Clinical review: thyroid hormone replacement in children after cardiac surgery--is it worth a try?
Cardiac surgery using cardiopulmonary bypass produces a generalized systemic inflammatory response, resulting in increased postoperative morbidity and mortality. Under these circumstances, a typical pattern of thyroid abnormalities is seen in the absence of primary disease, defined as sick euthyroid syndrome (SES). The presence of postoperative SES mainly in small children and neonates exposed to long bypass times and the pharmacological profile of thyroid hormones and their effects on the cardiovascular physiology make supplementation therapy an attractive treatment option to improve postoperative morbidity and mortality. Many studies have been performed with conflicting results. In this article, we review the important literature on the development of SES in paediatric postoperative cardiac patients, analyse the existing information on thyroid hormone replacement therapy in this patient group and try to summarize the findings for a recommendation.
Haas
Nikolaus A
NA
Paediatric Cardiac Intensive Care Unit, The Prince Charles Hospital, Brisbane, Australia. nikhaas@hdz-nrw.de
Camphausen
Christoph K
CK
Kececioglu
Deniz
D
D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D002648:Child; D005067:Euthyroid Sick Syndromes / Q000097:blood / Q000188:drug therapy* / Q000209:etiology; D006801:Humans; D011183:Postoperative Complications / Q000097:blood / Q000188:drug therapy*; D012307:Risk Factors; D014284:Triiodothyronine / Q000097:blood / Q000627:therapeutic use*
D014284:Triiodothyronine