• Eva M Marwali, Cindy E Boom, Indriwanto Sakidjan, Anwar Santoso, Dicky Fakhri, Ay Kartini, Aria Kekalih, Steven M Schwartz, and Nikolaus A Haas.
• 1Department of Pediatric Cardiac Intensive Care and Anaesthesiology, National Cardiovascular Center Harapan Kita, Jakarta, Indonesia. 2Department of Cardiology and Vascular Medicine, National Cardiovascular Center Harapan Kita, Jakarta, Indonesia. 3Department of Pediatric Cardiac Surgery, National Cardiovascular Center Harapan Kita, Jakarta, Indonesia. 4Department of Clinical Pathology, National Cardiovascular Center Harapan Kita, Jakarta, Indonesia. 5Division of Epidemiology and Biostatistics, Department of Community Medicine, University of Indonesia, Jakarta, Indonesia. 6Department of Critical Care Medicine, The Hospital for Sick Children, University of Toronto School of Medicine, Toronto, ON, Canada. 7Department of Congenital Heart Defects, Heart and Diabetes Centre, North Rhein-Westfalia, Bad Oeynhausen, Germany.
• Pediatr Crit Care Me. 2013 Sep 1;14(7):701-8.

ObjectivesThis study was conducted to determine if oral triiodothyronine supplementation could prevent the decrease of serum triiodothyronine levels that commonly occurs after cardiopulmonary bypass for pediatric congenital heart surgery. Secondary objectives included identifying any significant adverse effects of oral triiodothyronine supplementation, including any effects on the thyroid/pituitary axis.DesignRandomized, placebo-controlled, doubleblind clinical trialSettingOperating room and ICU.SubjectsInfants and children younger than 2 years of age undergoing congenital heart surgery using cardiopulmonary bypass (n = 43).InterventionsSubjects were assigned to placebo (n = 15, group A) or one of two treatment groups: a low-dose group (group B, n = 14, 0.5 mcg/kg triiodothyronine orally every 24 hr for 3 d) or a high-dose group (group C, n = 14, 0.5 mcg/kg triiodothyronine orally every 12 hr for 3 d).Measurements And Main ResultsThyroid hormone, including total and free triiodothyronine levels at predetermined time points, potential side effects indicating hyperthyroidism, indicators of the thyroid-pituitary axis, and clinical endpoints. Oral triiodothyronine supplementation twice-daily maintained serum triiodothyronine levels within normal limits in group C, whereas serum levels progressively declined in groups A and B. A statistically significant difference in triiodothyronine levels between the treatment groups occurred between 18 and 36 hours post cross-clamp release, with the largest difference in serum levels between group C and group A noted at 36 hours post cross-clamp release (total triiodothyronine, 0.71 ± 0.15 [0.34-1.08] ng/mL [p < 0.01]; free triiodothyronine, 2.56 ± 0.49 [1.33-3.79] pg/mL [p < 0.01]). There was no evidence of hyperthyroidism or suppression of the pituitary-thyroid axis in either treatment groupConclusionsOral triiodothyronine supplementation at a dose of 0.5 mcg/kg every 12 hours for 3 days can maintain total and free triiodothyronine levels within normal limits after open-heart surgery using cardiopulmonary bypass for congenital heart disease.

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