The Potential Association of Later Initiation of Oral/Enteral Nutrition on Euthyroid Sick Syndrome in Burn Patients

Abstract

Objective. The aim of this study was to determine if early initiation of oral/enteral nutrition in burn patients minimizes the drop in fT3 levels, reduces the potential for euthyroid sick syndrome (ESS), and shortens the length of hospital stay (LHS). Subjects and Methods. We retrospectively evaluated the statistical association of serum fT3, fT4, and TSH at the first (2nd–5th day) and second sample collection (9th–12th day) after the burn injury in 152 burn patients. Three groups were established depending on time of initiation of the oral/enteral nutrition: <24 h before the injury (Group 1), 24–48 h after the injury (Group 2), and >48 h after the injury (Group 3). Results. They were expressed as mean ± standard deviation. We found that LHS and the fT3 levels were statistically different in the 3 groups. The LHS (in days) was, respectively, in each group, 16.77 ± 4.56, 21.98 ± 4.86, and 26.06 ± 5.47. Despite the quantifiable drop in fT3, ESS was present only at the first sample collection (2.61 ± 0.92 days) in Group 3, but there was no group with ESS at the second sample collection (9.89 ± 1.01 days). Our data suggest that early initiation of nutritional supplementation decreases the length of hospitalization and is associated with decreasing fT3 serum concentration depression. Conclusion. Early initiation of oral/enteral nutrition counteracts ESS and improves the LHS in burn patients.

Euthyroid Sick Syndrome

“…Studies have shown that early nutritional support in postoperative patients can prevent development of the euthyroid sick syndrome, suggesting again that acute fasting-induced euthyroid sick syndrome is an adaptive and potentially beneficial mechanism (65). On the other hand, early feeding within 24 h in hospitalized burn patients with evidence of the euthyroid sick syndrome, compared to delayed feeding after more than 48 h was associated with prevention of euthyroid sick syndrome development as well as decreased length of stay (90). As most acute illness is accompanied by decrease in caloric intake or malnutrition and/or a higher catabolic state, this aspect of the euthyroid sick syndrome appears to be physiologic and does not require treatment with thyroid hormone replacement.…”

Therapeutic Efficacy of Nasoenteric Tube Feeding in Children Needing Enteral Nutrition

“…A meta-analysis and systemic review study reported that early enteral nutrition provided within 24 h after injury showed benefits of a reduced duration of hospital stay and low caloric deficit and weight loss but a high incidence of diarrhea and vomiting in pediatric burn patients (30). Hypoalbuminemia in burn patients is strongly associated with burn severity and high mortality rate (31,32).…”

Role of enteral nutrition in nonthyroidal illness syndrome: a retrospective observational study

“…Previous studies have reported several approaches for improving thyroid function in different patient populations with NTIS [ 4 – 6 ]. Some studies suggested the association between nutritional deficiency and NTIS, indicating a potential role of enteral nutrition (EN) therapy in resolving NTIS [ 7 , 8 ]. Conversely, other studies reported that underlying illness plays a key role in NTIS, suggesting that EN therapy would not be expected to aid in the resolution of the thyroid abnormalities [ 9 , 10 ].…”