Oral and intravenous thyroxine (T4) achieve comparable serum levels for hormonal resuscitation protocol in organ donors: a randomized double-blinded study.
Sharpe MD, van Rassel B, et al.Canadian Journal of Anaesthesia 2013; 60(10): 998-1002.
Aims
To investigate whether oral administration of T4 achieves comparable serum T4 levels in solid organ donors, and if hemodynamic responses are similar to those of intravenous administration.
Interventions
Patients received either an oral or intravenous dose of T4. All patients received an oral and intravenous study drug preparation, one of which was a placebo.
Participants
32 adult solid organ donors.
Outcomes
The outcomes include the number and duration of inotropic/vasopressor therapies and free serum levels of T3 and T4.
Follow-up
13 hours.
CET Conclusions
This is a nicely done study which shows that orally administered T4 is well absorbed in organ donors, achieving a bioavailability of over 90% of intravenous T4. There was no difference in the time that donors required inotropic/vasopressor support prior to organ procurement with oral or IV T4 and the plasma T3 and T4 levels were similar as was the number of organs donated from donors. Thus assuming that hormonal resuscitation in organ donors (steroid, thyroxin and vasopressin) is important in providing a better quality donor (and to my mind this remains unproven) then T4 can be administered orally, which is important in that intravenous T4 is not always available.
Data analysis
Per protocol analysis
Trial registration
ClinicalTrials.gov NCT00238030