뇌사 장기 기증자에서 나타나는 갑상선 호르몬 변화
Thyroid Hormonal Changes in Brain Death Donors
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Background: We analyzed thyroid hormone values in brain death patients to determine the need for thyroid hormone replacement therapy. Methods: We analyzed 111 brain death donors (77 males and 34 females, mean age, 41.1 years (range; 8 months−72 years) in Ajou University Hospital from 2000 to 2010. Results: The mean values of thyroid hormones were T3; 72.5 ng/dl (normal range [NR] 60-181 ng/dl), T4; 5.0 μg/dl (NR 4.5−10.9 μg/dl), free T4 1.0 ng/dl (NR 0.8-1.5 ng/dl), and TSH 1.5 μIU/ml (NR 0.35−5.5 μIU/ml), respectively. However, the values of T4 (correlation coefficient −0.264, p = 0.005), free T4 (correlation coefficient −0.305, p = 0.001) and TSH (correlation −0.206, p = 0.031) significantly decreased based on the increase of interval from the brain death-inducing event to the evaluation time (hereafter, interval). The patients with greater than 8 days of interval (N = 30) showed significantly low thyroid hormone values compared to patients with less than 8 days of interval (N = 81); T3 (70.3 ng/dl vs. 77.0 ng/dl, p = 0.242), T4 (4.7 ng/dl vs. 5.3 ng/dl, p = 0.015), free T4 (0.8 ng/dl vs. 1.2 ng/dl, p = 0.006) and TSH (1.0 μIU/ml vs. 2.0 μIU/ml, p = 0.000), respectively. Conclusions: As the intervals from the brain death-inducing events increased, all thyroid hormone values of brain death donors except T3 significantly decreased. Therefore, we recommend that careful consideration should be given to the interval from brain death-inducing event for the evaluation of thyroid hormone status of brain death patients.
Abstract
Background: We analyzed thyroid hormone values in brain death patients to determine the need for thyroid hormone replacement therapy. Methods: We analyzed 111 brain death donors (77 males and 34 females, mean age, 41.1 years (range; 8 months−72 years) in Ajou University Hospital from 2000 to 2010. Results: The mean values of thyroid hormones were T3; 72.5 ng/dl (normal range [NR] 60-181 ng/dl), T4; 5.0 μg/dl (NR 4.5−10.9 μg/dl), free T4 1.0 ng/dl (NR 0.8-1.5 ng/dl), and TSH 1.5 μIU/ml (NR 0.35−5.5 μIU/ml), respectively. However, the values of T4 (correlation coefficient −0.264, p = 0.005), free T4 (correlation coefficient −0.305, p = 0.001) and TSH (correlation −0.206, p = 0.031) significantly decreased based on the increase of interval from the brain death-inducing event to the evaluation time (hereafter, interval). The patients with greater than 8 days of interval (N = 30) showed significantly low thyroid hormone values compared to patients with less than 8 days of interval (N = 81); T3 (70.3 ng/dl vs. 77.0 ng/dl, p = 0.242), T4 (4.7 ng/dl vs. 5.3 ng/dl, p = 0.015), free T4 (0.8 ng/dl vs. 1.2 ng/dl, p = 0.006) and TSH (1.0 μIU/ml vs. 2.0 μIU/ml, p = 0.000), respectively. Conclusions: As the intervals from the brain death-inducing events increased, all thyroid hormone values of brain death donors except T3 significantly decreased. Therefore, we recommend that careful consideration should be given to the interval from brain death-inducing event for the evaluation of thyroid hormone status of brain death patients.
참고문헌 (20)
- The Korean Society of Critical Care Medicine, "Critical Care Medicine", pp.585~ (2010), Koonja Publishing
- Cooper DK, "Physiologic changes following brain death", Transplant Proc, 31, pp.1001~1002 (1999)
- Jenkins DH, "Improving the approach to organ donation: a review", World J Surg, 23, pp.644~649 (1999)
- Novitzky D, "Novel actions of thyroid hormone: the role of triiodothyronine in cardiac transplantation", Thyroid, 6, pp.531~536 (1996)
- Salim A, "Using thyroid hormone in brain-dead donors to maximize the number of organs available for transplantation", Clin Transplant, 21, pp.405~409 (2007)
- Goarin JP, "The effects of triiodothyronine on hemodynamic status and cardiac function in potential heart donors", Anesth Analg, 83, pp.41~47 (1996)
- Mariot J, "Hormone levels, hemodynamics, and metabolism in brain dead organ donors", Transplant Proc, 27, pp.793~794 (1995)
- Randell TT, "Triiodothyronine treatment is not indicated in brain-dead multiorgan donors: a controlled study", Transplant Proc, 25, pp.1552~1553 (1993)
- Chen JM, "Vasopressin deficiency and pressor hypersensitivity in hemodynamically unstable organ donors", Circulation, 100(19), pp.II244~246 (1999)
- Wheeldon DR, "Transforming the "unacceptable" donor: outcomes from the adoption of a standardized donor management technique", J Heart Lung Transplant, 14, pp.734~742 (1995)
- Novitzky D, "Hemodynamic and metabolic responses to hormonal therapy in brain-dead potential organ donors", Transplantation, 43, pp.852~854 (1987)
- Novitzky D, "Change from aerobic to anaerobic metabolism after brain death, and reversal following triiodothyronine therapy", Transplantation, 45, pp.32~36 (1988)
- Novitzky D, "Value of triiodothyronine (T3) therapy to brain-dead potential organ donors", J Heart Transplant, 5, pp.486~487 (1986)
- Zuppa AF, "The effect of a thyroid hormone infusion on vasopressor support in critically ill children with cessation of neurologic function", Crit Care Med, 32, pp.2318~2322 (2004)
- Randell TT, "Triiodothyronine treatment in brain-dead multiorgan donors--a controlled study", Transplantation, 54, pp.736~738 (1992)
- Robertson KM, "Endocrine changes and haemodynamic stability after brain death", Transplant Proc, 21, pp.1197~1198 (1989)
- Novitzky D, "Hormonal therapy of the brain-dead organ donor: experimental and clinical studies", Transplantation, 82, pp.1396~1401 (2006)
- Ishikawa T, "Morphological and functional alterations in the adenohypophysis in cases of brain death", Leg Med, 11(1), pp.S234~237 (2009)
- Surks MI, "American Thyroid Association guidelines for use of laboratory tests in thyroid disorders", JAMA, 263, pp.1529~1532 (1990)
- Rosendale JD, "Aggressive pharmacologic donor management results in more transplanted organs", Transplantation, 75, pp.482~487 (2003)