Euthyroid Sick Syndrome after Open Heart Surgery

開心手術後之正甲狀腺功能疾病症候群

何慈育(Tsyr-Yuh Ho) ； 李必昌(Pi-Chang Lee) ； 翁仁崇(Zen-Chung Weng) ； 蔡明志(Ming-Chih Tsai) ； 梁致明(Chi-Ming Liang) ； 林致源(Chih-Yuan Lin) ； 孟春昌(Chung-Chang Laura Meng) ； 黃碧桃(Betau Hwang)

《Acta Cardiologica Sinica》 21卷4期 (2005/12) Pp. 207-213

摘要

背景　甲狀腺素對於血液動力學上的影響已被相當地暸解。它們對身體的影響包括：增強心臟收縮、加快心跳速率、以及增加心臟肌肉的氧氣消耗等等。先天性心臟病的病患，藉由心肺機器來輔助開心手術，也會造成身體許多內分泌的改變，進而造成手術後血液動力學上的影響。在此，我們總共納入了二十位先天性心臟病的患者，分別在手術前、中、後抽血，來分析他們甲狀腺功能變化的情形。
方法　我們發現甲狀腺功能在手術後有一短暫的下降情形；其中特別是三碘甲狀腺素(triiodothyronine)在心肺機開始三十分鐘、及手術後一天，皆有明顯地下降，並且達到統計學上有意義的變化。在此二十位病人的研究當中，甲狀腺功能的變化屬於正甲狀腺功能疾病症候群(euthyroid sick syndrome)，並且手術並沒有併發症產生，也沒有任何一位病人有接受甲狀腺素的治療，所有的病人都順利的康復與出院。
結論　對於本篇的研究，我們認為患有先天性心臟病的病患，在接受開心手術之後，會出現短暫的正甲狀腺功能疾病症候群，但是這樣的甲狀腺功能變化，並不需要任何的甲狀腺素治療，而且正甲狀腺功能疾病症候群會在短時間（約一週）內自行恢復正常。

關鍵字

心臟手術 ； 體外心肺循環機 ； 先天性心藏臟病 ； 正甲狀腺功能疾病症候群 ； 甲狀腺功能

並列摘要

Background: The hemodynamic effects of thyroid hormones are well documented, and include effects on cardiac contractility, heart rate and myocardial oxygen consumption.1 Major cardiac surgery under cardiopulmonary bypass (CPB) support may produce many alterations in endocrine homeostasis, which can exert substantial hemodynamic effects postoperatively. 2 Twenty patients with various congenital heart diseases (CHDs) were enrolled to analyze their thyroid function before, during and after cardiac surgery.
Materials and Methods: We found that there were short-term reversible postoperative declines in free thyroxine (T4), total T4, total tri-iodothyronine (TT3) and thyrotropin concentrations. TT3 decreased significantly from preoperative state to 30min after the start of CPB (p=0.007) and 1 day postoperatively (p=0.008). The significant changes of the thyroid hormones in our 20 patients belonged to the euthyroid sick syndrome (ESS). There was no surgical complication and no need for thyroid hormone replacement. All these patients recovered and were discharged home smoothly.
Conclusions: We conclude that patients with CHDs under cardiac surgery might present with ESS in postoperative period, but have no need for thyroid hormone replacement and will recover spontaneously within one week.

並列關鍵字

Cardiac surgery ； Cardiopulmonary bypass ； Congenital heart disease ； Euthyroid sick syndrome ； Thyroid function