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Previous Volume 333:1522-1527 December 7, 1995 Number 23 Next

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ABSTRACT

Background Thyroid hormone has many effects on the cardiovascular system. During and after cardiopulmonary bypass, serum triiodothyronine concentrations decline transiently, which may contribute to postoperative hemodynamic dysfunction. We investigated whether the perioperative administration of triiodothyronine (liothyronine sodium) enhances cardiovascular performance in high-risk patients undergoing coronary-artery bypass surgery.

Methods We administered triiodothyronine or placebo to 142 patients with coronary artery disease and depressed left ventricular function. The hormone was administered as an intravenous bolus of 0.8 µg per kilogram of body weight when the aortic cross-clamp was removed after the completion of bypass surgery and then as an infusion of 0.113 µg per kilogram per hour for six hours. Clinical and hemodynamic responses were serially recorded, as was any need for inotropic or vasodilator drugs.

Results The patients' preoperative serum triiodothyronine concentrations were normal (mean [±SD] value, 81±22 ng per deciliter [1.2±0.3 nmol per liter]), and they decreased by 40 percent (P<0.001) 30 minutes after the onset of cardiopulmonary bypass. The concentrations in patients given intravenous triiodothyronine became supranormal and were significantly higher than those in patients given placebo (P<0.001). However, the concentrations were once again similar in the two groups 24 hours after surgery. The mean postoperative cardiac index was higher in the triiodothyronine group (2.97±0.72 vs. 2.67±0.61 liters per minute per square meter of body-surface area, P = 0.007), and systemic vascular resistance was lower (1073±314 vs. 1235±387 dyn · sec · cm-⁵, P = 0.003). The two groups did not differ significantly in the incidence of arrhythmia or the need for therapy with inotropic and vasodilator drugs during the 24 hours after surgery, or in perioperative mortality and morbidity.

Conclusions Raising serum triiodothyronine concentrations in patients undergoing coronary-artery bypass surgery increases cardiac output and lowers systemic vascular resistance but does not change outcome or alter the need for standard postoperative therapy.

Source Information

From the Departments of Cardiothoracic Surgery (J.D.K., M.G., R.E.H., O.W.I., K.K.) and Anesthesiology (S.J.T.), New York Hospital–Cornell University Medical College, New York; and the Division of Endocrinology, Department of Medicine, North Shore University Hospital–Cornell University Medical College, Manhassett, N.Y. (I.K., K.O.).

Address reprint requests to Dr. Klemperer at the Department of Cardiothoracic Surgery, New York Hospital, 525 E. 68th St., New York, NY 10021.

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