Background: To develop an understanding of current practices in the management of
transient secondary hypothyroidism in pediatric postoperative cardiopulmonary bypass (CPB) patients.
Methods: Electronic survey comprising a 10-item questionnaire was sent to sixty-four high volume
pediatric heart centers in the United States and United Kingdom. Survey participants included
cardiologists, intensivists, cardiothoracic surgeons, and advanced practice providers. A retrospective
chart review was also performed at a large regional referral center in the Midwest on subjects
0-18 years old who underwent CPB from 2005-2015. Information obtained included a unique identifier,
date of birth, age, procedure performed, CPB time, date of surgery and date and type of Thyroid
Function Test (TFT) ordered.
Results: 1,153 individuals from 64 congenital heart centers were contacted via email to participate
in the electronic survey. In the 3-month response window, 129 completed surveys were received
from cardiologists (55%), intensivists (17%), surgeons (15%), “other” (8%), and advanced practice
providers (5%). This yielded a response rate of 11.2%. Of the 129 respondents, only 10 providers
routinely order TFTs prior to (n=7) and after (n=1) CPB or when clinically indicated (n=2). All 10
providers order thyroid stimulating hormone test, 7 order thyroxine, and 3 order triiodothyronine.
Only 1 provider routinely treats children with prophylactic thyroid hormone replacement therapy
after CPB. Our retrospective review included 502 CPB events with 442 unique patients. Of the
events, 20 patients received preoperative TFT testing while 11 received postoperative testing.
Conclusions: There is a general lack of uniformity in the evaluation, diagnosis, and treatment of
transient secondary hypothyroidism in pediatric postoperative CPB patients.