From the Guidelines
Levothyroxine (T4) is not used in brain death, instead, triiodothyronine (T3) is used.
Rationale for Hormonal Resuscitation
- The goal of hormonal resuscitation is to improve ventricular performance, raise systolic blood pressure, and reduce inotropic requirements in brain-dead donors 1.
- Triiodothyronine (T3) is used in hormonal resuscitation, with a recommended dose of 4-µg bolus, followed by a continuous infusion at 3 µg/h 1.
- The use of T3, along with other hormones such as arginine vasopressin and methylprednisolone, has been shown to improve donor management and increase the number of organs available for transplantation 1.
- Levothyroxine (T4) is not mentioned in the provided evidence as a recommended treatment for brain-dead donors, and its use is not supported by the available data 1.
- Key points to consider when managing brain-dead donors include:
- Maintaining acid-base balance and correcting hormonal perturbations
- Achieving euvolemia and adjusting vasoconstrictors and vasodilators to maintain a normal afterload
- Optimizing cardiac output without relying on high doses of β-agonists or other inotropes 1.
From the Research
Use of Levothyroxine in Brain Death
- Levothyroxine (T4) is used in brain death to reverse hemodynamic instability and prevent cardiovascular collapse, leading to more available organs for transplantation 2.
- The administration of levothyroxine sodium therapy in brain-dead potential organ donors has been shown to decrease vasopressor requirements and prevent cardiovascular collapse, resulting in an increase in the quantity and quality of organs available for transplantation 2.
Hemodynamic Effects of Levothyroxine
- A study found that levothyroxine therapy plays an important role in the management of hemodynamically unstable potential organ donors by decreasing vasopressor requirements and preventing cardiovascular collapse 2.
- However, another study found that intravenous levothyroxine infusion did not result in significantly more hearts being transplanted than saline infusion in hemodynamically unstable brain-dead potential heart donors 3.
- High-dose methylprednisolone alone or in combination with levothyroxine allowed for significant reduction in vasopressor support in organ donors, while levothyroxine alone offered no advantage in reducing vasopressor support 4.
Organ Donation Outcomes
- Early initiation of levothyroxine therapy before the declaration of brain death may be considered in potential organ donors, as it was associated with an increase in solid organ procurement rate 5.
- The use of levothyroxine in brain-dead potential organ donors has been proposed to maximize donation and transplant outcomes, but its efficacy is controversial due to lack of high-level evidence 6.
- A study found that the early use of levothyroxine and aggressive blood product resuscitation was associated with a significantly higher number of solid organs donated per donor 5.