Ann. Thorac. Surg. 1998;66:1450-1451.
FULL TEXT  

Rapid Recovery After Coronary Artery Bypass Grafting: Is the Elderly Patient Eligible?
Ott et al.
Ann. Thorac. Surg. 1997;63:634-639.
ABSTRACT | FULL TEXT  

Euthyroid Sick Syndrome: Is It a Misnomer?
Chopra
J. Clin. Endocrinol. Metab. 1997;82:329-334.
FULL TEXT  

THYROID HORMONE DOES NOT IMPROVE OUTCOME OF CARDIAC SURGERY
JWatch General 1996;1996:7-7.
FULL TEXT