Skip to main content Accessibility help

Effects of triiodothyronine supplementation following modified Fontan procedure

  • Richard D. Mainwaring (a1), John J. Lamberti (a1), Jerald C. Nelson (a1), Glenn F. Billman (a2), Thomas L. Carter (a1) and Kenneth H. Schell (a1)...


Patients undergoing the modified Fontan procedure may develop low cardiac output postoperatively. Since thyroid hormone has important effects on cardiovascular function, the present study was undertaken to evaluate the influence of triiodothyronine supplementation. Ten consecutive patients under-going the Fontan procedure were administered intravenous triiodothyronine (0.4 mcg per kg) following surgery. Clinical outcome and thyroid hormone profiles were assessed and then compared to a previous series of patients undergoing the Fontan procedure who had not received triiodothyronine supplementation. Both groups initially demonstrated marked decreases in serum free triiodothyronine levels. The group which received triiodothyronine supplementation demonstrated a more rapid return of serum triiodothyronine levels to baseline [259±17 vs 121±15 pg/dl (p<0.05) on the fifth postoperative day and 336±18 vs 178±12 pg/dl (p<0.05) on the eighth day]. In addition, patients receiving supplemental triiodothyronine demonstrated more rapid recovery of total triiodothyronine, free thyroxine, total thyroxine and thyroglobulin levels. The group which received triiodothyronine supplementation had a shorter length of hospital stay [9±2 vs 14±3 (p<0.05)] as compared to patients who did not receive exogenous triiodothyronine. The results of this study demonstrate that triiodothyronine supplementation aids in the recovery of thyroid hormone levels following Fontan procedure. This endocrinologic finding correlated with improved clinical outcome.


Corresponding author

Richard D. Mainwaring, M.D. 3030 Children's Way, Suite 310, San Diego, CA 92123. Fax: (619) 974-8032


Hide All
1.Dillmann, WH. Cardiac Function in Thyroid Disease: Clinical Features and Management Considerations. Ann Thor Surg 1993; 56: S915.
2.Klein, I. Thyroid Hormone and The Cardiovascular System. Am J Med 1990; 88: 631637.
3.Sypniewski, E. Comparative Pharmacology of The Thyroid Hormones. Ann Thor Surg 1993; 56: S28.
4.Paschen, U, Muller, MJ, Darup, J, Kalmar, P, Seitz, HJ. Alteration in Thyroid Hormone Concentration during and after Coronary Bypass Operation. Annales d'Endocrinologie (Paris) 1983; 44: 239242.
5.Chu, S, Huang, T, Shu, R, Wang, S, Wang, C. Thyroid Hormone Changes After Cardiovascular Surgery and Clinical Implications. Ann of Thor Surg 1991; 52: 791796.
6.Holland, FW II, Brown, PS Jr, Clark, RE. Acute Severe Post-ischemic Myocardial Depression Reversed by Triiodothyronine. Ann Thor Surg 1992; 54: 301305.
7.Novitzky, D, Cooper, DKC, Swanepoel, A. Inotropic Effect of Triiodothyronine in Low Cardiac Output Following Cardioplegic Arrest and Cardiopulmonary Bypass: An Initial Experience in Patients Undergoing Open-heart Surgery. Eur J Cardio-Thorac Surg 1989; 3: 140145. Vivie, ER and Rupprath, G. Long Term Results After Fontan Procedure and Its Modifications. J Thorac Cardiovasc Surg 1986; 91: 690697.
9.Franklin, WH and Norwood, WI. Management of Complications Related to the Fontan Procedure. Complications in Cardiothoracic Surgery; 1991, Waldhausen and Orringer, Mosby Yearbook, 202211.
10.Mainwaring, RD, Lamberti, JJ, Carter, TL Jr, Nelson, JC. Reduction in Triiodothyronine Levels Following Modified Fontan Procedure. J Card Surg 1994; 9: 322331.
11.Larsen, PR. Triiodothyronine: Review of Recent Studies of Its Pathology and Pathophysiology in Man. Metabolism 1972; 21: 10731092.
12.Sterling, K and Brenner, MA. Free Thyroxine in Human Serum: Simplified Measurement with the Aid of Magnesium Precipitation. J Clin Invest 1996; 45: 153163.
13.Chopra, IJ. A Radioimmunoassay for Measurement of Thyroxine in Unextracted Serum. J Clin Endocrinol Metab 1972; 34: 938.
14.Nelson, JC and Tomei, RT. Direct Determination of Free Thyroxine in Undiluted Serum by Equilibrium Dialysis/Radionimmunoassay. Clin Chem 1988; 34: 17371744.
15.Spencer, C, LoPresti, JS, Patel, A, Guttler, RB, Eigen, A, Shen, D, Gray, D, Nicoloff, JT. Applications of a Ne Chemiluminometric Thyrotropin Assay to Subnormal Measurement. J Clin Endocrinol Metab 1990; 70: 453460.
16.Van Herle, AJ, Uller, RP, Matthews, NL, Brown, J. Radioimmunoassy for Measurement of Thyroglobulin in Human Serum. J Clin Invest 1973; 52: 13201327.
17.Morkin, E, Flink, IL, Goldman, S. Biochemical and Physiologic Effects of Thyroid Hormone in Cardiac Performance. Prog Cardiovasc Dis 1983; 25: 435464.
18.Samuels, HH, Furman, BM, Horowitz, ZD, Ye, ZS. Regulation of Gene Expression by Thyroid Hormone. J Clin Invest 1988; 81: 957967.
19.Dillmann, WH. Biochemical Basis of Thyroid Hormone Action in the Heart. Am J Med 1990; 88: 626630.
20.Larsen, PR and Ingbar, SH. The Thyroid Gland in William's Textbook of Endocrinology, 8th Ed.Wilson, JD and Foster, DW. WB Saunders Company, Philadelphia, PA, 1992, 365374.
21.Wartofsky, L and Burman, KD. Alterations in Thyroid Function in Patients with Systemic Illness: The “euthyroid sick syndrome.” Endocr Rev 1982; 3: 164217.
22.Hermus, RM, Sweep, CGJ, Vandermeer, MJM, Ross, HA, Smals, AGH, Benraad, TJ, Kloppenborg, PWC. Continuous Infusion of Interleukin-1b Induces a Non-thyroidal Illness Syndrome in the Rat. Endocrinology 1992; 131: 21392146.



Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed