Relationship of Preoperative Thyroid Dysfunction to Clinical Outcomes in Pediatric Cardiac Surgery
Abstract Context Thyroid function may be assessed in children before cardiac surgery because of concerns that hypothyroidism or thyrotoxicosis might adversely affect cardiac function perioperatively. However, the relationship between preoperative thyroid dysfunction and surgical outcomes is unknown....
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| Veröffentlicht in: | The journal of clinical endocrinology and metabolism 2021-05, Vol.106 (5), p.e2129-e2136 |
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| container_title | The journal of clinical endocrinology and metabolism |
| container_volume | 106 |
| creator | Brown, Morgan L Quinonez, Luis G Staffa, Steven J DiNardo, James A Wassner, Ari J |
| description | Abstract
Context
Thyroid function may be assessed in children before cardiac surgery because of concerns that hypothyroidism or thyrotoxicosis might adversely affect cardiac function perioperatively. However, the relationship between preoperative thyroid dysfunction and surgical outcomes is unknown.
Objective
Determine the relationship between preoperative thyroid dysfunction and outcomes of pediatric cardiac surgery.
Methods
Retrospective cohort study (January 2005 to July 2019).
Setting
Academic pediatric hospital.
Patients
All patients |
| doi_str_mv | 10.1210/clinem/dgab040 |
| format | Article |
| fullrecord | <record><control><sourceid>gale_proqu</sourceid><recordid>TN_cdi_proquest_miscellaneous_2480754160</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><galeid>A702375159</galeid><oup_id>10.1210/clinem/dgab040</oup_id><sourcerecordid>A702375159</sourcerecordid><originalsourceid>FETCH-LOGICAL-c464t-c904ef7c47659c637d95599e9f7da71420767cbb3099a503e710bcfeb7a37fc03</originalsourceid><addsrcrecordid>eNqFkU1r3DAQhkVpaLZprz0WQS_twcnIkqzqGDb9gkBCkkJvQpZHGwXbciW7sP--WnabQwmEOcwwPPPOMC8h7xicsprBmevDiMNZt7EtCHhBVkwLWSmm1UuyAqhZpVX965i8zvkBgAkh-StyzLnQNdfNirQ32Ns5xDHfh4lGT68TxglT6f1Bene_TTF09GKb_TK6HUfnSNdlaXC2p1fL7OKAmYaRXmMX7JyCo2ubSuno7ZI2mLZvyJG3fca3h3xCfn79crf-Xl1effuxPr-snGjEXDkNAr1yQjVSu4arTkupNWqvOquYqEE1yrUtB62tBI6KQes8tspy5R3wE_Jxrzul-HvBPJshZId9b0eMSza1-AxKCtbs0A__oQ9xSWO5ztRaNoyDLI96pDa2RxNGH-dk3U7UnCuouZJM6kKdPkGV6HAILo7oQ-k_NeBSzDmhN1MKg01bw8DsTDV7U83B1DLw_nDt0g7YPeL_XCzApz0Ql-k5sb-246wa</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2956130545</pqid></control><display><type>article</type><title>Relationship of Preoperative Thyroid Dysfunction to Clinical Outcomes in Pediatric Cardiac Surgery</title><source>Oxford University Press Journals All Titles (1996-Current)</source><source>EZB-FREE-00999 freely available EZB journals</source><source>Alma/SFX Local Collection</source><creator>Brown, Morgan L ; Quinonez, Luis G ; Staffa, Steven J ; DiNardo, James A ; Wassner, Ari J</creator><creatorcontrib>Brown, Morgan L ; Quinonez, Luis G ; Staffa, Steven J ; DiNardo, James A ; Wassner, Ari J</creatorcontrib><description>Abstract
Context
Thyroid function may be assessed in children before cardiac surgery because of concerns that hypothyroidism or thyrotoxicosis might adversely affect cardiac function perioperatively. However, the relationship between preoperative thyroid dysfunction and surgical outcomes is unknown.
Objective
Determine the relationship between preoperative thyroid dysfunction and outcomes of pediatric cardiac surgery.
Methods
Retrospective cohort study (January 2005 to July 2019).
Setting
Academic pediatric hospital.
Patients
All patients <19 years old who underwent cardiac surgery with cardiopulmonary bypass and had thyrotropin (TSH) measured within 14 days preoperatively. Exclusion criteria included neonates (≤30 days), preoperative extracorporeal life support, salvage operations, or transplantation procedures.
Main Outcome Measures
Subjects were stratified by preoperative TSH concentration (mIU/L): low (<0.5), normal (0.5-5), mildly high (5.01-10), or moderately high (>10). Outcomes were compared among subjects with normal TSH (control) and each group with abnormal TSH concentrations. The primary outcome was 30-day mortality. Secondary outcomes included time to extubation, intensive care unit and hospital length of stay, and operative complications.
Results
Among 592 patients analyzed, preoperative TSH was low in 15 (2.5%), normal in 347 (58.6%), mildly high in 177 (29.9%), and moderately high in 53 (9.0%). Free thyroxine was measured in 77.4% of patients and was low in 0 to 4.4% of subjects, with no differences among TSH groups. Thirty-day mortality was similar among TSH groups. There were no differences in any secondary outcome between patients with abnormal TSH and patients with normal TSH.
Conclusion
Preoperative mild to moderate subclinical hypothyroidism was not associated with adverse postoperative outcomes in children undergoing cardiopulmonary bypass procedures.</description><identifier>ISSN: 0021-972X</identifier><identifier>EISSN: 1945-7197</identifier><identifier>DOI: 10.1210/clinem/dgab040</identifier><identifier>PMID: 33492396</identifier><language>eng</language><publisher>US: Oxford University Press</publisher><subject>Children ; Children's hospitals ; Coronary artery bypass ; Health aspects ; Heart ; Heart surgery ; Hypothyroidism ; Mortality ; Neonates ; Patient outcomes ; Patients ; Pediatric cardiology ; Pediatrics ; Procainamide ; Surgery ; Surgical outcomes ; Thyroid ; Thyroid diseases ; Thyroid gland ; Thyroid-stimulating hormone ; Thyrotoxicosis ; Thyrotropin ; Thyroxine ; Transplantation</subject><ispartof>The journal of clinical endocrinology and metabolism, 2021-05, Vol.106 (5), p.e2129-e2136</ispartof><rights>The Author(s) 2021. Published by Oxford University Press on behalf of the Endocrine Society. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com 2021</rights><rights>The Author(s) 2021. Published by Oxford University Press on behalf of the Endocrine Society. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.</rights><rights>COPYRIGHT 2021 Oxford University Press</rights><rights>The Author(s) 2021. Published by Oxford University Press on behalf of the Endocrine Society. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c464t-c904ef7c47659c637d95599e9f7da71420767cbb3099a503e710bcfeb7a37fc03</citedby><cites>FETCH-LOGICAL-c464t-c904ef7c47659c637d95599e9f7da71420767cbb3099a503e710bcfeb7a37fc03</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/33492396$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Brown, Morgan L</creatorcontrib><creatorcontrib>Quinonez, Luis G</creatorcontrib><creatorcontrib>Staffa, Steven J</creatorcontrib><creatorcontrib>DiNardo, James A</creatorcontrib><creatorcontrib>Wassner, Ari J</creatorcontrib><title>Relationship of Preoperative Thyroid Dysfunction to Clinical Outcomes in Pediatric Cardiac Surgery</title><title>The journal of clinical endocrinology and metabolism</title><addtitle>J Clin Endocrinol Metab</addtitle><description>Abstract
Context
Thyroid function may be assessed in children before cardiac surgery because of concerns that hypothyroidism or thyrotoxicosis might adversely affect cardiac function perioperatively. However, the relationship between preoperative thyroid dysfunction and surgical outcomes is unknown.
Objective
Determine the relationship between preoperative thyroid dysfunction and outcomes of pediatric cardiac surgery.
Methods
Retrospective cohort study (January 2005 to July 2019).
Setting
Academic pediatric hospital.
Patients
All patients <19 years old who underwent cardiac surgery with cardiopulmonary bypass and had thyrotropin (TSH) measured within 14 days preoperatively. Exclusion criteria included neonates (≤30 days), preoperative extracorporeal life support, salvage operations, or transplantation procedures.
Main Outcome Measures
Subjects were stratified by preoperative TSH concentration (mIU/L): low (<0.5), normal (0.5-5), mildly high (5.01-10), or moderately high (>10). Outcomes were compared among subjects with normal TSH (control) and each group with abnormal TSH concentrations. The primary outcome was 30-day mortality. Secondary outcomes included time to extubation, intensive care unit and hospital length of stay, and operative complications.
Results
Among 592 patients analyzed, preoperative TSH was low in 15 (2.5%), normal in 347 (58.6%), mildly high in 177 (29.9%), and moderately high in 53 (9.0%). Free thyroxine was measured in 77.4% of patients and was low in 0 to 4.4% of subjects, with no differences among TSH groups. Thirty-day mortality was similar among TSH groups. There were no differences in any secondary outcome between patients with abnormal TSH and patients with normal TSH.
Conclusion
Preoperative mild to moderate subclinical hypothyroidism was not associated with adverse postoperative outcomes in children undergoing cardiopulmonary bypass procedures.</description><subject>Children</subject><subject>Children's hospitals</subject><subject>Coronary artery bypass</subject><subject>Health aspects</subject><subject>Heart</subject><subject>Heart surgery</subject><subject>Hypothyroidism</subject><subject>Mortality</subject><subject>Neonates</subject><subject>Patient outcomes</subject><subject>Patients</subject><subject>Pediatric cardiology</subject><subject>Pediatrics</subject><subject>Procainamide</subject><subject>Surgery</subject><subject>Surgical outcomes</subject><subject>Thyroid</subject><subject>Thyroid diseases</subject><subject>Thyroid gland</subject><subject>Thyroid-stimulating hormone</subject><subject>Thyrotoxicosis</subject><subject>Thyrotropin</subject><subject>Thyroxine</subject><subject>Transplantation</subject><issn>0021-972X</issn><issn>1945-7197</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><recordid>eNqFkU1r3DAQhkVpaLZprz0WQS_twcnIkqzqGDb9gkBCkkJvQpZHGwXbciW7sP--WnabQwmEOcwwPPPOMC8h7xicsprBmevDiMNZt7EtCHhBVkwLWSmm1UuyAqhZpVX965i8zvkBgAkh-StyzLnQNdfNirQ32Ns5xDHfh4lGT68TxglT6f1Bene_TTF09GKb_TK6HUfnSNdlaXC2p1fL7OKAmYaRXmMX7JyCo2ubSuno7ZI2mLZvyJG3fca3h3xCfn79crf-Xl1effuxPr-snGjEXDkNAr1yQjVSu4arTkupNWqvOquYqEE1yrUtB62tBI6KQes8tspy5R3wE_Jxrzul-HvBPJshZId9b0eMSza1-AxKCtbs0A__oQ9xSWO5ztRaNoyDLI96pDa2RxNGH-dk3U7UnCuouZJM6kKdPkGV6HAILo7oQ-k_NeBSzDmhN1MKg01bw8DsTDV7U83B1DLw_nDt0g7YPeL_XCzApz0Ql-k5sb-246wa</recordid><startdate>20210501</startdate><enddate>20210501</enddate><creator>Brown, Morgan L</creator><creator>Quinonez, Luis G</creator><creator>Staffa, Steven J</creator><creator>DiNardo, James A</creator><creator>Wassner, Ari J</creator><general>Oxford University Press</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7QP</scope><scope>7T5</scope><scope>7TM</scope><scope>H94</scope><scope>K9.</scope><scope>7X8</scope></search><sort><creationdate>20210501</creationdate><title>Relationship of Preoperative Thyroid Dysfunction to Clinical Outcomes in Pediatric Cardiac Surgery</title><author>Brown, Morgan L ; Quinonez, Luis G ; Staffa, Steven J ; DiNardo, James A ; Wassner, Ari J</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c464t-c904ef7c47659c637d95599e9f7da71420767cbb3099a503e710bcfeb7a37fc03</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>Children</topic><topic>Children's hospitals</topic><topic>Coronary artery bypass</topic><topic>Health aspects</topic><topic>Heart</topic><topic>Heart surgery</topic><topic>Hypothyroidism</topic><topic>Mortality</topic><topic>Neonates</topic><topic>Patient outcomes</topic><topic>Patients</topic><topic>Pediatric cardiology</topic><topic>Pediatrics</topic><topic>Procainamide</topic><topic>Surgery</topic><topic>Surgical outcomes</topic><topic>Thyroid</topic><topic>Thyroid diseases</topic><topic>Thyroid gland</topic><topic>Thyroid-stimulating hormone</topic><topic>Thyrotoxicosis</topic><topic>Thyrotropin</topic><topic>Thyroxine</topic><topic>Transplantation</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Brown, Morgan L</creatorcontrib><creatorcontrib>Quinonez, Luis G</creatorcontrib><creatorcontrib>Staffa, Steven J</creatorcontrib><creatorcontrib>DiNardo, James A</creatorcontrib><creatorcontrib>Wassner, Ari J</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>Calcium & Calcified Tissue Abstracts</collection><collection>Immunology Abstracts</collection><collection>Nucleic Acids Abstracts</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>MEDLINE - Academic</collection><jtitle>The journal of clinical endocrinology and metabolism</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Brown, Morgan L</au><au>Quinonez, Luis G</au><au>Staffa, Steven J</au><au>DiNardo, James A</au><au>Wassner, Ari J</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Relationship of Preoperative Thyroid Dysfunction to Clinical Outcomes in Pediatric Cardiac Surgery</atitle><jtitle>The journal of clinical endocrinology and metabolism</jtitle><addtitle>J Clin Endocrinol Metab</addtitle><date>2021-05-01</date><risdate>2021</risdate><volume>106</volume><issue>5</issue><spage>e2129</spage><epage>e2136</epage><pages>e2129-e2136</pages><issn>0021-972X</issn><eissn>1945-7197</eissn><abstract>Abstract
Context
Thyroid function may be assessed in children before cardiac surgery because of concerns that hypothyroidism or thyrotoxicosis might adversely affect cardiac function perioperatively. However, the relationship between preoperative thyroid dysfunction and surgical outcomes is unknown.
Objective
Determine the relationship between preoperative thyroid dysfunction and outcomes of pediatric cardiac surgery.
Methods
Retrospective cohort study (January 2005 to July 2019).
Setting
Academic pediatric hospital.
Patients
All patients <19 years old who underwent cardiac surgery with cardiopulmonary bypass and had thyrotropin (TSH) measured within 14 days preoperatively. Exclusion criteria included neonates (≤30 days), preoperative extracorporeal life support, salvage operations, or transplantation procedures.
Main Outcome Measures
Subjects were stratified by preoperative TSH concentration (mIU/L): low (<0.5), normal (0.5-5), mildly high (5.01-10), or moderately high (>10). Outcomes were compared among subjects with normal TSH (control) and each group with abnormal TSH concentrations. The primary outcome was 30-day mortality. Secondary outcomes included time to extubation, intensive care unit and hospital length of stay, and operative complications.
Results
Among 592 patients analyzed, preoperative TSH was low in 15 (2.5%), normal in 347 (58.6%), mildly high in 177 (29.9%), and moderately high in 53 (9.0%). Free thyroxine was measured in 77.4% of patients and was low in 0 to 4.4% of subjects, with no differences among TSH groups. Thirty-day mortality was similar among TSH groups. There were no differences in any secondary outcome between patients with abnormal TSH and patients with normal TSH.
Conclusion
Preoperative mild to moderate subclinical hypothyroidism was not associated with adverse postoperative outcomes in children undergoing cardiopulmonary bypass procedures.</abstract><cop>US</cop><pub>Oxford University Press</pub><pmid>33492396</pmid><doi>10.1210/clinem/dgab040</doi><oa>free_for_read</oa></addata></record> |
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| identifier | ISSN: 0021-972X |
| ispartof | The journal of clinical endocrinology and metabolism, 2021-05, Vol.106 (5), p.e2129-e2136 |
| issn | 0021-972X 1945-7197 |
| language | eng |
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| source | Oxford University Press Journals All Titles (1996-Current); EZB-FREE-00999 freely available EZB journals; Alma/SFX Local Collection |
| subjects | Children Children's hospitals Coronary artery bypass Health aspects Heart Heart surgery Hypothyroidism Mortality Neonates Patient outcomes Patients Pediatric cardiology Pediatrics Procainamide Surgery Surgical outcomes Thyroid Thyroid diseases Thyroid gland Thyroid-stimulating hormone Thyrotoxicosis Thyrotropin Thyroxine Transplantation |
| title | Relationship of Preoperative Thyroid Dysfunction to Clinical Outcomes in Pediatric Cardiac Surgery |
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