Lerner Reut Kassif, Gruber Noah, Pollak Uri
Department of Pediatrics, The Edmond and Lily Safra Children's Hospital, The Chaim Sheba Medical Center, Tel Hashomer, Israel.
The Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
World J Pediatr Congenit Heart Surg. 2019 Sep;10(5):604-615. doi: 10.1177/2150135119857704.
Patients with congenital heart disease have higher prevalence of thyroid dysfunction due to embryonic and genetic coexistence. Marked changes in cardiac function occur secondary to alternations in thyroid hormone levels. Cardiac catheterizations or cardiac surgeries with cardiopulmonary bypass can cause abnormalities in the circulating hormones, in the absence of primary thyroid disease. Therefore, monitoring of thyroid function should be routinely performed in children with congenital heart disease. Thyroid hormone supplementation has been postulated as a possible therapeutic option; however, the therapeutic decisions should be made based on individual circumstances, symptoms, and the severity of the thyroid dysfunction.
To describe the correlation between congenital heart disease in children and thyroid dysfunction and the debate on monitoring, intervention, and treatment.
PubMed, Clinical Key, and the Cochrane Library were searched using keywords relevant to congenital heart disease/surgery, cardiopulmonary bypass, thyroid hormones, sick euthyroid syndrome, and cardiac catheterization. Studies were limited to the English language and to children 0 to 18 years old. Studies in adults with important findings were reviewed as well. All clinical studies believed to have relevance were considered. All relevant studies were reviewed, and the most pertinent data were incorporated in this review.
There is lack of significant evidence concerning treatment for thyroid dysfunction in children with a congenital cardiac diagnosis. Adequately powered studies are needed before a uniform recommendation about treatment can be made.
由于胚胎发育和遗传因素并存，先天性心脏病患者甲状腺功能障碍的患病率较高。甲状腺激素水平的改变会继发心脏功能的显著变化。在没有原发性甲状腺疾病的情况下，心脏导管插入术或体外循环心脏手术可导致循环激素异常。因此，先天性心脏病患儿应常规监测甲状腺功能。甲状腺激素补充疗法被认为是一种可能的治疗选择；然而，治疗决策应根据个体情况、症状以及甲状腺功能障碍的严重程度来做出。
描述儿童先天性心脏病与甲状腺功能障碍之间的相关性，以及关于监测、干预和治疗的争论。
使用与先天性心脏病/手术、体外循环、甲状腺激素、低甲状腺素病态综合征和心脏导管插入术相关的关键词在PubMed、Clinical Key和Cochrane图书馆进行检索。研究限于英文文献且研究对象为0至18岁儿童。也对有重要发现的成人研究进行了综述。所有被认为相关的临床研究均被纳入考虑。对所有相关研究进行了综述，并将最相关的数据纳入本综述。
关于先天性心脏病患儿甲状腺功能障碍的治疗，缺乏充分的证据。在能够做出统一的治疗建议之前，需要开展有足够样本量的研究。
