Young infants benefited from thyroid supplementation after cardiopulmonary bypass

Portman MA. Circulation. 2010;122:S224-S233.

Issue: December 2010

Supplementation of triiodothyronine lessened the time that infants younger than 5 months spent on a respirator after undergoing cardiopulmonary bypass, according to recent research.

A research team at Seattle Children’s Hospital and the University of Washington conducted the Triiodothyronine Supplementation in Infants and Children Undergoing Cardiopulmonary Bypass (TRICC) study to determine the safety and efficacy of IV T₃ in children younger than 2 years.

“Cardiopulmonary bypass induces marked and persistent depression of circulating thyroid hormone levels in adults and children,” the researchers wrote. “Depression of thyroid hormone levels contributes to postoperative morbidity in adults undergoing cardiopulmonary bypass. Thus, thyroid hormone repletion in the form of T₃ during and after cardiopulmonary bypass is an intuitive solution.”

The TRICC study was a prospective, multicenter, double blind, randomized, placebo-controlled trial. It included 198 patients who were randomly assigned to IV T₃ or placebo after cardiopulmonary bypass. The primary outcome was time to extubation.

Overall, the treatment did not reduce time to extubation; it was similar in both groups. There were no significant differences between the groups in regards to heart rate, mean arterial blood pressure or mean arterial BP times heart rate during the first 24 hours. There was also no difference in adverse events between the groups.

However, researchers found a significant interaction between age and treatment. Infants younger than 5 months who received T₃ had a time to extubation of 55 hours vs. 98 hours for those who received placebo. In patients older than 5 months who received T₃, the time to extubation was longer: 20 hours vs. 16 hours in those who received placebo.

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