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Thyroid Hormone Treatment in Heart Surgery and Heart Transplantation

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Thyroid and Heart

Abstract

The development of brain death not only causes major structural injury to the heart, but also leads to major hormonal changes. In particular, there is a rapid reduction in the circulating level of thyroid hormone. This leads to an inability of the body to metabolize aerobically. Anaerobic metabolism results in loss of energy stores in the myocardium, resulting in a deterioration in cardiac function. Replacement therapy with triiodothyronine reverses the situation—aerobic metabolism resumes and cardiac function improves. Our experience in both experimental large animal models and in brain-dead human subjects is summarized.Similar changes occur in patients undergoing heart surgery requiring cardiopulmonary bypass, and also following regional myocardial ischemia, and we suggest that thyroid hormone therapy is also beneficial in these patients. It therefore became our policy to treat both the brain-dead heart donor and the heart recipient with triiodothyronine.Finally, we make a case for thyroid hormone therapy to be considered in patients with severe or critical non-thyroidal illness syndrome (NTIS), and report its beneficial effect in one such patient.

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Authors and Affiliations

  1. Formerly, Cardiothoracic Surgeon, University of South Florida, Tampa General Hospital, Tampa, FL, USA

    Dimitri Novitzky

  2. Xenotransplantation Program, Department of Surgery, University of Alabama at Birmingham, Birmingham, AL, USA

    David K. C. Cooper

Authors
  1. Dimitri Novitzky
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  2. David K. C. Cooper
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Correspondence to David K. C. Cooper .

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Editors and Affiliations

  1. Institute of Clinical Physiology (IFC) National Research Council (CNR), Pisa, Italy

    Giorgio Iervasi

  2. Institute of Clinical Physiology (IFC) National Research Council (CNR), Pisa, Italy

    Alessandro Pingitore

  3. NYITCOM College of Osteopathic Medicine Biomedical Sciences Department, Old Westbury, NY, USA

    A.Martin Gerdes

  4. Institute of Clinical and Translational Medicine, Newcastle University/Queen Elizabeth Hospital, Newcastle upon Tyne, UK

    Salman Razvi

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Novitzky, D., Cooper, D.K.C. (2020). Thyroid Hormone Treatment in Heart Surgery and Heart Transplantation. In: Iervasi, G., Pingitore, A., Gerdes, A., Razvi, S. (eds) Thyroid and Heart . Springer, Cham. https://doi.org/10.1007/978-3-030-36871-5_30

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  • DOI: https://doi.org/10.1007/978-3-030-36871-5_30

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