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Nonthyroidal illness syndrome in off-pump coronary artery bypass surgery [Anatol J Cardiol]
Anatol J Cardiol. 2015; 15(10): 836-842 | DOI: 10.5152/akd.2014.5732  

Nonthyroidal illness syndrome in off-pump coronary artery bypass surgery

Selma Caluk1, Jasmin Caluk2, Enes Osmanovic2
1Department of Nuclear Medicine, University Clinical Center Tuzla, Tuzla-Bosna-Herzeg
2Department of Interventional Cardiology, BH Heart Center Tuzla, Tuzla-Bosna-Herzeg

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.

Keywords: off-pump coronary artery bypass, non-thyroidal illness syndrome, coronary artery bypass grafting, cardiac surgery, thyroid


Off-pompa koroner arter baypass cerrahisi, tiroid dışı hastalık sendromu

Selma Caluk1, Jasmin Caluk2, Enes Osmanovic2
1Department of Nuclear Medicine, University Clinical Center Tuzla, Tuzla-Bosna-Herzeg
2Department of Interventional Cardiology, BH Heart Center Tuzla, Tuzla-Bosna-Herzeg

Amaç: Bu koroner arter baypas greft (KABG) genellikle non-tiroid hastalığı sendromu (NTIS) neden olduğu bilinmektedir. -Kardiyopulmoner baypass kullanılmadan ve CABG (off-pump koroner arter baypass OPCAB), veya 'dayak-KABG kardiyopulmoner baypass kullanımı ile (ONCAB on-pump koroner arter baypass): Bugün, CABG iki ana teknik vardır kalp cerrahisi '.OPCAB teknik daha az invaziv olarak kabul edilir. Biz prospektif NTIS ortaya çıkması üzerine bu cerrahi tekniklerin etkisi araştırıldı. Yöntemler: Tiroid hormonları (FT3 ve FT4) ve thyreostimulating hormon (TSH) ücretsiz fraksiyonların serum düzeyleri ONCAB 36 hastanın tekniğini ve 34 hastada OPCAB tekniği kullanılarak, koroner arter baypas cerrahisi tabi 70 ardışık hasta analiz edildi. Hormon seviyelerinin ölçümleri, ameliyattan 12 saat önce uygulandı ve ameliyattan 14 gün sonra değerlendirildi. Bulgular: FT3, temel erken ve geç postoperatif serum düzeyleri (p=0,46, p=0,63, p=0,86 sırasıyla), FT4 (p=0,66, p=0,30, p=0,41 sırasıyla), iTSH (p=0,24, p=0,06, p=0,32, sırasıyla) her iki grupta benzerdi. FT3 ve TSH düzeyleri (p <0,0001, p <0,0001) ameliyattan 12 saat sonra anlamlı ölçüde düşüktür ve FT4 düzeyleri aynı zamanda (p <0,0001) yükseldi. Üçüncü ölçüme rağmen hala kesin başlangıç ​​değerleri içinde, geri fizyolojik seviyelere incelenen tüm parametrelerin dönüş gösterdi. Sonuç: NTIS KABG yapılan hastalarda belirginleşti. OPCAB teknik daha az invaziv olarak kabul edilmesine rağmen, NTIS oluşumu üzerindeki etkisi ONCAB tekniği önemli ölçüde farklı değildir.

Anahtar Kelimeler: tiroid dışı hastalık sendromu, off-pompa koroner arter baypass cerrahisi, off-pump koroner arter baypass grafting


Selma Caluk, Jasmin Caluk, Enes Osmanovic. Nonthyroidal illness syndrome in off-pump coronary artery bypass surgery. Anatol J Cardiol. 2015; 15(10): 836-842


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