Thyroid hormone and cardiac surgery

Thyroid hormone has important effects on the heart and peripheral vascular system. The relationship between thyroid disease states and cardiovascular hemodynamics is well recognized. Diverse clinical situations are associated with low serum triiodothyronine (T-3) levels including a number of cardiovascular illnesses. In particular, cardiopulmonary bypass and open heart operations result in a low T-3 state and are often complicated by significant cardiovascular dysfunction similar to that observed in clinical hypothyroidism. Multiple lines of evidence have suggested that T-3 can act acutely as a positive inotrope and vasodilator agent. This recognition has prompted a number of investigators to study the effects of T-3 administration to patients in the perioperative period. This paper reviews the experimental background that supported such clinical trials as well as outlines the results that have been documented in both adult and pediatric patients undergoing cardiac surgery. Low serum T-3 levels resulting from cardiopulmonary bypass can be safely reversed with pharmacologic T-3 supplementation. Data have suggested that T-3 repletion may improve postoperative hemodynamic performance and lower the incidence of arrythmias. However, beneficial effects on major clinical outcome variables have not yet been conclusively demonstrated, and require future large-scale clinical trials.