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J Thorac Cardiovasc Surg 2004;127:1509-1511
© 2004 The American Association for Thoracic Surgery

Brief communication

Thyroid dysfunction after pediatric cardiac surgery

^a Pediatric Residency Program, University of Minnesota, St Paul, Minn, USA
^b Department of Pediatric Endocrinology, University of Minnesota, St Paul, Minn, USA
^c Department of Cardiovascular Surgery, University of Minnesota, St Paul, Minn, USA
^d Department of Pediatric Cardiology, University of Minnesota, St Paul, Minn, USA

Received for publication October 30, 2003; accepted for publication November 17, 2003.

^* Address for reprints: Elizabeth Braunlin, MD, PhD, MMC 94, Fairview-University Medical Center, 420 Delaware Street SE, Minneapolis, MN 55455, USA

The first 20% of the full text of this article appears below.

Plasma protein loss from prolonged chest tube drainage in pediatric patients after surgery can cause hypoalbuminemia and low levels of antithrombin (AT) III and immunoglobulins (Igs). We report 5 cases of hypothyroidism possibly secondary to loss of thyroid binding globulin from prolonged chest tube drainage.

Clinical summary

Patient 1, a 3.23-kg girl born with pulmonary and aortic stenosis, atrial septal defect (ASD), and ventricular septal defect (VSD), underwent aortic and pulmonary valvotomies, ASD closure, and patent ductus arteriosus ligation on day of life (DOL) 2. Chest tube drainage was greater than 100 mL/d until postoperative day (POD) 108. To decrease lymphatic drainage, thoracic duct ligation was performed on POD 33, and somatostatin (7 µg · kg · d) was administered on PODs 37 to 41. Thyroid function on newborn screening was normal. On POD 8, the thyroid stimulating hormone (TSH) level was 15.18 mU/L (normal value 0.4-5.0 mU/L), and the free thyroxine level was 0.95 ng/dL (normal value 0.9-2.6 ng/dL). TSH levels decreased to 8.57 mU/L by POD 39 (free thyroxine level 1.39 ng/dL) and 4.08 mU/L by POD 95 (free thyroxine level 0.72 ng/dL). Because the levels of serum IgG and ATIII were low, the patient received serial intravenous (IV) Ig and ATIII replacement while chest tubes were present. The patient died on POD 108 from acute renal failure and sepsis.

Patient 2, a 3.56-kg boy born with D-transposition of the great arteries, ASD, and VSD, underwent complete repair on DOL 4. Chest tube output greater than 100 mL/day occurred until POD 111. To decrease lymphatic drainage, the thoracic duct was ligated on POD 81, and he received somatostatin (5-10 µg · kg · d) on PODs 43 to 47. Peritoneal dialysis was initiated on POD 14 for renal . . . [Full Text of this Article]