Clinical review: Thyroid hormone therapy for postoperative nonthyroidal illnesses: a systematic review and synthesis

• Published in: The journal of clinical endocrinology and metabolism 2010-10, Vol.95 (10), p.4526-4534
• Main Authors: Kaptein, Elaine M, Sanchez, Andrea, Beale, Elizabeth, Chan, Linda S
• Format: Article
• Language: English
• Subjects: Adult; Dose-Response Relationship, Drug; Drug Administration Schedule; Hormone Replacement Therapy - utilization; Humans; Postoperative Complications - drug therapy; Postoperative Complications - prevention & control; Postoperative Period; Randomized Controlled Trials as Topic; Triiodothyronine - administration & dosage; Triiodothyronine - adverse effects; Triiodothyronine - therapeutic use
• ISSN: 1945-7197
• DOI: 10.1210/jc.2010-1052

Effects of thyroid hormone therapy on postoperative morbidity and mortality in adults remain controversial. The aim was to conduct a systematic review evaluating effects and risks of postoperative T(3) therapy in adults. Electronic databases and reference lists through March 2010 were searched. Studies with comparable control groups comparing T(3) to placebo therapy in randomized controlled trials were selected. Two reviewers independently screened and reviewed titles, abstracts, and articles. Data were abstracted from 14 randomized controlled trials (13 cardiac surgery and one renal transplantation). In seven studies, iv T(3) was given in high doses (0.175-0.333 μg/kg · h) for 6 to 9 h, in four studies iv T(3) was given in low doses (0.0275-0.0333 μg/kg · h for 14 to 24 h), and in three studies T(3) was given orally in variable doses and durations. Both high- and low-dose iv T(3) therapy increased cardiac index after coronary artery bypass surgery. Mortality was not significantly altered by high-dose iv T(3) therapy and could not be assessed for low-dose iv or oral T(3). Effects on systemic vascular resistance, heart rate, pulmonary capillary wedge pressure, new onset atrial fibrillation, inotrope use, serum TSH and T(4) were inconclusive. Numbers of usable unique studies and group sizes were small. Duration of T(3) therapy was short, and dosages and routes of administration varied. Short duration postoperative iv T(3) therapy increases cardiac index and does not alter mortality. Effects on other parameters are inconclusive.