Thyroid Pathology in High-Risk Cardiac Surgery Patients with Coronary Artery Disease

DOI: https://doi.org/10.30702/ujcvs/22.30(01)/GR009-0914
Keywords: thyroid dysfunction, hypothyroidism, risk stratification, comorbidity, high-risk patient, surgical revascularization

Abstract

The aim. To analyze the features of the perioperative period in high-risk cardiac surgery patients with coronary artery disease (CAD) and thyroid disease.

Materials and methods. Retrospective analysis of data of 354 high-risk patients with CAD who were operated and discharged from the National Amosov Institute of Cardiovascular Surgery of the NAMS of Ukraine from 2009 to 2019. All the patients underwent standard clinical and laboratory tests, ECG, echocardiography, coronary angiography and surgical myocardial revascularization with correction of concomitant cardiac pathology. Ultrasound screening of thyroid disease and thyroid hormone levels was not performed in all patients, however, patients with severe symptoms were referred for follow-up.

Results. Thyroid disease was diagnosed in 37 (10.4%) patients, of whom 11 (3.1%) had hypothyroidism and were receiving hormone replacement therapy, and 1 (0.28%) had hyperthyroidism on tyrosol therapy. Ultrasound signs of thyroiditis were detected in 7 (1.9%) patients, nodular goiter in 29 (8.1%), and retrosternal goiter in 1 (0.28%) patient. Depending on the cardiac surgical pathology, the prevalence of hypothyroidism did not differ in patients with uncomplicated and complicated forms of CAD (7 [3.6%] and 4 [2.5%] patients, respectively, p = 0.5498). Patients with hypothyroidism received hormone replacement therapy with levothyroxine in a dosage prescribed by an endocrinologist. The day before the surgery, thyroid-stimulating hormone control was performed to confirm the achievement of compensation. When comparing the course of the operative period in compensated hypothyroidism and clinical euthyroidism, no significant differences were found, and the postoperative period didn’t differ in the occurrence of atrial fibrillation (p = 0.0801), hydrothorax (p = 0.5280), but a decrease in the estimated glomerular filtration rate at discharge was found in patients with hypothyroidism (59.5 ± 16.8 vs. 71.3 ± 19.6 ml/min/1.73 m2, p = 0.0493).

Conclusions. Timely detection of thyroid dysfunction allows to compensate the condition and avoid postoperative complications. Analysis of the perioperative period in patients with hypothyroidism showed no effect of compensated hypothyroidism on the operative and postoperative periods in high-risk patients with CAD. Decreased glomerular filtration rate after surgery in patients with hypothyroidism requires further study and adherence to the strategy of nephroprotection in polymorbid patients.

References

  1. Gogayeva OK. [Determination of comorbidity index for high-risk patients with coronary artery disease before cardiac surgery]. Zaporozhye medical journal. 2021;23(4):485-91. Ukrainian. https://doi.org/10.14739/2310-1210.2021.4.233643
  2. Chukur OO. [Dynamics of morbidity and expansion of pathology of the thyroid gland among adult population of Ukraine]. Visnyk sotsialnoi hihiieny ta orhanizatsii okhorony zdorovia Ukrainy. 2018;4(78):19-25. Ukrainian. https://doi.org/10.11603/1681-2786.2018.4.10020
  3. Gogayeva OK, Rudenko AV, Lazoryshynets VV, Dzakhoieva LS. [Analysis of the endocrine status of patients with coronary artery disease in cardiac surgery]. Ukrainian Journal of Cardiology. 2021;28(1):26-33. Ukrainian. https://doi.org/10.31928/1608-635X-2021.1.2633
  4. Danzi S, Klein I. Thyroid hormone and the cardiovascular system. Med Clin North Am. 2012;96(2):257-68. https://doi.org/10.1016/j.mcna.2012.01.006
  5. Muneer R, Naqvi SAA, Gul O, Zaidi SDH, Dar MI. Thyroid and Heart: Severe Three Vessel Coronary Artery Disease in a Middle-Aged Female with Hypothyroidism. Cureus. 2019;11(11):e6095. https://doi.org/10.7759/cureus.6095
  6. Pearce SH, Brabant G, Duntas LH, Monzani F, Peeters RP, Razvi S, Wemeau JL. 2013 ETA Guideline: Management of Subclinical Hypothyroidism. Eur Thyroid J. 2013;2(4):215-28. https://doi.org/10.1159/000356507
  7. Bai MF, Gao CY, Yang CK, Wang XP, Liu J, Qi DT, Zhang Y, Hao PY, Li MW. Effects of thyroid dysfunction on the severity of coronary artery lesions and its prognosis. J Cardiol. 2014;64(6):496-500. https://doi.org/10.1016/j.jjcc.2014.03.009
  8. Ning Y, Cheng YJ, Liu LJ, Sara JD, Cao ZY, Zheng WP, Zhang TS, Han HJ, Yang ZY, Zhang Y, Wang FL, Pan RY, Huang JL, Wu LL, Zhang M, Wei YX. What is the association of hypothyroidism with risks of cardiovascular events and mortality? A meta-analysis of 55 cohort studies involving 1,898,314 participants. BMC Med. 2017;15(1):21. https://doi.org/10.1186/s12916-017-0777-9
  9. Kim H, Kong SH, Moon JH, Kim SY, Park KH, Kim JS, Choh JH, Park YJ, Lim C. Subclinical Hypothyroidism Affects the Long-Term Outcomes of Patients Who Undergo Coronary Artery Bypass Grafting Surgery but Not Heart Valve Surgery. Endocrinol Metab (Seoul). 2020;35(2):308-18. https://doi.org/10.3803/EnM.2020.35.2.308
  10. Galindo RJ, Hurtado CR, Pasquel FJ, Garcia Tome R, Peng L, Umpierrez GE. National trends in incidence, mortality, and clinical outcomes of patients hospitalized for thyrotoxicosis with and without thyroid storm in the United States, 2004-2013. Thyroid. 2019;29(1):36-43. https://doi.org/10.1089/thy.2018.0275
  11. Akamizu T. Thyroid storm: a Japanese perspective. Thyroid. 2018;28(1):32-40. https://doi.org/10.1089/thy.2017.0243
  12. Bish LT, Bavaria JE, Augoustides J. Thyroid storm after coronary artery bypass grafting. J Thorac Cardiovasc Surg. 2010;140(5):e67-9. https://doi.org/10.1016/j.jtcvs.2010.06.034
  13. Lee JH. Thyroid storm after coronary artery bypass surgery: a case report. J Cardiothorac Surg. 2020;15(1):22. https://doi.org/10.1186/s13019-020-1044-2
  14. Satoh T, Isozaki O, Suzuki A, Wakino S, Iburi T, Tsuboi K, Kanamoto N, Otani H, Furukawa Y, Teramukai S, Akamizu T. 2016 guidelines for the management of thyroid storm from the Japan thyroid association and Japan Endocrine Society (first edition). Endocr J. 2016;63(12):1025-64. https://doi.org/10.1507/endocrj.EJ16-0336
  15. Tarçın Ö, Orhan G, Tandogar UN, Mihmanl M, Baştopçu M, Yekeler İ. Does thyroid dysfunction affect early mortality and morbidity after coronary artery bypass graft surgery? Cardiovasc Surg Int. 2018;5(1):1-8. https://doi.org/10.5606/e-cvsi.2018.684
  16. Rudenko AV, Bagirov MM, Gogayeva OK, Seyikovskyi OV, Dzakhoeva LS, Zakharova VP, Solomka SM, Klimenko LA, Spisarenko SP, Malysheva TA. [Clinical Case of Surgical Treatment of Thrombosed Aneurysm of Left Ventricle with Concomitant Giant Retrosternal Goiter]. Cardiovascular Surgery Herald. 2014;22:279-84. Russian.
  17. Gogayeva OK. [Preoperative verification of comorbidity in patients with high-risk coronary heart disease on the eve of surgical myocardial revascularization]. Mizhnarodnyi medychnyi zhurnal. 2021;27(3):10-14. Ukrainian. https://doi.org/10.37436/2308-5274-2021-3-2
Published
2022-03-23
How to Cite
Gogayeva, O. K., Rudenko, A. V., Lazoryshynets, V. V., Rudenko, S. A., & Andrushchenko, T. A. (2022). Thyroid Pathology in High-Risk Cardiac Surgery Patients with Coronary Artery Disease. Ukrainian Journal of Cardiovascular Surgery, 30(1), 9-14. https://doi.org/10.30702/ujcvs/22.30(01)/GR009-0914
Issue
Ukrainian Journal of Cardiovascular Surgery Vol 30 No 1 2022
Section
ISCHEMIC HEART DISEASE