The Effects of Supplementary Parenteral Nutrition on Thyroid Hormone Patterns in Surgical Patients with Liver Cirrhosis

Kiyoaki Ouchi, Shuji Matsubara, Ryuji Sato, Junichi Mikuni, Seiki Matsuno

Department of Surgery, Tohoku University School of Medicine

The relationship between nutritional intervention and circulating thyroid hormones and rapid-turnover proteins was investigated in surgical patients with liver cirrhosis. Fourteen patients with well-comensated liver cirrhosis who were operated on esophageal varices or hepatoma were divided into two groups. The oral group was offered an oral diet containing 2.200 Kcal/day before the operation and conventional intravenous infusions of 5% glucose after the operation (500∼600 Kcal/day). The supplementary parenteral nutrition (SPN) group was offered the same oral diet as the oral group, combined with intravenous 50% glucose, fat emulsion and branched-chain enriched amino acids solution, 600∼1,000 Kcal and 7.32 g of nitrogen per day during the 10 days before operation, and 800∼1,800 Kcal and 7.32∼9.76 g of nitrogen per day during the first 2 postoperative weeks. The plasma triiodothvronine (T3) level was higher in the SPN group (1.26±0.09 ng/ml) than in the oral group (0.91±0.08) (p<0.001) and the reverse T3 (rT3) level was lower in the SPN group (297±33 pg/ml) than in the oral group (351±29) (p<0.01) on the day of surgery. In addition, SPN significantly attenuated the low T3 and high rT3 levels found in the oral group throughout the 2 postoperative weeks. Furthermore, attenuation of decreases in very shortturnover proteins was achieved in the SPN group. It is likely that SPN contributed to the partial correction of liver dysfunction and metabolic imbalance in traumatized cirrhotic patients.

Key words
liver cirrhosis, perioperative nutritional support, thyroid hormones, rapid-turnover protein

Reprint requests
Kiyoaki Ouchi Department of Surgery, Tohoku University School of Medicine
1-1 Seiryomachi, Aoba-ku, Sendai, 980 JAPAN

Accepted
June 13, 1990

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