Perioperative Thyroid Hormone Kinetics in Patients Undergoing Major Oral and Maxillofacial Operations

Purpose

The aim of this study was to investigate the perioperative response of serum thyroid hormones in patients who underwent extensive maxillofacial operations with desflurane (0.2 to 1.5 MAC) and remifentanil (0.05 to 0.3 μg/kg/min) anesthesia.

Materials and Methods

Serum thyroxine, total and free triiodothyronine, thyroid-stimulating hormone, interleukin-1β and 6, TNF-α, free fatty acids, S100B protein, CRP, as well as amyloid A protein were measured in 13 patients subjected to extensive oral and maxillofacial operations. Samples were collected before anesthesia induction, at the end, and 6, 12, 24, and 72 hours after the end of surgery. Patients during the study fasted, and at the postoperative period received Ringer’s saline or with 5% dextrose alternatively, at the rate of 0.5 to 1.5 mL/kg/hr.

Results

Thyroid hormones concentrations showed a significant decrease over time whereas their values recovered to the baseline 72 hours after surgery. Interleukin 1β, 6, S100B protein, CRP, serum amyloid A protein, and free fatty acids showed a significant increase 6, 12, and 24 hours after the end of the operation as related to the basal value. No significant clinical complications were recorded over the study.

Conclusion

Patients undergoing extensive oral and maxillofacial surgery exhibit marked decrease in serum thyroid hormones. Stress response, anesthesia, and perioperative fasting may be decisive factors eliciting this response. These metabolic derangements do not deteriorate the clinical outcome and subsequently may be an adaptive response for energy preservation in various organs.

⁎ Senior Researcher, Department of Pharmacology, University of Athens, Athens, Greece.

† Consultant, Department of Anaesthesiology, General Hospital of Athens, Athens, Greece.

‡ Consultant and Head of the Department, Department of Oral and Maxillofacial Surgery, General Hospital of Athens, Athens, Greece.

§ Associate Professor, Department of Plastic and Reconstructive Surgery, General Hospital of Ioannina, University of Ioannina, Ioannina, Greece.

∥ Research Fellow, Department of Pharmacology, Medical School, University of Athens, Athens, Greece.

¶ Consultant, Department of Oral and Maxillofacial Surgery, General Hospital of Athens, Athens, Greece.

# Resident, Department of Anesthesiology, General Hospital of Athens, Athens, Greece.

⁎⁎ Consultant, Department of Anaesthesiology, General Hospital of Athens, Athens, Greece.

†† Consultant and Head of the Department, Department of Anesthesiology, General Hospital of Athens, Athens, Greece.

‡‡ Assistant Professor, Department of Pharmacology, Medical School, University of Athens, Athens, Greece.

§§ Associate Professor, Department of Pharmacology, Medical School, University of Athens, Athens, Greece.

Address correspondence and reprint requests to Dr Saranteas: 19, Karatza str and Klemanso, 18534 Piraeus, Greece

PII: S0278-2391(06)01381-4

doi:10.1016/j.joms.2005.12.067

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