Thyroid hormone metabolism in pediatric cardiac patients treated by continuous povidone–iodine irrigation for deep sternal wound infection

Objective: The purpose of this study was to assess the influence of povidone–iodine mediastinal irrigation used for the treatment of deep sternal wound infection (DSWI) on thyroid function. Methods: Thyroid function was studied in 18 pediatric cardiac patients treated with continuous povidone–iodine irrigation for DSWI. The median age of patients was 8 months (18 days–5.3 years). Serum concentrations of total triiodothyronine (TT3), total thyroxine (TT4), free triiodothyronine (FT3), free thyroxine (FT4), thyroid-stimulating hormone (TSH), reverse triiodothyronine (rT3) and thyroxine-binding globulin (TBG) were measured at three time points: (a) prior to mediastinal reexploration (before povidone–iodine exposure); (b) immediately after discontinuation of povidone–iodine irrigation; (c) 2 weeks after discontinuation of mediastinal irrigation. Urinary iodine excretion was examined on the last day of povidone–iodine exposure. Results: Prior to the mediastinal reexploration, the median TT3 and TT4 levels were below the normal range, then increased significantly to concentrations within the normal range. The median serum FT3 levels were within the normal range throughout the observation period, though a significant increase of FT3 levels was observed after discontinuation of irrigation. The median serum FT4 concentrations were within the normal range prior to irrigation and did not change significantly. The median rT3 levels were within the normal range, close to upper normal limit. The median TBG levels were within the normal range throughout the observation period, though a significant increase of TBG levels was observed during the period of mediastinal irrigation. The median TSH level was within the normal range prior to mediastinal irrigation and did not change significantly. Urinary iodine concentrations in infants with povidone–iodine irrigation were significantly higher 6700 μg/l (range, 1600–15 000 μg/l) than in the group of 53 healthy infants 200 μg/l (range, 20–780 μg/l, P<0,001). Conclusions: Our data showed that the use of povidone–iodine irrigation in the patients with DSWI has not lead to any significant alteration in thyroid function within the study period.     

Effect of fentanyl-oxygen anesthesia during cardiac surgery on serum thyroid hormones

Twenty-five euthyroid patients who underwent cardiac surgery with fentanyl-oxygen anesthesia were studied. The authors confirm that some thyroid hormones undoubtedly take part in a non-specific pool of reactions caused by surgical stress. For one or more days, all the patients had total triiodothyronine (TT3) and free triiodothyronine (FT3) levels clearly below the normal values, with a parallel increase in reverse triiodothyronine (rT3, biologically inactive). Changes in total (TT4) and free thyroxine (FT4), although significant, were smaller and hard to interpret. The most important changes occurred on the first postoperative day. Of seven patients who before the operation had a TT3 value below the lower normal limit, six had at discharge a mean TT3 level significantly above it. Serum TT3 concentrations could be a reliable prognostic index. High-dose fentanyl anesthesia probably does not affect thyroid hormone response to surgical stress. To date, the mechanisms which cause reduction of serum triiodothyronine have not been fully discovered and it is not known for certain whether this reduction is beneficial to the human organism.     

Alterations in Thyroid Hormones and Thyrotropin (TSH) in Morbidly Obese Patients before and after Vertical Gastroplasty

Background: Published results of studies of thyroid function in obesity and after weight loss have differed. Methods: The circulating concentrations of thyroid hormones and TSH were studied in 30 consecutive, euthyroid morbidly obese patients before and after weight loss from vertical gastroplasty, with the aim to determine the relation between body weight loss and pituitarythyroid axis function. Serum TSH, free T3 (FT3) and free T4 (FT4) were measured before operation and repeated 6 and 18 months postoperatively. Results: A significant increase, but within normal levels, in FT3 value at 6 and, mainly, at 18 months after gastroplasty was observed (p = 0.002). The FT4 value was slightly increased at the same time and serum TSH was found to be significantly decreased (p = 0.03 and p = 0.01 respectively). The relative increase in FT4 was negatively correlated with excess body weight and Body Mass Index reduction. This correlation was only moderate with values ranging from r = 0.34 to r = 0.47. Conclusions: Although there were statistically significant differences in thyroid function tests before and after loss of weight, these were not biologically significant. The hypophyseal/thyroid axis remains always active and contributes to body weight homeostasis and its regulation.     

Euthyroid sick syndrome in trauma patients with severe inflammatory response syndrome

Objective： To investigate the alternations of thyroid hormone in traumatic patients with severe inflammatory response syndrome （SIRS）. Methods： Fifty traumatic patients with severe SIRS were enrolled and divided into two groups according to whether they presented multiorgan dysfunction syndrome （MODS）. Thyroid hormone measurements were taken, including total triiodothyronine （ TT3 ）, total thyroxine （TT4）, free triiodothyronine （FT3）, free thyroxine （ FT4 ） and thyroid stimulating hormone （TSH）. The acute physiology and chronic health evaluation II （ APACHE II ） score was calculated according to clinical data. The outcomes of recovery or deterioration were recorded, as well as the length of time from the onset of SIRS to the time thyroid hormones were measured. Results： Euthyroid sick syndrome （ESS） was presented in 45 cases. TT3 level was negatively correlated with APACHE II score （r = -0.330, P 〈0. 05）, and TT3/TI＇4 value was negatively correlated with the duration of SIRS（ r = -0.316, P〈0.05）. TT3, TT4 and levels in MODS patients were significantly lower than those without MODS （ P 〈 0.05 ）. MODS patients got low TT4 or FT4 level more frequently than those without MODS （ P 〈 0.05 ）. Compared with the patients in normal TSH group, the patients with decreased TSH had lower T3, T4, recovery rate and higher APACHE II scores, MODS incidence, but there was no difference between two groups （P〉0.05）. Conclusions： Trauma patients with severe SIRS have high possibility to get ESS, which occurs more frequently and severely in MODS patients. It shows the influences of SIRS on the thyroid axes. With the persistence and aggravation of SIRS, there is a progressive reduction of thyroid hormone.     

Prevalence of Subclinical Hypothyroidism in a Morbidly Obese Population and Improvement after Weight Loss Induced by Roux-en-Y Gastric Bypass

Background:There are many studies concerning thyroid function in obesity, and some of them describe higher TSH levels in obese subjects. Few studies evaluated long-term changes in thyroid function caused by weight loss after bariatric surgery. Our aims were to evaluate the prevalence of subclinical hypothyroidism (SH) in a morbidly obese population and to analyze the effect of weight loss induced by Roux-en-Y gastric bypass (RYGBP) on TSH and thyroid hormone (TH) levels. Methods: TSH, free thyroxine (fT4) and total triiodothyronine (T3) levels were analyzed before and 12 months after RYGBP in patients with grade III or grade II obesity with co-morbidities. Subjects taking TH and/or with positive antithyroid antibodies and/or with overt hypothyroidism were excluded. Results: 72 subjects (62F/10M), with mean age 39.6±9.8 years and mean BMI 53.0±10.4 kg/m² were studied. The prevalence of SH before RYGBP was 25% (n=18). There was a significant post-surgical decrease in BMI in the whole population, as well as in SH patients. In the SH group and normal TSH group, there was a decrease in TSH and T3, but not in fT4. TSH was not correlated with initial BMI or percent change in BMI. TSH concentrations reached normal values in all SH patients after RYGBP. Conclusion: Our data confirm that severe obesity is associated with increased TSH. The decrease in TSH was independent of BMI, but occurred in all SH patients. A putative effect of weight reduction on the improvement of SH in all patients may be an additional benefit of bariatric surgery.     

Thyroid function in brain-dead donors

Twenty brain-dead potential organ donors were studied prospectively to establish thyroid function. Two or three consecutive blood samples were obtained during brain death. Seven times a sample was available before brain death occurred. Free triiodothyronine (FT3) fell in most patients (80%). Very low (<1.6 pmol/l) and subnormal levels (between 2 and 3 pmol/l) were found in 65% and 15% of the patients, respectively. Serum reverse total triiodothyronine (rT3) was inversely correlated with FT3. Free thyroxine (FT4) was less often decreased (mean 14.68±1.42 pmol/l) and 35% of the patients had normal levels. Mean thyroid stimulating hormone (TSH) remained normal (0.71±0.15 U/ml). The study of consecutive samples during brain death did not show a constant, progressive decrease in hormonal levels. There is no statistical difference between values observed before and after brain death. No correlation was found between FT3 levels and hemodynamic data or immediate allograft function. The pattern of thyroid function in these patients was typical of the sick euthyroid syndrome with a low T3 or low T3 and low T4 serum levels. This syndrome usually does not need to be treated. However, many experiment findings and some clinical data argue in favor of T3 therapy in donors and possibly in recipients. The dosage regimen must be adjusted to be effective without causing harm to multiorgan donors before it can be widely used. It remains to be proved that low FT3 serum indicates low intracellular FT3 and worse metabolic function in clinical conditions.     

SERUM THYROID HORMONES CHANGES IN PATIENTS UNDERGOING CAESAREAN SECTION UNDER GENERAL OR REGIONAL ANAESTHESIA

The effects of anaesthesia on serum thyroid hormones were studiedin 32 pregnant young women undergoing Caesarean section at term.Eighteen patients received general anaesthesia and 14 lumbarextradural blockade. Maternal serum concentrations of thyrotrophin(TSH), thyroxine (T4), triiodothyronine (T3) and reverse triiodothyronine(rT3) were measured using radioimmunoassay at 0, delivery and24 h. There were no significant changes in TSH in the two groups.T4 concentrations decreased significantly at 24 h in the generalanaesthesia group but regional anaesthesia produced a significantdecrease only at the time of delivery. T3 concentrations decreasedwith both techniques. Reverse T3 increased markedly with generalanaesthesia only at 24 h.     

Thyroid function in brain-dead donors

Abstract. Twenty brain-dead potential organ donors were studied prospectively to establish thyroid function. Two or three consecutive blood samples were obtained during brain death. Seven times a sample was available before brain death occurred. Free triiodothyronine (FT3) fell in most patients (80%). Very low (< 1. 6 pmol/1) and subnormal levels (between 2 and 3 pmol/1) were found in 65% and 15% of the patients, respectively. Serum reverse total triiodothyronine (rT3) was inversely correlated with FT3. Free thyroxine (FT4) was less often decreased (mean 14. 68 1. 42 pmol/1) and 35% of the patients had normal levels. Mean thyroid stimulating hormone (TSH) remained normal (0. 71 0. 15 μTJ/ml). The study of consecutive samples during brain death did not show a constant, progressive decrease in hormonal levels. There is no statistical difference between values observed before and after brain death. No correlation was found between FT3 levels and hemodynamic data or immediate allograft function. The pattern of thyroid function in these patients was typical of the sick euthyroid syndrome with a low T3 or low T3 and low T4 serum levels. This syndrome usually does not need to be treated. However, many experiment findings and some clinical data argue in favor of T3 therapy in donors and possibly in recipients. The dosage regimen must be adjusted to be effective without causing harm to multiorgan donors before it can be widely used. It remains to be proved that low FT3 serum indicates low intracellular FT3 and worse metabolic function in clinical conditions.     

二氧化碳气腹对术中血浆甲状腺素影响的观察

目的：探讨腹腔镜胆囊切除术（LC）中CO2气腹对甲状腺功能的影响。方法：全麻下胆囊切除术60例随机分为LC组（30例）和非腹腔镜组（30例）,于术前1日及术中不同时期抽取静脉血标本,用放射免疫法检测血浆甲状腺（TT3,TT4,FT3,FT4,rTs,TSH)的变化,结果：60例患者术前甲腺素水平均为正常。LC气腹后TT3,TT4,TSH升高（P＜0．01,与术前相比）,非腹腔镜者术中TT3有所一降。结论：LC术中甲状腺功能增强可能与CO2气腹有关。     

心内直视手术前后甲状腺激素监测

目的 为了了解体外循环（ＣＰＢ）手术前后甲状腺激素代谢的变化规律,及其与心功能变化的相关性。方法 以３６例患者ＣＰＢ术前２小时、术后１￣５天血浆甲状腺激素进行监测,另对其中１６例手术前后心功能变化进行动态监测,并观察它们之间的相互关系。结果 术前血浆甲状腺激素水平正常。ＦＴ３、ＦＴ４、ＴＴ３、ＴＴ４术后均呈现先下降后逐渐回升的变化趋势。ＴＳＨ术后第１天升至最高水平（Ｐ〈０．０５）,此后缓慢下降至术     

心内直视手术对甲状腺激素代谢的影响及其临床意义

为了解体外循环心脏直视手术对甲状腺激素代谢的影响并探讨其临床意义。作者选择２１例心脏直视手术病人，用放免法分别于术前、术中、术后２、２４小时测定其血浆Ｔ３、Ｔ４、游离Ｔ３（ＦＴ３）、游离Ｔ４（ＦＴ４）、反Ｔ３（ｒＴ３）及促甲状腺激素ＴＳＨ的含量。结果发现Ｔ４、ＦＴ４术中降低，术后２小时恢复正常（Ｐ＜０．０５）。Ｔ３、ＦＴ３呈下降趋势，术后２４小时降至最低（Ｐ＜０．０１）。ｒＴ３进行性升高。ＴＳＨ术中一过性升高。结论：甲状腺激素在ＣＰＢ时变化为术中低Ｔ３、Ｔ４综合征，术后为低Ｔ３综合征。提示ＣＰＢ后Ｔ３补充治疗有利于病人康复及某些术后难治性心功能不全的处理。     

Thyroid function tests in patients undergoing maintenance dialysis: characterization of the 'low-T4 syndrome' in subjects on regular hemodialysis and continuous ambulatory peritoneal dialysis

Thyroid function tests were evaluated in 38 patients on regular hemodialysis (HD), in 36 on continuous ambulatory peritoneal dialysis (CAPD) and in 39 healthy controls. A significant reduction in total thyroxine (TT4), total triiodothyronine (TT3), reverse (rT3), and free T4 (fT4) mean levels and normal TSH, free T3, TBG and albumin concentrations was found in both HD and CAPD patients. A 'low-T4 syndrome' (serum T4 less than 5 micrograms/dl) was found in 9 CAPD (25%) and 20 HD (53%) patients, but none of them had fT4 levels below the normal laboratory range. The only striking difference between low-T4 HD and low-T4 CAPD patients was the significantly lower TBG and albumin serum levels in CAPD group. Low-T4 HD displayed normal TBG levels but enhanced fT4/TT4 and fT4/TT4 X TBG ratios. We concluded that: the abnormalities in thyroid function tests in patients on long-term dialysis (HD and CAPD) do not express the existence of a true hypothyroidism; a different pathogenesis of the low-T4 syndrome in the CAPD and HD groups may be hypothesized: in the former it could be attributed to a reduction in serum-binding capacity for thyroid hormones, in the latter the relative increase in fT4 percentage despite normal TBG levels suggests either the presence of T4-TBG-binding inhibitor(s), or structural abnormalities of thyroid-hormone-binding proteins.     

多囊卵巢综合征女性性功能与性激素和甲状腺激素的相关性

目的 分析多囊卵巢综合征(PCOS)患者的性功能与性激素及甲状腺激素的相关性.方法 采用横断面研究方法,对2019年1～12月就诊北京妇产医院妇科内分泌科的PCOS患者,使用女性性功能指数量表(female Sexual Function Index,FSFI)评估性功能;测量其基本体质指标并测定基础血清性激素水平,包...     

Hormone therapy as postoperative care in patients with differentiated thyroid cancer

TSH suppression therapy has been performed for 150 patients as postoperative care for differentiated thyroid cancer. L-thyroxine (LT4) was given in a dose of 2.1-4.8 micrograms/kg/day, per os. Serum thyroid hormone determinations were done after confirming that the drug had continually been taken for more than three months. Serum free T4 (FT4) values were elevated higher than the upper normal limits (1.9 ng/dl) in 127 of 150 cases (84.7%). In 100 cases of these, serum free T3 (FT3), reverse T3 (rT3) and TSH were estimated. In 98 cases (98%), serum FT3 was within the normal limits (3-6 pg/ml) and no correlation was found between values of FT4 and FT3. These serum rT3 values, however, were elevated higher than the normal range (13-43 ng/dl) in 41 cases (41%) correlating with FT4 values. Serum TSH, FT4 and FT3 showed no correlation with given LT4 doses. There was no correlation between the serum TSH and FT3. However, some correlation (r = -0.4046) was found between serum TSH and rT3 values. From these results the following conclusions were obtained: i) There must be some auto-regulating mechanisms to keep the serum FT3 values at the normal level by promoting a de-iodinating process from T4 to rT3 when serum T4 level increased, since rT3 has no hormone activity. ii) Administration of synthesized LT4 is safer and more adequately usable than synthesized L-triiodothyronine or desiccated thyroid, as the TSH suppression therapy, because the above mentioned autoregulating mechanism would take place.(ABSTRACT TRUNCATED AT 250 WORDS)     

Alterations in thyroid hormones, cortisol, and catecholamine concentration in patients after orthopedic surgery

Changes in serum and plasma concentrations of thyroid hormones, cortisol, and catecholamines were measured simultaneously in 16 patients undergoing major elective orthopedic surgery. Blood samples were collected preoperatively and at 2, 6, 24, 48, 96, and 168 hr after surgery. A significant decrease in TT3 and FT3 and an increase in rT3 were noted after surgery. TT4 started to decrease 48 hr after surgery whereas FT4 showed no significant change over the same period of time. The concentration of TSH fell progressively after surgery reaching a nadir by Day 7. The concentrations of cortisol were increased markedly throughout the course after surgery. Adrenaline and noradrenaline levels were increased markedly during the first 24 hr postsurgery. Both the thyroglobulin and TBG together with albumin concentration values were decreased after surgery as compared to preoperative values. It is concluded that the changes in thyroid hormone levels after major elective orthopedic surgery seem to be independent of changes in plasma catecholamines and/or cortisol concentrations.     

Spontaneous pituitary-thyroid function after surgical treatment of nontoxic goitre. A controlled long-term study

The free thyroxine index (FT4I), triiodothyronine (T3) and thyroid stimulating hormone (TSH) in serum and the peak serum TSH (TRH test) were measured in 18 patients with nontoxic uninodular goitre and 32 patients with nontoxic multinodular goitre before and 3, 6, 12, 24 and 36 months after goitre resection. Thyroid hormone therapy was not given postoperatively. Resection of non-toxic goitre provoked a transient rise in TSH baseline level, with peak about one year after surgery. Three years after the resection the TSH baseline had returned to the preoperative level. The TSH changes were significantly more pronounced in the multinodular goitrous group, in which resection was bilateral, than in the uninodular goitrous group. The changes in serum FT4I and serum T3 were of moderate degree and most pronounced in the multinodular group. During long-term observation, serum FT4I increased slightly but significantly in both groups, but serum T3 showed significant reduction, albeit within reference range. The results of the study suggest that thyroid hormone therapy as a routine procedure after simple goitre resection lacks a tenable rational basis.     

基础甲状腺功能与IVF-ET妊娠结局的相关性研究

目的研究基础甲状腺功能三项(TSH、FT3、FT4水平)与体外受精-胚胎移植妊娠结局之间的关系。方法以2014年9月至2015年5月在南京大学医学院附属鼓楼医院生殖医学中心行长方案体外受精/卵胞浆内单精子注射-胚胎移植术(IVF/ICSI-ET)并行新鲜胚胎移植的不孕症患者作为研究对象。于IVF前月经第2~4天空腹留血,检测基础甲状腺功能三项:促甲状腺激素(TSH)、游离三碘甲状腺原氨酸(FT3)、游离四碘甲状腺原氨酸(FT4)。纳入甲状腺功能三项均正常的患者486例,分析基础甲状腺功能与IVF/ICSI妊娠结局的关系。结果 (1)486例患者中临床妊娠305例,活产249例,早期自然流产23例;(2)临床妊娠组与未妊娠组比较,TSH、FT3、FT4水平均无统计学差异(P0.05),临床妊娠组女方年龄小[(29.4±3.9)vs.(30.7±4.3)岁,P=0.001)]、子宫内膜厚[(11.0±2.2)mm vs.(9.9±1.9)mm,P0.001)];(3)活产组与早期自然流产组相比,基础TSH、FT3、FT4差异均无统计学意义(P0.05);(4)基础TSH≥2.5mIU/L的患者与TSH2.5mIU/L者的临床妊娠率、活产率、早期自然流产率和新生儿出生体重均无统计学差异(P0.05)。结论基础甲状腺功能三项如在正常范围不影响IVF结局,IVF前TSH≥2.5mIU/L但4.2mIU/L时不增加早期自然流产率,也不影响新生儿出生体重。     

连续星状神经节阻滞对重度颅脑损伤患者血清甲状腺激素及皮质醇水平的影响

目的 探讨连续星状神经节阻滞对重度颅脑损伤患者血清甲状腺激素[三碘甲状腺原氨酸(T3)、甲状腺素(T4)、反三碘甲状腺原氨酸(rT3)、促甲状腺激素(TSH)]及皮质醇(Cor)水平的影响.方法 急诊行开颅手术的重度颅脑损伤患者80例,性别不限,年龄22～61岁,ASA分级Ⅱ或Ⅲ级,格拉斯哥昏迷量表评分3～8分,采用随机数字表法,将患者随机分为2组(n=40):对照组(C组)和连续星状神经节阻滞组(SGB组).气管插管后SGB组于开颅侧行连续SGB,注射0.2%罗哌卡因7ml后,持续输注0.2%罗哌卡因2 ml/h,持续时间为48 h;2组术后均予常规治疗.于术前30 min、术后3、7 d采集静脉血样,采用放射免疫法测定血清T3、T4、rT3、TSH及Cor浓度;术后90 d采用格拉斯哥预后评分判定临床疗效.结果 与C组比较,SGB组术后血清T3浓度升高,T4、rT3、TSH和Cor浓度降低(P＜0.05或0.01),SGB组临床疗效分级优于C组(P＜0.05).结论 连续星状神经节阻滞可有效减轻重型颅脑损伤患者的应激反应,改善下丘脑-垂体-甲状腺轴功能,有助于患者恢复.

Abstract：

Objective To investigate the effects of continuous stellate ganglion block (SGB) on serum thyroid hormone and cortisol levels in patients with severe brain injury.Methods Eighty ASA Ⅱ or Ⅲ patients with severe brain injury aged 22-61 yr undergoing emergency craniotomy were randomly divided into 2 groups ( n = 40 each): control group (group C) received routine treatment only and continuous SGB group (group SGB) received continuous SGB with 0.2% ropivacaine besides routine treatment. SGB was performed on the operated side after induction of general anesthesia and tracheal intubation. An epidural catheter was placed. A bolus of 0.2% ropivacaine 7 ml was followed by continuous infusion of 0.2% ropivacaine at a rate of 2 ml/h. Continuous SGB was maintained for 48 h. Successful SGB was confirmed by increase in skin temperature by ≥1.5℃ behind earlobe on the operated side.Venous blood samples were obtained at 30 min before and 3 and 7 day after operation for determination of serum thyroid stimulating hormone (TSH), triiodothyronine (T3) ,thyroxine (T4) , reverse triiodothyronine(rT3) and cortisol concentrations. Glasgow prognosis score was used to evaluate the clinical results at 3 months after operation. Results Serum T4 , rT3 , TSH and cortisol concentrations were significantly lower while the serum T3 concentration was higher in the SGB group than in group C at 3 and 7 d after operation. The clinical results were significant better in SGB group than in group C according to Glasgow prognosis scores at 3 months after operation. Conclusion Continuous SGB can inhibit the stress response, and improve hypothalamus-pituitary-thyroid gland axis function and is helpful to patient's recovery from injury.     

Thyroid gland volume and serum concentrations of thyroid hormones in chronic renal failure

Thyroid gland volume, ultrasonically determined, and thyroid function were investigated in 40 patients with chronic renal failure (33 of these on hemodialysis) and 40 sex-, age- and weight-matched healthy controls. None had thyroid autoantibodies or a clinically detectable goiter. The median thyroid gland volume was significantly elevated in the uremic patients: 24 ml (range 8-43 ml) compared with the healthy controls 17 ml (range 10-22 ml) (p less than 0.005). The serum concentrations of thyroxine (T4), triiodothyronine (T3), free thyroxine index (FT4I) and free triiodothyronine index (FT3I) were significantly decreased in uremic subjects compared with the controls. The serum concentration of thyrotropin did not differ significantly between patients and controls. None of the thyroid function variables correlated with thyroid gland volume. In conclusion, thyroid gland volume was increased in patients with chronic renal failure. The alterations in thyroid hormone concentrations could, however, not explain this finding.