The prognostic value of severe malnutrition in the development of nonthyroidal illness in head and neck cancer patients.
BACKGROUND
Thyroid hormone metabolism is modulated by starvation and overfeeding but also by dietary composition. Unfortunately, little is known about the effect of malnutrition on disease-induced nonthyroidal illness (NTI). In this study, we investigated whether the degree of NTI after surgery differed between severely malnourished and well-fed patients with head and neck cancer.


METHODS
Plasma levels of the thyroid hormones 3',5-triiodothyronine (T(3)), reverse T(3) (rT(3)), free T(4) (FT(4)), and thyrotropin (TSH) were measured on the first day before the operation and on the first, fourth, and seventh day after the operation in 16 malnourished patients who were admitted for intentional curative surgery of T1-T4 carcinomas of the head and neck. Six well-fed head and neck cancer patients eligible for surgical treatment served as a control group.


RESULTS
In the malnourished group, rT(3) showed a significant increase, whereas T(3) and FT(4) decreased significantly due to the operation. TSH showed no significant change. During the postoperative course, it took 7 days until rT(3) and 4 days until T(3) and FT(4) were restored to their preoperative value. In contrast, well-fed patients did not develop NTI.


CONCLUSIONS
This study shows that peri- and postoperative rT(3), T(3), and FT(4) levels change significantly in malnourished patients compared with well-fed patients. Therefore, it can be concluded that nutrition status of patients undergoing major head and neck surgery should be optimized in order to prevent the development of NTI.
Siroen
M P C
MP
Department of Surgery, VU University Medical Center, Amsterdam, The Netherlands.
van Bokhorst-de van der Schueren
M A E
MA
Richir
M C
MC
Sauerwein
H P
HP
Leemans
C R
CR
Quak
J J
JJ
van Leeuwen
P A M
PA
D016022:Case-Control Studies; D005260:Female; D006258:Head and Neck Neoplasms / Q000097:blood / Q000150:complications* / Q000601:surgery; D006801:Humans; D008297:Male; D044342:Malnutrition / Q000097:blood / Q000150:complications*; D008875:Middle Aged; D009752:Nutritional Status; D011184:Postoperative Period; D011379:Prognosis; D011446:Prospective Studies; D013959:Thyroid Diseases / Q000097:blood / Q000453:epidemiology* / Q000209:etiology; D013963:Thyroid Hormones / Q000097:blood*; D013972:Thyrotropin / Q000097:blood; D013974:Thyroxine / Q000097:blood; D014284:Triiodothyronine / Q000097:blood; D014285:Triiodothyronine, Reverse / Q000097:blood
D013963:Thyroid Hormones; D014284:Triiodothyronine; D014285:Triiodothyronine, Reverse; D013972:Thyrotropin; D013974:Thyroxine