Malnutrition and nonthyroidal illness syndrome after stroke

In the present study, nonthyroidal illness syndrome (NTIS), which is characterized by reduction of serum triiodothyronine (T3) without elevation of thyroid-stimulating hormone (TSH), was induced by protein-energy malnutrition (PCM). Protein-energy malnutrition is a common condition and is associated with worse clinical outcome in stroke patients admitted to a rehabilitation service. However, little is known about NTIS in stroke patients. Therefore, we studied the effects of PCM and NTIS on functional dependence in 51 stroke patients. We examined thyroid function by measuring serum free T3 (free T3), free thyroxine (free T4), and TSH. We estimated whether patients had mild NTIS (reduction of only free T3) or serious NTIS (reduction of both free T3 and free T4), examined PCM by measuring serum albumin, calculated body mass index (BMI) from weight and height on admission, and examined disability by obtaining the functional independence measurement (FIM). The 51 patients were divided into 2 groups according to FIM score on admission (low and high). The low-FIM group was divided into 2 subgroups according to the change in FIM score during hospitalization (improved or non-improved). Hypoalbuminemia was observed in 57% of patients, underweight in 22%, and mild NTIS in 82%; serious NTIS was not observed in any patients. Albumin and BMI were significantly higher in the high-FIM group than in the low-FIM group. Serum albumin concentration and BMI significantly positively correlated with free T3. Free T3 (but not albumin or BMI) was significantly higher in the improved subgroup than in the non-improved subgroup. Nonthyroidal illness syndrome after stroke was common and was provoked by PCM, which occurred in a high proportion of functionally dependent patients. It appears that, once stroke patients develop NTIS, it is difficult to achieve functional improvement. Therefore, during the recovery period after stroke, it is important to determine whether NTIS is present and ensure proper intensive rehabilitation and nutritional management.