Low TSH level predicts a poor clinical outcome in patients with anterior circulation ischemic stroke after endovascular thrombectomy

Chen, Zhongyun; Sun, Yijia; Zhang, Yingbo; He, Yanbo; Chen, Hongbo; Su, Yingying

doi:10.1007/s10072-020-04281-0

“…Studies investigating the relationship between TSH level and outcome in the acute phase revealed conflicting results. While two studies demonstrated a protective effect of elevated TSH on stroke severity and prognosis [ 27 , 28 ], another study failed to find such association [ 29 ]. According to a meta-analysis, patients with low initial TSH levels have a poor outcome at 3-month follow-up.…”

Section: Discussionmentioning

confidence: 99%

Thyroid Hormone Levels Help to Predict Outcome of Critically Ill Patients Undergoing Early Neurological Rehabilitation

Boltzmann

¹

,

Schmidt

²

,

Rollnik

³

2022

BioMed Research International

1

0

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The present study was aimed at examining thyroid hormones and other clinical factors to improve the accuracy of outcome prediction among critically ill patients undergoing early neurological rehabilitation. Patients consecutively admitted to an intensive or intermediate care unit were screened for eligibility. Serum levels of free triiodothyronine (fT3), free thyroxine (fT4), and thyroid-stimulating hormone (TSH) were collected during the first three days after admission. The Glasgow Outcome Scale (GOS) was defined as the primary outcome measure. Thyroid hormone levels and other clinical factors were entered into a binary logistic regression model to predict a good outcome at the end of early rehabilitative treatment. 395 patients (268 males) with a median age of 62 years ( IQR = 52 − 76 ) and a median disease duration of 19 days ( IQR = 13 − 28 ) were included in the study. Most patients (80%) had decreased fT3 values. Patients with low fT3 were admitted earlier to the rehabilitation facility and had more severe impairment upon admission compared to patients with fT3 values within the normal range. Both decreased fT3 and TSH levels were associated with an unfavorable outcome ( GOS ≤ 3 ), but only TSH proved to be an independent predictor in multivariate analyses ( OR = 1.11 ; 95 % CI = 1.02 − 1.22 ). These data suggest that decreased fT3 and TSH levels upon admission may predict an unfavorable outcome at the end of early rehabilitative treatment. Thus, thyroid hormone levels are not only important during acute treatment but also in prolonged critical illness.

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“…Data on the prevalence of low TSH (5.4–32.6%) was reported in a few studies [ 76 , 106 ]. Low TSH was an independent risk factor for mortality [ 106 ], poor functional outcome [ 76 , 106 ], and it showed the potential to predict fatigue after acute ischemic stroke [ 107 ].…”

Section: Thyroid Hormones and Clinical Outcomes In Post-stroke Patientsmentioning

confidence: 99%

“…Data on the prevalence of low TSH (5.4–32.6%) was reported in a few studies [ 76 , 106 ]. Low TSH was an independent risk factor for mortality [ 106 ], poor functional outcome [ 76 , 106 ], and it showed the potential to predict fatigue after acute ischemic stroke [ 107 ]. Recently, it was reported that high TSH levels on admission might be associated with mortality [ 108 ] and depression in acute ischemic stroke patients [ 109 ].…”

Section: Thyroid Hormones and Clinical Outcomes In Post-stroke Patientsmentioning

confidence: 99%

Cardiovascular and Neuronal Consequences of Thyroid Hormones Alterations in the Ischemic Stroke

Murolo

¹

,

Vincenzo

²

,

Cicatiello

³

et al. 2022

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Ischemic stroke is one of the leading global causes of neurological morbidity and decease. Its etiology depends on multiple events such as cardiac embolism, brain capillaries occlusion and atherosclerosis, which ultimately culminate in blood flow interruption, incurring hypoxia and nutrient deprivation. Thyroid hormones (THs) are pleiotropic modulators of several metabolic pathways, and critically influence different aspects of tissues development. The brain is a key TH target tissue and both hypo- and hyperthyroidism, during embryonic and adult life, are associated with deranged neuronal formation and cognitive functions. Accordingly, increasing pieces of evidence are drawing attention on the consistent relationship between the THs status and the acute cerebral and cardiac diseases. However, the concrete contribution of THs systemic or local alteration to the pathology outcome still needs to be fully addressed. In this review, we aim to summarize the multiple influences that THs exert on the brain and heart patho-physiology, to deepen the reasons for the harmful effects of hypo- and hyperthyroidism on these organs and to provide insights on the intricate relationship between the THs variations and the pathological alterations that take place after the ischemic injury.

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“…There are some evidences that thyroid hormones play a neuroprotective role in the recovery of post-ischemic stroke (7) and display a protective association between subclinical hypothyroidism and better outcomes (8,9) However, other studies suggest that lower serum concentrations of T3 are associated with poor outcome after ischemic stroke (6,10).In addition, it is not well recognized whether there are any associations between FT3, the bioactive form of T3, and functional outcome of ischemic stroke. Studies on the relationship between FT3 levels and functional outcomes after ischemic stroke are controversial (10)(11)(12)(13)(14)(15)(16) .Thus, our study aimed to investigate whether the serum concentrations of thyroid hormones on admission, including thyroid stimulating hormone (TSH), free triiodothyronine (FT3), and free thyroxine (FT4) were associated with 3-month functional outcome in acute ischemic stroke.…”

Section: Introductionmentioning

confidence: 99%

Free triiodothyronine is associated with poor outcome after acute ischemic stroke

Song

¹

,

Yang

²

,

Wang

³

2021

Preprint

0

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Aims It is unclear whether thyroid hormones are associated with functional outcome after ischemic stroke. We aimed to investigate the impact of thyroid hormones at admission on functional outcome at 3 months after acute ischemic stroke. Methods A total of 480 consecutive patients for ischemic stroke within 48 hours of onset were enrolled in this study. Thyroid hormones including thyroid-stimulating hormone (TSH), free triiodothyronine (FT3), and free thyroxine (FT4) were measured at admission and functional outcomes were assessed at 3 months with the modified Rankin Scale (mRS) ranging from 0 to 6. Poor outcome was defined as mRS≥3. Results FT3 levels at admission were considerably lower in poor outcome patients than those with good outcome at 3 months (3.53±0.70pmol/L vs 4.04±0.68pmol/L, respectively; P＜0.001). Lower levels of FT3 were observed with higher mRS scores. Multivariable logistic regression analysis revealed that FT3 levels were significantly associated with risk of poor outcome at 3 months independent of conventional risk factors such as age, NIHSS score and recanalized therapy. In addition, patients in the bottom quartile of FT3 levels had a 2.56-fold higher risk of developing poor outcome compared with patients in the top quartile (OR=2.56; 95%CI 1.15-5.69, p =0.021). The sensitivity and specificity of FT3 (≤3.69pmol/L) predicting poor outcome were 62.70% and 72.03% respectively. Conclusion Our study suggests that FT3 levels at admission are significantly and independently associated with risk of poor outcome after ischemic stroke and lower FT3 levels can be regarded as a prognostic biomarker for poor outcome at 3 months.

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Low TSH level predicts a poor clinical outcome in patients with anterior circulation ischemic stroke after endovascular thrombectomy

Cited by 11 publications

References 36 publications

Thyroid Hormone Levels Help to Predict Outcome of Critically Ill Patients Undergoing Early Neurological Rehabilitation

Thyroid Hormone Levels Help to Predict Outcome of Critically Ill Patients Undergoing Early Neurological Rehabilitation

Cardiovascular and Neuronal Consequences of Thyroid Hormones Alterations in the Ischemic Stroke

Free triiodothyronine is associated with poor outcome after acute ischemic stroke

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