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The Prognostic Value of Severe Malnutrition in the Development of Nonthyroidal Illness in Head and Neck Cancer Patients

M. P. C. Siroen, MD^*, M. A. E. van Bokhorst-de van der Schueren, PhD, M. C. Richir, MD^*, H. P. Sauerwein, MD, PhD, C. R. Leemans, MD, PhD, J. J. Quak, MD, PhD and P. A. M. van Leeuwen, MD, PhD^*

From the ^* Departments of Surgery, Dietetics, and Otolaryngology/Head and Neck Surgery, VU University Medical Center, Amsterdam, The Netherlands; and the Department of Internal Medicine, Academic Medical Center, Amsterdam, The Netherlands

Correspondence: P. A. M. van Leeuwen, MD, PhD, VU University Medical Center, Department of Surgery, PO Box 7057, 1007 MB Amsterdam, The Netherlands. Electronic mail may be sent to pam.vleeuwen{at}vumc.nl or mpc.siroen{at}vumc.nl.

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 (T₃), reverse T₃ (rT₃), free T₄ (FT₄), 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, rT₃ showed a significant increase, whereas T₃ and FT₄ decreased significantly due to the operation. TSH showed no significant change. During the postoperative course, it took 7 days until rT₃ and 4 days until T₃ and FT₄ were restored to their preoperative value. In contrast, well-fed patients did not develop NTI. Conclusions: This study shows that peri- and postoperative rT₃, T₃, and FT₄ 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.

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