Mittnacht Janna, Choukair Daniela, Kneppo Carolin, Brunner Romuald, Parzer Peter, Gorenflo Matthias, Bettendorf Markus
Division of Paediatric Endocrinology and Diabetes, Department of Paediatrics, University Hospital Heidelberg, Heidelberg, Germany.
Horm Res Paediatr. 2015;84(2):130-6. doi: 10.1159/000381711. Epub 2015 May 7.
Transient thyroid dysfunction occurs in children after cardiopulmonary bypass (CPB). We demonstrated significant benefits of acute postoperative tri-iodothyronine (T3) treatment for recovery and myocardial function. Now we report the long-term neurodevelopment of these children.
Twenty-eight children (70% of the original study population) could be recruited for a follow-up examination (median age 10.7 years, range 10-19.6 years) retaining the double-blind, randomized, placebo-controlled protocol. Cognitive function and motor development were tested, as were growth and thyroid and cardiac functions.
The median full-scale intelligence quotient of all children was within the reference range and similar in the placebo and T3 groups. Tests for motor and cognitive functions, growth, and thyroid and cardiac functions revealed concurrent results.
Overall intellectual development is preserved in adolescents treated with CPB in infancy irrespectively of low postoperative thyroid hormone concentrations. While acute postoperative T3 treatment in children after CPB improves recovery, no significant long-term effects on neurodevelopment could be detected. We therefore speculate that transient postoperative thyroid dysfunction by means of nonthyroidal illness syndrome is predominantly mediated by extranuclear, nongenomic mechanisms and thus acutely affects the cardiovascular system but not the development of the central nervous system mediated by genomic mechanisms.
体外循环（CPB）术后儿童会出现短暂性甲状腺功能障碍。我们已证明术后急性给予三碘甲状腺原氨酸（T3）治疗对恢复和心肌功能有显著益处。现在我们报告这些儿童的长期神经发育情况。
28名儿童（占原研究人群的70%）可被招募进行随访检查（中位年龄10.7岁，范围10 - 19.6岁），并保留双盲、随机、安慰剂对照方案。测试了认知功能和运动发育情况，以及生长、甲状腺和心脏功能。
所有儿童的中位全量表智商在参考范围内，且安慰剂组和T3组相似。运动和认知功能、生长、甲状腺和心脏功能测试结果一致。
婴儿期接受CPB治疗的青少年，无论术后甲状腺激素浓度如何，其整体智力发育均得以保留。虽然CPB术后儿童急性给予T3治疗可改善恢复情况，但未检测到对神经发育有显著长期影响。因此，我们推测非甲状腺疾病综合征所致的术后短暂性甲状腺功能障碍主要由核外、非基因组机制介导，从而急性影响心血管系统，但不影响由基因组机制介导的中枢神经系统发育。
