Cardiovascular Effects of Intravenous Triiodothyronine in Patients Undergoing Coronary Artery Bypass Graft Surgery:  A Randomized, Double-blind, Placebo-Controlled Trial

Elliott Bennett-Guerrero, MD; John L. Jimenez, MD; William D. White, MPH; Elizabeth B. D'Amico, BSN; Beatrice I. Baldwin, CRNA; Debra A. Schwinn, MD; Nancy P. Bouknight; Cynthia M. Chuey; Fiona M. Clements, MD; Narda D. Croughwell; Norbert P. Debruijn, MD; Katharine A. Greenblo; Katherine P. Grichnik, MD; Andrew K. Hilton, MD; Lewis R. Hodgins, MD; Bruce J. Leone, MD; John B. Leslie, MD; Jonathan B. Mark, MD; Michael G. Mythen, MD; Mark F. Newman, MD; Sally A. Phillips, MD; Joseph G. Reves, MD; Connie C. Sessions; Robert N. Sladen, MD; Thomas F. Slaughter, MD; Thomas E. Stanley III, MD; George W. Tennis; Joyce O. Witt.; Robert W. Anderson, MD; Robert D. Davis, MD; James M. Douglas Jr, MD; James W. Gaynor, MD; Donald D. Glower, MD; Robert H. Jones, MD; Sally A. King, MA; Kevin P. Landolfo, MD; James E. Lowe, MD; Newland Oldham Jr, MD; Peter K. Smith, MD; L. Richard Smith, PhD; Peter Vantrigt III, MD; Walter G. Wolfe, MD
JAMA. 1996;275(9):687-692. doi:10.1001/jama.1996.03530330031025.
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Objective.  —To test the hypothesis that triiodothyronine (T3) administration improves hemodynamic variables and decreases inotropic drug requirements in cardiac surgery patients.

Design.  —Prospective, randomized, double-blind, placebo-controlled trial.

Setting.  —Tertiary care medical center.

Patients.  —A total of 211 patients undergoing coronary artery surgery at high risk for requiring inotropic drug support.

Intervention.  —At release of aortic cross-clamp, patients were randomized to an intravenous infusion of T3 (0.8 μg/kg followed by 0.12 μg·kg-1·h-1 for 6 hours), dopamine (positive control, 5 μg·kg-1·min-1 for 6 hours), or placebo.

Main Outcome Measures.  —Perioperative hemodynamic variables, inotropic support requirements, and serum T3 concentrations.

Results.  —Mean±SEM free T3 serum concentrations decreased significantly during cardiopulmonary bypass in all groups (from 0.0035±0.0001 nmol/L [0.23±0.01 ng/dL] to 0.001±0.0001 nmol/L [0.07±0.00 ng/dL]; P=001) and increased to 0.0133±0.0004 nmol/L [0.87±0.03 ng/dL] (twice normal range; P<.001) following initiation of intravenous T3. Intravenous T3 did not change hemodynamic variables or inotropic drug requirements; however, heart rate increased (P<.001), and a trend toward decreased use of inotropic agents was demonstrated in the dopamine group.

Conclusions.  —Triiodothyronine administration prevents decreases in serum thyroid hormone concentrations associated with cardiopulmonary bypass. Intravenous T3 does not have dramatic effects on hemodynamic variables in this setting as has been previously suggested. Although mild effects on myocardial performance may exist, we cannot recommend at this time the routine use of intravenous T3 as an inotropic agent in patients undergoing coronary artery bypass graft surgery.(JAMA. 1996;275:687-692)


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