Fistula Rate After Salvage Laryngectomy With Aggressive Levothyroxine Replacement, A Prospective Phase 2 Clinical Trial

Patients undergoing salvage laryngectomy are predisposed to hypothyroidism due to the tissue effects of radiation and due to surgical manipulation of the thyroid during surgery. Hypothyroidism impairs wound healing and has been linked to pharyngocutaneous fistula formation. These effects are compounded by the sequela of prior radiation (XRT) and chemoradiation (CRT), which induces a hypoxic, hypocellular, and hypovascular environment, which also predisposes patients to fistula formation. The hypothesis of this study is that aggressive thyroid hormone replacement after salvage laryngectomy reduces the rate of pharyngocutaneous fistula.