Bettendorf M, Schmidt K G, Tiefenbacher U, Grulich-Henn J, Heinrich U E, Schönberg D K
Department of Pediatrics, University of Heidelberg, Germany.
Pediatr Res. 1997 Mar;41(3):375-9. doi: 10.1203/00006450-199703000-00012.
Thyroid hormone status was assessed in 132 children with congenital heart defects undergoing cardiac surgery (median age 3.1 y; range 2 d to 16.2 y). Plasma TSH, thyroxine (T4), free thyroxine (fT4), triiodothyronine (T3), reverse triiodothyronine (rT3), thyroglobulin (Tg), and urinary iodine excretion were measured before and every other day after cardiac surgery (d 1-21). After surgery we observed strikingly low plasma concentrations of TSH (0.4 mU/L; 0.2-1.3), T3 (0.6 nmol/L; 0.3-1.2), T4 (48.9 nmol/L; 12.9-82.4), IT4 (12.9 pmol/L; 5.1-19.3), and Tg (9.4 micrograms/L; 1.5-20.6), whereas rT3 plasma concentrations increased (0.13 pmol/L; 0.05-0.3; n = 40). The maximal post-operative changes of TSH and rT3 preceded changes of T3, T4, fT4, and Tg. Postoperative urinary iodine excretion increased significantly (n = 109). Thyroid hormone plasma concentrations were lowest after cardiopulmonary bypass operations and in patients treated with dopamine. In patients with postoperative T3 plasma concentrations less than 0.6 nmol/L (n =52) the period of mechanical ventilation and intensive care treatment was significantly prolonged. Furthermore, the cumulative doses of inotropic and vasoactive catecholamines and furosemide were significantly higher in this patient group. Our results demonstrate transient secondary hypothyroidism in children after cardiac surgery that may contribute to postoperative cardiac and respiratory dysfunction and may delay recovery. Possible benefits of thyroid hormone replacement therapy need to be thoroughly examined.
对132例接受心脏手术的先天性心脏病患儿（中位年龄3.1岁；范围2天至16.2岁）的甲状腺激素状态进行了评估。在心脏手术前及术后每隔一天（第1 - 21天）测量血浆促甲状腺激素（TSH）、甲状腺素（T4）、游离甲状腺素（fT4）、三碘甲状腺原氨酸（T3）、反三碘甲状腺原氨酸（rT3）、甲状腺球蛋白（Tg）以及尿碘排泄量。术后我们观察到TSH（0.4 mU/L；0.2 - 1.3）、T3（0.6 nmol/L；0.3 - 1.2）、T4（48.9 nmol/L；12.9 - 82.4）、fT4（12.9 pmol/L；5.1 - 19.3）和Tg（9.4微克/升；1.5 - 20.6）的血浆浓度显著降低，而rT3血浆浓度升高（0.13 pmol/L；0.05 - 0.3；n = 40）。TSH和rT3术后的最大变化先于T3、T4、fT4和Tg的变化。术后尿碘排泄量显著增加（n = 109）。甲状腺激素血浆浓度在体外循环手术后及接受多巴胺治疗的患者中最低。术后T3血浆浓度低于0.6 nmol/L的患者（n = 52），机械通气和重症监护治疗时间显著延长。此外，该患者组中强心和血管活性儿茶酚胺以及呋塞米的累积剂量显著更高。我们的结果表明，儿童心脏手术后存在短暂性继发性甲状腺功能减退，这可能导致术后心脏和呼吸功能障碍，并可能延迟恢复。甲状腺激素替代疗法的潜在益处需要进行全面研究。
