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. 2015 Oct;15(10):836-42.
doi: 10.5152/akd.2014.5732. Epub 2014 Nov 11.

Nonthyroidal illness syndrome in off-pump coronary artery bypass surger

Selma Caluk  1 , Jasmin Caluk, Enes Osmanovic
Affiliations

Nonthyroidal illness syndrome in off-pump coronary artery bypass surger

Selma Caluk et al. Anatol J Cardiol. 2015 Oct.

Abstract

Objective: It is well known that coronary artery bypass grafting (CABG) is often the cause of non-thyroidal illness syndrome (NTIS). Non-thyroidal illness syndrome (NTIS) is a state characterized by low levels of tri-iodo-thyronine (T3) and high levels of reverse T3 (rT3), with normal or low levels of thyroxin (T4) and normal, low-normal, or low levels of thyroid-stimulating hormone (TSH). Today, there are two main techniques of CABG: CABG with the use of cardiopulmonary bypass (on-pump coronary artery bypass - ONCAB) and CABG without the use of cardiopulmonary bypass (off-pump coronary artery bypass OPCAB), or 'beating-heart surgery.' The OPCAB technique is considered to be less invasive. We prospectively investigated the influence of these surgical techniques on the occurrence of NTIS.

Methods: Serum levels of free fractions of thyroid hormones (FT3 and FT4) and TSH were analyzed in 70 consecutive patients subjected to CABG surgery, using the ONCAB technique in 36 patients and OPCAB technique in 34 patients. The measurements of hormone levels were performed prior to surgery and 12 hours and 14 days after surgery.

Results: The basic, the early, and the late postoperative serum levels of FT3 (p=0.458, p=0.632, p=0.869, respectively), FT4 (p=0.664, p=0.301, p=0.417, respectively), and TSH (p=0.249, p=0.058, p=0.324, respectively) were similar in both groups. The levels of FT3 and TSH were significantly lower 12 hours after surgery (p<0.0001, p<0.0001, respectively), and the FT4 levels rose at the same time (p<0.0001). The third measurement showed the return of all investigated parameters back to physiological levels, although they were still not precisely within the initial values.

Conclusion: NTIS occurs significantly in patients subjected to CABG. Although the OPCAB technique is considered to be less invasive, its impact on the occurrence of NTIS does not differ significantly from the ONCAB technique.

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Conflict of interest statement

Conflict of interest: None declared.

Figures

Figure 1
Figure 1
FT3 levels measured before surgery, 12 hours after surgery, and 14 days after surgery among patients operated using ONCAB and the patients operated using OPCAB technique FT3 - free fraction of tri-iodothyronine; ONCAB - patients operated on using on-pump coronary artery bypass technique; OPCAB - patients operated on using off-pump coronary artery bypass technique
Figure 2
Figure 2
FT4 levels measured before surgery, 12 hours after surgery, and 14 days after surgery among patients operated using ONCAB and the patients operated using OPCAB technique FT4 - free fraction of thyroxine; ONCAB - patients operated on using on-pump coronary artery bypass technique; OPCAB - patients operated on using off-pump coronary artery bypass technique
Figure 3
Figure 3
TSH levels measured before surgery, 12 hours after surgery, and 14 days after surgery among patients operated using ONCAB and the patients operated using OPCAB technique ONCAB - patients operated on using on-pump coronary artery bypass technique; OPCAB - patients operated on using off-pump coronary artery bypass technique; TSH - thyroid-stimulating hormone
Figure 4
Figure 4
Occurrence of NTIS among operated patients NTIS - non-thyroidal illness syndrome
Figure 5
Figure 5
Occurrence of NTIS among patients operated using ONCAB and among patients operated using OPCAB technique NTIS - non-thyroidal illness syndrome; OPCAB - patients operated on using off-pump coronary artery bypass technique
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