Long-term follow-up of a double-blind, randomised, placebo controlled study of Triiodothyronine (T3) treatment in children after cardiac surgery

Program: Abstracts - Orals, Featured Poster Presentations, and Posters
Session: MON 437-470-Non-neoplastic Thyroid Disorders
Monday, June 17, 2013: 1:45 PM-3:45 PM
Expo Halls ABC (Moscone Center)

Poster Board MON-441
Markus Bettendorf*1, Janna Mittnacht1, Romuald Brunner1, Matthias Gorenflo2 and Daniela Choukair1
1University Hospital Heidelberg, Heidelberg, Germany, 2Universtity Hospial Heidelberg, Heidelberg, Germany
Objectives: Transient secondary hypothyroidism occurs in children with congenital cardiac malformations after cardiopulmonary bypass (CPB) operations. We previously reported significant benefits of acute postoperative T3 treatment on their recovery (1). Now we evaluated the long-term outcome on cognitive and motor development in these children.

Methods: 40 children (median age 0.6 years) with congenital cardiac malformations were initially randomized in a double blind protocol and treated either with one daily infusion of 1 µg/kg T3 or saline for a maximum time of 12 days after surgery. 28 of these 40 children (placebo n= 14, T3 n =14) could now be recruited for a structured follow-up examination (median age 11.8 years) including tests for neuropsychological functioning (Wechsler Intelligence Scale for children (WISC-III), Trail Making Test Part B (TMT B), d2 Test of Attention (d2), Lincoln-Oseretzky Motor Development Scale (LOS KF 18); Child Behavior Checklist for assessment of emotional and behavioral problems) and evaluations of thyroid functions (plasma TSH,T4,T3,fT4,fT3,rT3,thyroglobulin) and cardiac functions (echocardiography). The original blind study design was retained. Results are given as mean and confidence interval. The study was approved by the local ethics committee.

Results: The full scale IQ score (WISC-III: 100;94-106) of all children were within the reference range (91-109) and similar in the placebo and the T3 group (101;93 -108 and 99;87 -111; p=ns). Tests for motor and cognitive functions (LOS KF 18, TMT B and d2) as thyroid functions and indices of cardiac function were also not significantly different in the two study groups.

Conclusion: Overall intellectual development is preserved in adolescents with congenital cardiac malformations previously treated with CPB operations in infancy irrespective of low postoperative thyroid hormone concentrations and T3 supplementation. While the acute postoperative T3 treatment in children after CPB improves recovery, no significant long-term effects on cognitive and motor developments, thyroid fuctions or indices of cardiac function could be detected.

(1) Bettendorf M et al. Lancet. 2000;356(9229):529-34.

Nothing to Disclose: MB, JM, RB, MG, DC

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