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Thyroid function reduced by pancreatic, liver surgery
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Pancreatic surgery reduced thyroid function, according to researchers in Poland.
Katarzyna Wojciechowska-Durczynska, MD, and colleagues measured free triiodothyronine, free thyroxine and thyrotropin (thyroid-stimulating hormone) concentrations in 51 patients (25 men, 26 women; mean age, 61.6 years) before and immediately after major and minor pancreas and liver surgeries.
Katarzyna Wojciechowska-Durczynska
“The comparable results of thyroid function tests in two subgroups — analyzed by us — suggest that the extent of abdominal surgery does not impact significantly on the thyroid condition,” Wojciechowska-Durczynska, of the department of endocrinology and metabolic disease at Medical University of Lodz and Polish Mother’s Memorial Hospital – Research Institute, in Lodz, Poland, told Endocrine Today. “However, it is worth stressing that, in our study, the patients who underwent minor surgery were patients with unresectable abdominal tumors who were subjected to palliative interventions, being with obvious reasons in the worse general condition before operation than other subjects who underwent major surgery.”
The patients were categorized into two groups according to the type of surgery they were to undergo. Researchers measured free T3, free T4 and TSH on the day before surgery and again on the first, third and fifth day after surgery. According to data, mean serum free T3 levels decreased during the study in both major and minor subgroups (P<.001) compared with baseline values.
Of patients who underwent major surgery, researchers found the free T4 concentration reduced by the third day (1.082) compared with patients who displayed liver tumors (P=.002). They reported similar findings on the fifth day.
Of patients who underwent minor surgery, the researchers found free T3 concentrations had decreased by the third day in patients with pancreatic disease (1.629) compared with patients who displayed liver tumors (P=.015), according to data.
“Our further analyses revealed lower mean free thyroid hormone concentrations after surgery in pancreatic tumor patients when compared with liver tumor patients. It is tempting to speculate that novel finding could be explained by an increased proportion of free thyroid hormones after liver surgery, caused by lower thyroid hormone-binding proteins concentration (hypoproteinemia),” Wojciechowska-Durczynska said. “Another explanation might be based on an assumption that pancreatic surgery, generally, is a more serious intervention, with more serious complications. It is to be recalled that lower free thyroid hormone levels are known to be a manifestation of particularly deep and serious metabolic disturbances.”
According to the study, although the extent of abdominal surgery did not have a significant effect on thyroid function, these data suggest patients are more likely to display lower T4 levels after pancreatic surgery.
“In our opinion, results of our study emphasize the role of thyrometabolic state in the evaluation of patients’ general condition after various abdominal surgical procedures,” Wojciechowska-Durczynska said. – by Samantha Costa
Disclosure: The researchers report no relevant financial disclosures.
Perspective
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Elizabeth N. Pearce, MD, MSc
This study by Wojciechowska-Durczynska and colleagues followed thyroid function prospectively in 51 patients with liver or pancreatic cancers who underwent abdominal surgeries. As expected, among these sick patients who experienced surgical stress, mean serum free T3 decreased significantly over the 3 to 5 days following both minor and major surgeries. It is unclear from the report whether any of the patients were treated with medications such as glucocorticoids or iodinated contrast media, which might have contributed to the changes in free T3. In addition, it is unclear whether the thyroid function changes were related to the surgeries or to perioperative dietary restrictions; food deprivation, especially carbohydrate restriction, is known to cause reductions in free T3. As noted by the authors, the patients who underwent minor (palliative) surgeries tended to be sicker at baseline than those who underwent more minor abdominal procedures; it is not clear whether the extent of T3 suppression postoperatively would be associated with the extent of surgery among patients with similar degrees of illness preoperatively.
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