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July 10, 1996

Triiodothyronine and Cardiac Surgery

Author Affiliations

Lemoyne, Pa

JAMA. 1996;276(2):100. doi:10.1001/jama.1996.03540020022013

To the Editor.  —The article by Dr Bennett-Guerrero and colleagues1 gives the impression that triiodothyronine (T3) is being considered for routine use in the community as an inotropic agent after coronary artery bypass surgery. My hospital's cost for T3 is $900, and the cost for dopamine is $15. Dopamine will always be preferential on a routine basis on cost alone.Animal data show that T3 is most beneficial after severe global myocardial ischemia.2-4 Yet the study by Bennett-Guerrero et al excluded all preoperative patients requiring intraaortic balloon pump or inotropic support. Essentially, the group of patients most likely to benefit were excluded from the trial.The comparison of a hormone to an inotropic agent is the comparison of apples to oranges. The mechanism of action is different. No one is sure how T3 works on myocardial cell function. I agree that dopamine is the