Online ISSN: 2149-3189
2015
Monthly
Nicaea Medical Publishing
Türkiye

The importance and prognostic effect of thyroid hormones in patients with transposition of the great arteries

Ergin Arslanoğlu, Kenan Abdurrahman Kara, Shiraslan Bakhshaliyev, Fatih Yiğit, Doğan Çağrı Tanrıverdi, Eylem Tunçer, Nihat Çine, Hakan Ceyran
  • Ergin Arslanoğlu (Author) Department of Pediatric Cardiovascular Surgery, University of Health Sciences, İstanbul Kartal Koşuyolu Training and Research Hospital, İstanbul, Türkiye https://orcid.org/0000-0002-0066-7062
  • Kenan Abdurrahman Kara (Author) Department of Pediatric Cardiovascular Surgery, University of Health Sciences, İstanbul Kartal Koşuyolu Training and Research Hospital, İstanbul, Türkiye https://orcid.org/0000-0003-1295-7689
  • Shiraslan Bakhshaliyev (Author) Department of Pediatric Cardiovascular Surgery, Liv Bona Dea Hospital, Bakü, Azerbaijan https://orcid.org/0000-0002-2022-9430
  • Fatih Yiğit (Author) Department of Pediatric Cardiovascular Surgery, University of Health Sciences, İstanbul Kartal Koşuyolu Training and Research Hospital, İstanbul, Türkiye https://orcid.org/0000-0002-0911-5897
  • Doğan Çağrı Tanrıverdi (Author) Department of Pediatric Cardiology, University of Health Sciences, İstanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, İstanbul, Türkiye https://orcid.org/0000-0002-9871-1155
  • Eylem Tunçer (Author) Department of Pediatric Cardiovascular Surgery, University of Health Sciences, İstanbul Kartal Koşuyolu Training and Research Hospital, İstanbul, Türkiye https://orcid.org/0000-0001-9177-2089
  • Nihat Çine (Author) Department of Pediatric Cardiovascular Surgery, University of Health Sciences, İstanbul Kartal Koşuyolu Training and Research Hospital, İstanbul, Türkiye https://orcid.org/0000-0003-4805-3518
  • Hakan Ceyran (Author) Department of Pediatric Cardiovascular Surgery, University of Health Sciences, İstanbul Kartal Koşuyolu Training and Research Hospital, İstanbul, Türkiye https://orcid.org/0000-0002-2023-2701
DOI
https://doi.org/10.18621/eurj.1488539
Abstract
Objectives: Transposition of the great arteries (TGA) is a rare congenital heart disease that occurs in 3 in 10,000 newborns and is rapidly fatal (90%) within one year if left untreated. The prognosis of this pathology changed after introducing an early arterial switch operation (ASO), while the left ventricle could still adapt to systemic high-pressure conditions. Appropriate regulation of thyroid hormones positively impacts metabolism, cardiac function, and postoperative recovery. Therefore, regular thyroid hormone monitoring and thyroid function monitoring of TGA patients may help to improve the health status and prognosis of this group of postoperative patients.
Methods: In our study, 127 patients who underwent ASO at our pediatric cardiac surgery clinic between 01.01.2014 and 18.09.2021 were retrospectively analyzed and included. Among the patients, 43% (n=54) were females, and 57% (n=73) were males.
Results: The coronary arteries were normal in 89.7% (n=114) and abnormal in 10.3% (n=13) of the patients. Twenty-one of the patients exited, and mortality was calculated to be 16.5%. There were no significant differences in mortality or thyroid stimulating hormone (TSH), free thyroxine (T4), or free triiodothyronine (T3) values (P=0.674, P=0.345, P=0.478). In our study, in which we investigated the effect of thyroid hormone levels on prognosis in neonatal patients with TGA with normal free T3, T4, and TSH values, we found that TSH levels were greater in the group with advanced aortic regurgitation and exitus, although the effect of thyroid hormones on postoperative results was not statistically significant.
Conclusions: Congenital hypothyroidism is a common disease with cardiac effects. During the neonatal period, this disease may conceal itself. Careful, expert clinical follow-up and clinical trials are crucial to improve outcomes in the surgical treatment of transposition of the great arteries, a complex congenital heart disease.
Keywords
Transposition of the great arteries, arterial switch operation, thyroid hormones, thyroid stimulating hormone
References

1. Mainwaring RD, Lamberti JJ, Billman GF, Nelson JC. Suppression of the pituitary thyroid axis after cardiopulmonary bypass in the neonate. Ann Thorac Surg. 1994;58(4):1078-1082. doi: 10.1016/0003-4975(94)90459-6.

2. Daoud Z, Nuri HA, Miette A, Pomè G. Transposition of the great vessels and intact ventricular septum: is there an age limit for the arterial switch? Personal experience and review of the literature. Cardiol Young. 2020;30(7):1012-1017. doi: 10.1017/S1047951120001456.

3. Yu D, Zou L, Cun Y, et al. Preoperative thyroid hormone levels predict ICU mortality after cardiopulmonary bypass in congenital heart disease patients younger than 3 months old. BMC Pediatr. 2021;21(1):50. doi: 10.1186/s12887-021-02513-6.

4. Jonas RA. The Arterial Switch Operation in 2019: How to Do It and How to Teach It. World J Pediatr Congenit Heart Surg. 2019;10(1):90-97. doi: 10.1177/2150135118811115.

5. Léger J, Olivieri A, Donaldson M, et al; ESPE-PES-SLEP-JSPE-APEG-APPES-ISPAE; Congenital Hypothyroidism Consensus Conference Group. European Society for Paediatric Endocrinology consensus guidelines on screening, diagnosis, and management of congenital hypothyroidism. J Clin Endocrinol Metab. 2014;99(2):363-384. doi: 10.1210/jc.2013-1891.

6. Yordam N, Calikoğlu AS, Hatun S, et al. Screening for congenital hypothyroidism in Turkey. Eur J Pediatr. 1995;154(8):614-616. doi: 10.1007/BF02079061.

7. Klemperer JD. Thyroid hormone and cardiac surgery. Thyroid. 2002;12(6):517-521. doi: 10.1089/105072502760143917.

8. Portman MA, Fearneyhough C, Ning XH, Duncan BW, Rosenthal GL, Lupinetti FM. Triiodothyronine repletion in infants during cardiopulmonary bypass for congenital heart disease. J Thorac Cardiovasc Surg. 2000;120(3):604-608. doi: 10.1067/mtc.2000.108900.

9. Bettendorf M, Schmidt KG, Grulich-Henn J, Ulmer HE, Heinrich UE. Tri-iodothyronine treatment in children after cardiac surgery: a double-blind, randomised, placebo-controlled study. Lancet. 2000;356(9229):529-534. doi: 10.1016/S0140-6736(00)02576-9.

10. García Hernández JA, Montero Valladares C, Martínez López AI, et al. [Risk factors associated with arterial switch operation for transposition of the great arteries]. Rev Esp Cardiol. 2005;58(7):815-821. [Article in Spanish]

11. Santens B, Van De Bruaene A, De Meester P, et al. Outcome of arterial switch operation for transposition of the great arteries. A 35-year follow-up study. Int J Cardiol. 2020;316:94-100. doi: 10.1016/j.ijcard.2020.04.072.

12. Li M, Iismaa SE, Naqvi N, Nicks A, Husain A, Graham RM. Thyroid hormone action in postnatal heart development. Stem Cell Res. 2014;13(3 Pt B):582-591. doi: 10.1016/j.scr.2014.07.001.

13. Akpınar EE. An underestimated comorbidity of COPD: Thyroid dysfunction. Tuberk Toraks. 2019;67(2):131-135. doi: 10.5578/tt.68257.

14. Latham GJ, Joffe DC, Eisses MJ, Richards MJ, Geiduschek JM. Anesthetic Considerations and Management of Transposition of the Great Arteries. Semin Cardiothorac Vasc Anesth. 2015;19(3):233-242. doi: 10.1177/1089253215581852.

15. Nishiyama S, Mikeda T, Okada T, Nakamura K, Kotani T, Hishinuma A. Transient hypothyroidism or persistent hyperthyrotropinemia in neonates born to mothers with excessive iodine intake. Thyroid. 2004;14(12):1077-1083. doi: 10.1089/thy.2004.14.1077.

16. l'Allemand D, Grüters A, Heidemann P, Schürnbrand P. Iodine-induced alterations of thyroid function in newborn infants after prenatal and perinatal exposure to povidone iodine. J Pediatr. 1983;102(6):935-938. doi: 10.1016/s0022-3476(83)80028-6.

17. Lin CP, Chen W, Wu KW. Povidone-iodine in umbilical cord care interferes with neonatal screening for hypothyroidism. Eur J Pediatr. 1994;153(10):756-758. doi: 10.1007/BF01954494.

18. Zupan J, Garner P. Topical umbilical cord care at birth. Cochrane Database Syst Rev. 2000;(2):CD001057. doi: 10.1002/14651858.CD001057.

19. Plumpton KR, Anderson BJ, Beca J. Thyroid hormone and cortisol concentrations after congenital heart surgery in infants younger than 3 months of age. Intensive Care Med. 2010;36(2):321-328. doi: 10.1007/s00134-009-1648-4.

20. Arslanoğlu E, Işık ME, Kara KA, Çine N, Tunçer E, Ceyran H. Surgical Approach and Management Strategies in a Pediatric Cardiovascular Surgery Clinic During the COVID-19 Outbreak. Braz J Cardiovasc Surg. 2022;37(4):466-471. doi: 10.21470/1678-9741-2020-0614.

21. Talwar S, Khadgawat R, Sandeep JA, et al. Cardiopulmonary bypass and serum thyroid hormone profile in pediatric patients with congenital heart disease. Congenit Heart Dis. 2012;7(5):433-440. doi: 10.1111/j.1747-0803.2012.00667.x.

22. Danzi S, Klein I. Thyroid Abnormalities in Heart Failure. Heart Fail Clin. 2020;16(1):1-9. doi: 10.1016/j.hfc.2019.08.002.

23. Flores S, Loomba RS, Checchia PA, Graham EM, Bronicki RA. Thyroid Hormone (Triiodothyronine) Therapy in Children After Congenital Heart Surgery: A Meta-Analysis. Semin Thorac Cardiovasc Surg. 2020;32(1):87-95. doi: 10.1053/j.semtcvs.2019.05.020.

There are 23 references in total.
How to Cite
1.
Arslanoğlu E, Kara KA, Bakhshaliyev S, et al. The importance and prognostic effect of thyroid hormones in patients with transposition of the great arteries. Eur Res J. 2024;10(5):465-473. doi:10.18621/eurj.1488539
License
Creative Commons License

Copyright (c) 2024 The European Research Journal
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

View Vol. 10 No. 5 (2024)

Vol. 10 No. 5 (2024)

Article Information

  • Article Type Research Article
  • Submitted February 21, 2026
  • Published September 3, 2024
  • Issue Vol. 10 No. 5 (2024)
  • Section Research Article
  • File Downloads 500
  • Abstract Views 157
  • Altmetrics
  • Share
Download data is not yet available.