1
|
Shafia S, Khoramirad A, Akhoundzadeh K. Thyroid hormones and stroke, the gap between clinical and experimental studies. Brain Res Bull 2024; 213:110983. [PMID: 38795852 DOI: 10.1016/j.brainresbull.2024.110983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Revised: 05/19/2024] [Accepted: 05/21/2024] [Indexed: 05/28/2024]
Abstract
Despite plenty of human studies on changes in thyroid hormones after stroke and some animal studies that assessed the effects of thyroid hormone administration on stroke, conclusive evidence for clinical application is lacking. This review aimed to determine the consistency of the results between clinical and preclinical studies. This article reviewed the PubMed, Embase, web of Knowledge, and Google Scholar databases up to June 2023 using the MeSH terms "stroke, cerebral ischemia, cerebral infarction, brain ischemia, brain infarction, triiodothyronine (T3), tetraiodothyronine (T4), thyroxine (T4), and thyroid hormone". The results of clinical and preclinical studies related to T3 substantially confirm each other. That is, in most human studies lower T3 was associated with poor outcomes, and in experimental studies, T3 administration also had therapeutic effects. However, the results of experimental studies related to T4 could not support those of clinical studies. There seem to be some conflicts between experimental and human studies, especially regarding changes and effects of T4 after stroke. The gap between experimental and clinical studies may lead to non-applicable results, wasting time and money, and unnecessary killing of animals.
Collapse
Affiliation(s)
- Sakineh Shafia
- Immunogenetic Research Center, Department of Physiology, Mazandaran University of Medical Sciences, Sari, Iran.
| | - Ashraf Khoramirad
- Department of Nursing, Qom University of Medical Sciences, Qom, Iran.
| | - Kobra Akhoundzadeh
- Department of Physiology, Qom University of Medical Sciences, Qom, Iran.
| |
Collapse
|
2
|
Gkantzios A, Karapepera V, Tsiptsios D, Liaptsi E, Christidi F, Gkartzonika E, Karatzetzou S, Kokkotis C, Kyrtsopoulos M, Tsiakiri A, Bebeletsi P, Chaidemenou S, Koutsokostas C, Tsamakis K, Baltzi M, Mpalampanos D, Aggelousis N, Vadikolias K. Investigating the Predictive Value of Thyroid Hormone Levels for Stroke Prognosis. Neurol Int 2023; 15:926-953. [PMID: 37606393 PMCID: PMC10443262 DOI: 10.3390/neurolint15030060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 07/26/2023] [Accepted: 07/28/2023] [Indexed: 08/23/2023] Open
Abstract
Given the expansion of life expectancy, the aging of the population, and the anticipated rise in the number of stroke survivors in Europe with severe neurological consequences in the coming decades, stroke is becoming the most prevalent cause of functional disability. Therefore, the prognosis for a stroke must be timely and precise. Two databases (MEDLINE and Scopus) were searched to identify all relevant studies published between 1 January 2005 and 31 December 2022 that investigated the relationship between thyroid hormone levels and acute stroke severity, mortality, and post-hospital prognosis. Only full-text English-language articles were included. This review includes Thirty articles that were traced and incorporated into the present review. Emerging data regarding the potential predictive value of thyroid hormone levels suggests there may be a correlation between low T3 syndrome, subclinical hypothyroidism, and poor stroke outcome, especially in certain age groups. These findings may prove useful for rehabilitation and therapy planning in clinical practice. Serum thyroid hormone concentration measurement is a non-invasive, relatively harmless, and secure screening test that may be useful for this purpose.
Collapse
Affiliation(s)
- Aimilios Gkantzios
- Neurology Department, Democritus University of Thrace, 68100 Alexandroupolis, Greece; (A.G.); (V.K.); (E.L.); (F.C.); (S.K.); (M.K.); (A.T.); (P.B.); (S.C.); (C.K.); (K.V.)
| | - Vaia Karapepera
- Neurology Department, Democritus University of Thrace, 68100 Alexandroupolis, Greece; (A.G.); (V.K.); (E.L.); (F.C.); (S.K.); (M.K.); (A.T.); (P.B.); (S.C.); (C.K.); (K.V.)
| | - Dimitrios Tsiptsios
- Neurology Department, Democritus University of Thrace, 68100 Alexandroupolis, Greece; (A.G.); (V.K.); (E.L.); (F.C.); (S.K.); (M.K.); (A.T.); (P.B.); (S.C.); (C.K.); (K.V.)
| | - Eirini Liaptsi
- Neurology Department, Democritus University of Thrace, 68100 Alexandroupolis, Greece; (A.G.); (V.K.); (E.L.); (F.C.); (S.K.); (M.K.); (A.T.); (P.B.); (S.C.); (C.K.); (K.V.)
| | - Foteini Christidi
- Neurology Department, Democritus University of Thrace, 68100 Alexandroupolis, Greece; (A.G.); (V.K.); (E.L.); (F.C.); (S.K.); (M.K.); (A.T.); (P.B.); (S.C.); (C.K.); (K.V.)
| | - Elena Gkartzonika
- School of Philosophy, University of Ioannina, 45110 Ioannina, Greece;
| | - Stella Karatzetzou
- Neurology Department, Democritus University of Thrace, 68100 Alexandroupolis, Greece; (A.G.); (V.K.); (E.L.); (F.C.); (S.K.); (M.K.); (A.T.); (P.B.); (S.C.); (C.K.); (K.V.)
| | - Christos Kokkotis
- Department of Physical Education and Sport Science, Democritus University of Thrace, 69100 Komotini, Greece; (C.K.); (M.B.); (D.M.); (N.A.)
| | - Mihail Kyrtsopoulos
- Neurology Department, Democritus University of Thrace, 68100 Alexandroupolis, Greece; (A.G.); (V.K.); (E.L.); (F.C.); (S.K.); (M.K.); (A.T.); (P.B.); (S.C.); (C.K.); (K.V.)
| | - Anna Tsiakiri
- Neurology Department, Democritus University of Thrace, 68100 Alexandroupolis, Greece; (A.G.); (V.K.); (E.L.); (F.C.); (S.K.); (M.K.); (A.T.); (P.B.); (S.C.); (C.K.); (K.V.)
| | - Paschalina Bebeletsi
- Neurology Department, Democritus University of Thrace, 68100 Alexandroupolis, Greece; (A.G.); (V.K.); (E.L.); (F.C.); (S.K.); (M.K.); (A.T.); (P.B.); (S.C.); (C.K.); (K.V.)
| | - Sofia Chaidemenou
- Neurology Department, Democritus University of Thrace, 68100 Alexandroupolis, Greece; (A.G.); (V.K.); (E.L.); (F.C.); (S.K.); (M.K.); (A.T.); (P.B.); (S.C.); (C.K.); (K.V.)
| | - Christos Koutsokostas
- Neurology Department, Democritus University of Thrace, 68100 Alexandroupolis, Greece; (A.G.); (V.K.); (E.L.); (F.C.); (S.K.); (M.K.); (A.T.); (P.B.); (S.C.); (C.K.); (K.V.)
| | - Konstantinos Tsamakis
- King’s College London, Institute of Psychiatry, Psychology and Neuroscience, London SE5 8AF, UK;
| | - Maria Baltzi
- Department of Physical Education and Sport Science, Democritus University of Thrace, 69100 Komotini, Greece; (C.K.); (M.B.); (D.M.); (N.A.)
| | - Dimitrios Mpalampanos
- Department of Physical Education and Sport Science, Democritus University of Thrace, 69100 Komotini, Greece; (C.K.); (M.B.); (D.M.); (N.A.)
| | - Nikolaos Aggelousis
- Department of Physical Education and Sport Science, Democritus University of Thrace, 69100 Komotini, Greece; (C.K.); (M.B.); (D.M.); (N.A.)
| | - Konstantinos Vadikolias
- Neurology Department, Democritus University of Thrace, 68100 Alexandroupolis, Greece; (A.G.); (V.K.); (E.L.); (F.C.); (S.K.); (M.K.); (A.T.); (P.B.); (S.C.); (C.K.); (K.V.)
| |
Collapse
|
3
|
Chung CC, Su ECY, Chen JH, Chen YT, Kuo CY. XGBoost-Based Simple Three-Item Model Accurately Predicts Outcomes of Acute Ischemic Stroke. Diagnostics (Basel) 2023; 13:diagnostics13050842. [PMID: 36899986 PMCID: PMC10000880 DOI: 10.3390/diagnostics13050842] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Revised: 02/19/2023] [Accepted: 02/21/2023] [Indexed: 02/25/2023] Open
Abstract
An all-inclusive and accurate prediction of outcomes for patients with acute ischemic stroke (AIS) is crucial for clinical decision-making. This study developed extreme gradient boosting (XGBoost)-based models using three simple factors-age, fasting glucose, and National Institutes of Health Stroke Scale (NIHSS) scores-to predict the three-month functional outcomes after AIS. We retrieved the medical records of 1848 patients diagnosed with AIS and managed at a single medical center between 2016 and 2020. We developed and validated the predictions and ranked the importance of each variable. The XGBoost model achieved notable performance, with an area under the curve of 0.8595. As predicted by the model, the patients with initial NIHSS score > 5, aged over 64 years, and fasting blood glucose > 86 mg/dL were associated with unfavorable prognoses. For patients receiving endovascular therapy, fasting glucose was the most important predictor. The NIHSS score at admission was the most significant predictor for those who received other treatments. Our proposed XGBoost model showed a reliable predictive power of AIS outcomes using readily available and simple predictors and also demonstrated the validity of the model for application in patients receiving different AIS treatments, providing clinical evidence for future optimization of AIS treatment strategies.
Collapse
Affiliation(s)
- Chen-Chih Chung
- Department of Neurology, Taipei Medical University—Shuang Ho Hospital, New Taipei City 235, Taiwan
- Department of Neurology, School of Medicine, College of Medicine, Taipei Medical University, Taipei City 110, Taiwan
- Taipei Neuroscience Institute, Taipei Medical University—Shuang Ho Hospital, New Taipei City 235, Taiwan
| | - Emily Chia-Yu Su
- Graduate Institute of Biomedical Informatics, College of Medical Science and Technology, Taipei Medical University, Taipei City 110, Taiwan
- Clinical Big Data Research Center, Taipei Medical University Hospital, Taipei City 110, Taiwan
| | - Jia-Hung Chen
- Department of Neurology, Taipei Medical University—Shuang Ho Hospital, New Taipei City 235, Taiwan
- Department of Neurology, School of Medicine, College of Medicine, Taipei Medical University, Taipei City 110, Taiwan
- Taipei Neuroscience Institute, Taipei Medical University—Shuang Ho Hospital, New Taipei City 235, Taiwan
| | - Yi-Tui Chen
- Smart Healthcare Interdisciplinary College, National Taipei University of Nursing and Health Sciences, Taipei City 112, Taiwan
- Department of Health Care Management, College of Health Technology, National Taipei University of Nursing and Health Sciences, Taipei City 112, Taiwan
- Department of Education and Research, Taipei City Hospital, Taipei City 103, Taiwan
| | - Chao-Yang Kuo
- Smart Healthcare Interdisciplinary College, National Taipei University of Nursing and Health Sciences, Taipei City 112, Taiwan
- Correspondence: ; Tel.: +886-2-28227101 (ext. 1385)
| |
Collapse
|
4
|
Colonnello E, Criniti A, Lorusso E, Curreli M, Santulli M, Angeloni A, Gnessi L, Gandini O, Lubrano C. Thyroid hormones and platelet activation in COVID-19 patients. J Endocrinol Invest 2023; 46:261-269. [PMID: 36064879 PMCID: PMC9444103 DOI: 10.1007/s40618-022-01896-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 08/04/2022] [Indexed: 01/25/2023]
Abstract
PURPOSE To retrospectively describe the association between thyroid hormones (TH) and platelet activation, as represented by mean platelet volume (MPV), in a cohort of patients hospitalized for COVID-19 with no known thyroid disease, and to correlate these data with the severity of COVID-19 and the occurrence of death/ARDS (Acute Respiratory Distress Syndrome). METHODS 103 patients with real-time polymerase chain reaction (RT-PCR) testing-confirmed COVID-19 and hospitalized were enrolled. Serum samples were collected from patients upon admission before starting any treatment. Chi-squared test was used to determine the association between euthyroid sick syndrome (ESS) and COVID-19 severity. Multivariate logistic regression was performed to evaluate the best independent predictors of COVID-19 deaths/ARDS. RESULTS 39/103 (37.9%) of patients were found to have ESS, and this condition was an independent predictor for the severity of COVID-19 (p = 0.003). Lower TSH and lower FT3/FT4 ratio correlated with higher MPV (p = 0,001 and p = 0.010), with an opposite trend with respect to what has been documented in non-COVID patients. Increasing MPV and lower FT3 significantly increased the risk, in COVID-19 patients, of an adverse outcome of death/ARDS. CONCLUSION Increased platelet activation, as represented by increased MPV, has already been reported to correlate with COVID-19 severity, possibly as a consequence of cytokine release. We demonstrated, in a cohort of 103 patients with COVID-19, that MPV is inversely correlated to TH levels, in particular in the case of ESS, where downregulation of TH axis may occur in case of systemic cytokine inflammation and more severe outcomes (death/ARDS). That ESS itself may directly cause platelet activation, as demonstrated by higher MPV in these patients, is an interesting hypothesis which deserves further investigation.
Collapse
Affiliation(s)
- E Colonnello
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - A Criniti
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - E Lorusso
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - M Curreli
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - M Santulli
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - A Angeloni
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - L Gnessi
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - O Gandini
- Department of Molecular Medicine, Sapienza University of Rome, Rome, Italy
| | - C Lubrano
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy.
| |
Collapse
|
5
|
Murolo M, Di Vincenzo O, Cicatiello AG, Scalfi L, Dentice M. Cardiovascular and Neuronal Consequences of Thyroid Hormones Alterations in the Ischemic Stroke. Metabolites 2022; 13:metabo13010022. [PMID: 36676947 PMCID: PMC9863748 DOI: 10.3390/metabo13010022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 11/15/2022] [Accepted: 12/20/2022] [Indexed: 12/24/2022] Open
Abstract
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.
Collapse
Affiliation(s)
- Melania Murolo
- Department of Clinical Medicine and Surgery, University of Naples “Federico II”, 80131 Naples, Italy
- Correspondence:
| | - Olivia Di Vincenzo
- Department of Clinical Medicine and Surgery, University of Naples “Federico II”, 80131 Naples, Italy
- Department of Public Health, University of Naples “Federico II”, 80131 Naples, Italy
| | | | - Luca Scalfi
- Department of Public Health, University of Naples “Federico II”, 80131 Naples, Italy
| | - Monica Dentice
- Department of Clinical Medicine and Surgery, University of Naples “Federico II”, 80131 Naples, Italy
- CEINGE-Biotecnologie Avanzate S.c.a.r.l., 80131 Naples, Italy
| |
Collapse
|
6
|
Huang S, Liu L, Tang X, Xie S, Li X, Kang X, Zhu S. Research progress on the role of hormones in ischemic stroke. Front Immunol 2022; 13:1062977. [PMID: 36569944 PMCID: PMC9769407 DOI: 10.3389/fimmu.2022.1062977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 11/18/2022] [Indexed: 12/12/2022] Open
Abstract
Ischemic stroke is a major cause of death and disability around the world. However, ischemic stroke treatment is currently limited, with a narrow therapeutic window and unsatisfactory post-treatment outcomes. Therefore, it is critical to investigate the pathophysiological mechanisms following ischemic stroke brain injury. Changes in the immunometabolism and endocrine system after ischemic stroke are important in understanding the pathophysiological mechanisms of cerebral ischemic injury. Hormones are biologically active substances produced by endocrine glands or endocrine cells that play an important role in the organism's growth, development, metabolism, reproduction, and aging. Hormone research in ischemic stroke has made very promising progress. Hormone levels fluctuate during an ischemic stroke. Hormones regulate neuronal plasticity, promote neurotrophic factor formation, reduce cell death, apoptosis, inflammation, excitotoxicity, oxidative and nitrative stress, and brain edema in ischemic stroke. In recent years, many studies have been done on the role of thyroid hormone, growth hormone, testosterone, prolactin, oxytocin, glucocorticoid, parathyroid hormone, and dopamine in ischemic stroke, but comprehensive reviews are scarce. This review focuses on the role of hormones in the pathophysiology of ischemic stroke and discusses the mechanisms involved, intending to provide a reference value for ischemic stroke treatment and prevention.
Collapse
Affiliation(s)
- Shuyuan Huang
- Department of Anesthesiology, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Lu Liu
- Department of Anesthesiology, Shenzhen People’s Hospital, The Second Clinical Medical College, Jinan University, The First Affiliated Hospital, Southern University of Science and Technology, Shenzhen, Guangdong, China
| | - Xiaodong Tang
- Department of Anesthesiology, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Shulan Xie
- Department of Anesthesiology, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Xinrui Li
- Department of Anesthesiology, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Xianhui Kang
- Department of Anesthesiology, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China,*Correspondence: Xianhui Kang, ; Shengmei Zhu,
| | - Shengmei Zhu
- Department of Anesthesiology, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China,*Correspondence: Xianhui Kang, ; Shengmei Zhu,
| |
Collapse
|
7
|
Shimizu T, Ueno Y, Tateishi Y, Doijiri R, Kuriki A, Kikuno M, Takekawa H, Shimada Y, Kanemaru K, Kamiya Y, Yamaguchi E, Koga M, Ihara M, Tsujino A, Hirata K, Hasegawa Y, Hattori N, Urabe T. Evaluating the Potential Pathology and Short-Term Outcomes of Cryptogenic Stroke Using the Etiological Classification System. J Atheroscler Thromb 2022; 30:377-389. [PMID: 35691846 PMCID: PMC10067338 DOI: 10.5551/jat.63267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
AIM Various embolic sources and pathogenetic mechanisms underlie cryptogenic stroke (CS). We investigated the association of etiological diversity with short-term outcomes in patients with CS using a modified atherosclerosis (A), small-vessel disease (S), cardiac pathology (C), other causes (O), and dissection (D) (ASCOD) system. METHODS Patients with CS who underwent transesophageal echocardiography were registered in this multicenter, observational study. In the modified classification system, O and D were inapplicable and thus excluded. Instead, atherosclerosis, small-vessel disease, cardiac pathology-CS classification was specifically constructed for the etiological diagnosis of CS. We utilized this system to explore the mechanism of CS by grading each pathology and evaluated its association with poorer modified Rankin Scale scores of 3-6 at hospital discharge. RESULTS A total of 672 patients (68.7±12.8 years, 220 females) were analyzed. In the multiple logistic regression model, female sex (odds ratio [OR], 1.87 [1.15-3.04]; P=0.012), body mass index (OR, 0.93 [0.88-0.99]; P=0.025), National Institute of Health Stroke Scale score (OR, 1.16 [1.12-1.21]; P<0.001), CHADS2 score (OR, 1.56 [1.30-1.86]; P<0.001), D-dimer (OR, 1.04 [1.01-1.08]; P=0.015), diffusion-weighted image (DWI) lesion size (OR, 1.44 [1.10-1.89]; P=0.009), and S+C score (OR, 1.26 [1.03-1.56]; P=0.029) were associated with poor functional outcome at discharge whereas the S+C score was marginally associated with poor functional outcome after excluding 137 patients with a premorbid modified Rankin Scale score of ≥ 3. CONCLUSIONS The coexistence of small-vessel disease and cardiac pathology might be associated with poor in-hospital functional outcome in CS.
Collapse
Affiliation(s)
- Takahiro Shimizu
- Department of Neurology, St. Marianna University School of Medicine
| | - Yuji Ueno
- Department of Neurology, Juntendo University Faculty of Medicine
| | - Yohei Tateishi
- Department of Neurology and Strokology, Nagasaki University Hospital
| | | | - Ayako Kuriki
- Department of Neurology, Showa University Koto Toyosu Hospital
| | - Muneaki Kikuno
- Department of Neurology, Tokyo Medical University.,Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center
| | | | | | - Kodai Kanemaru
- Department of Neurology, Tokyo Medical University.,Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center
| | - Yuki Kamiya
- Department of Neurology, Showa University Koto Toyosu Hospital
| | | | - Masatoshi Koga
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center
| | - Masafumi Ihara
- Department of Neurology, National Cerebral and Cardiovascular Center
| | - Akira Tsujino
- Department of Neurology and Strokology, Nagasaki University Hospital
| | | | | | - Nobutaka Hattori
- Department of Neurology, Juntendo University Faculty of Medicine
| | - Takao Urabe
- Department of Neurology, Juntendo University Urayasu Hospital
| |
Collapse
|
8
|
Lin JF, Wang JR, Wang JQ, Li JM. The detection of up-regulated anti-thyroid antibodies and autoimmune thyroid diseases in patients with autoimmune encephalitis: a retrospective study of 221 patients. Neurol Sci 2022; 43:3901-3910. [PMID: 35137351 PMCID: PMC9123159 DOI: 10.1007/s10072-022-05932-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 02/03/2022] [Indexed: 10/31/2022]
Abstract
OBJECTIVE To investigate the potential detection rate of anti-thyroid antibodies' (ATAbs) positivity, thyroid dysfunctions, and autoimmune thyroid diseases (AITDs) in autoimmune encephalitis (AE) and to analyze whether thyroid autoimmunity/dysfunction can affect the clinical course of AE. METHODS Two hundred twenty-one AE patients and 229 age- and sex-matched controls were included in this study. We measured the levels of ATAbs (anti-thyroglobulin antibodies [TgAb], anti-thyroid peroxidase anti-bodies [TPOAb]) and thyroid hormones in all the individuals. In addition, the association of thyroid autoimmunity/dysfunctions with functional outcomes of AE was identified by using logistic regression and Kaplan-Meier analyses. RESULTS The prevalence of TPOAb-positive and TgAb-positive was significantly higher in AE patients (16.3% and 16.7%, respectively) as compared with controls (9.6% and 7.4%, respectively; P = 0.034 and P = 0.002, respectively). In addition, the free triiodothyronine (fT3) level was significantly lower in AE patients as compared to the controls (P < 0.001). However, the frequency of AITDs (Hashimoto's thyroiditis and Graves' disease) did not significantly differ between AE patients and control subjects. Importantly, low fT3 was found to be associated with poor functional outcomes at the 3-month follow-up in AE. Adjustment of potential confounders did not change the association. However, the presence of ATAbs did not significantly alert the disease course of AE. CONCLUSIONS ATAbs-positive and/or AITD patients with symptomatic encephalopathy should undergo proper surveillance for AE. Moreover, low fT3 could serve as a possible predictor of poor short-term outcome in AE, thereby suggesting that monitoring of thyroid function in AE may be necessary.
Collapse
Affiliation(s)
- Jing-Fang Lin
- Department of Neurology, West China Hospital, Sichuan University, No. 37 Guoxue Road, Chengdu, 610041 Sichuan China
| | - Jie-Rui Wang
- Department of Neurology, West China Hospital, Sichuan University, No. 37 Guoxue Road, Chengdu, 610041 Sichuan China
| | - Jia-Qi Wang
- Department of Neurology, West China Hospital, Sichuan University, No. 37 Guoxue Road, Chengdu, 610041 Sichuan China
| | - Jin-Mei Li
- Department of Neurology, West China Hospital, Sichuan University, No. 37 Guoxue Road, Chengdu, 610041 Sichuan China
| |
Collapse
|
9
|
Zhang JN, Zhao XL. The Changes of Thyroid Function and Related Factors in Critical Patients without Thyroid Illness in ICU: A Retrospective Cross-Sectional Study. Ther Clin Risk Manag 2022; 18:571-578. [PMID: 35602261 PMCID: PMC9122052 DOI: 10.2147/tcrm.s361791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 04/26/2022] [Indexed: 11/23/2022] Open
Abstract
Objective To retrospectively analyze the changes of thyroid function and related factors in critical patients with non-thyroid illness, hoping to find some indicators for the further examination of the thyroid function in the intensive care unit situation. Methods The clinical data of 52 patients admitted to the ICU of Fuzhou First Hospital in Fujian Province, China, from May 2018 to March 2019 were collected. Patients were allocated into the central hypothyroidism group (CH group, n = 21) and the low T3 syndrome group (LT3S group, n = 31) based on thyroid function. All related medical data were collected, and the correlations between variables were identified using Spearman's or Pearson's rank correlation coefficients. Results The Acute Physiology and Chronic Health Evaluation (APACHE) II score in the CH group and the LT3S group were 20.6 ± 3.6 and 19.3 ± 3.6, respectively, measured within 24 hours following hospital admission. The mean value of thyroid-stimulating hormone (TSH) in the CH group (0.3 ± 0.3 IU/mL) was significantly lower than that in the LT3S group (1.7 ± 0.9 IU/mL), P < 0.001. Fasting plasma glucose (FPG) level in the CH group was significantly higher than that in the LT3S group (10.3 ± 5.0 mmol/L vs 6.8 ± 2.5 mmol/L, P = 0.002). Conclusion Central hypothyroidism may exist in critically ill patients and may be associated with elevated fasting plasma glucose levels; accordingly, it should be included as part of patient assessment. When FPG is higher than 6.4mmol/L on admission, thyroid function should be actively examined.
Collapse
Affiliation(s)
- Jiang-Nan Zhang
- Department of Endocrinology, The First Hospital of Fuzhou, Fuzhou, 350009, People’s Republic of China
| | - Xi-Le Zhao
- Department of Endocrinology, The First Hospital of Fuzhou, Fuzhou, 350009, People’s Republic of China
| |
Collapse
|
10
|
Thyroid Hormone Levels Help to Predict Outcome of Critically Ill Patients Undergoing Early Neurological Rehabilitation. BIOMED RESEARCH INTERNATIONAL 2022; 2022:8447080. [PMID: 35187173 PMCID: PMC8853786 DOI: 10.1155/2022/8447080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 01/27/2022] [Indexed: 11/29/2022]
Abstract
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.
Collapse
|
11
|
Song Y, Yang C, Wang H. Free Triiodothyronine Is Associated with Poor Outcomes after Acute Ischemic Stroke. Int J Clin Pract 2022; 2022:1982193. [PMID: 35685519 PMCID: PMC9159185 DOI: 10.1155/2022/1982193] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Revised: 12/22/2021] [Accepted: 01/05/2022] [Indexed: 02/05/2023] Open
Abstract
AIMS It is unclear whether thyroid hormones are associated with functional outcomes after ischemic stroke. We aimed to investigate the impact of serum levels of thyroid hormones at admission on functional outcomes at 3 months after acute ischemic stroke. METHODS A total of 480 consecutive patients with ischemic stroke who were admitted to our hospital within 48 h of onset were enrolled. The levels of thyroid hormones, including thyroid-stimulating hormone, free triiodothyronine (FT3), and free thyroxine, were measured at admission, and functional outcomes were assessed at 3 months using the modified Rankin Scale (mRS), with scores ranging from 0 to 6. Poor outcome was defined as mRS score ≥3. RESULTS FT3 levels at admission were considerably lower in patients with poor outcomes than in those with good outcomes at 3 months (3.53 ± 0.70 pmol/L vs. 4.04 ± 0.68 pmol/L; P < 0.001). Lower FT3 levels were observed in patients with higher mRS scores. Multivariable logistic regression analysis revealed that FT3 levels were significantly associated with a risk of poor outcomes at 3 months, independent of conventional risk factors such as age, National Institutes of Health Stroke Scale score, and recanalized therapy. In addition, patients in FT3 levels in the lowest quartile had a 2.56-fold higher risk of poor outcomes than those with FT3 levels in the highest quartile (odds ratio = 2.56, 95% confidence interval = 1.15-5.69, P=0.021). The sensitivity and specificity of FT3 level ≤3.69 pmol/L for predicting poor outcomes were 62.70% and 72.03%, respectively. CONCLUSION Our study suggests that FT3 levels at admission are significantly and independently associated with a risk of poor outcomes after ischemic stroke and that lower FT3 levels can be considered as a prognostic biomarker for poor outcomes at 3 months.
Collapse
Affiliation(s)
- Yue Song
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, China
| | - Changqiang Yang
- Department of Cardiovascular Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Hua Wang
- Department of Pediatrics, West China Second University Hospital, Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, China
| |
Collapse
|
12
|
Emerging role of free triiodothyronine in patients with anti-N-methyl-D-aspartate receptor encephalitis. Sci Rep 2021; 11:6045. [PMID: 33723352 PMCID: PMC7960963 DOI: 10.1038/s41598-021-85596-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 03/03/2021] [Indexed: 11/13/2022] Open
Abstract
We aimed to investigate the role of free triiodothyronine (FT3) in patients with anti-N-methyl-D-aspartate receptor (anti-NMDAR) encephalitis. 137 consecutive inpatients (2016–2019) were registered prospectively and followed up for 12 months. 96 eligible patients were included in the study. The modified Rankin scale (mRS) score was collected, and the score of 3–6 was defined as a poor outcome. The patients were equally classified into 3 subgroups based on their FT3 levels obtained within 24 h of admission, and the subgroup differences were analyzed by parametric or nonparametric tests as appropriate. Logistic regression analysis was performed. We found that there was no difference in the mRS scores upon admission among 3 subgroups, however, patients in the low-FT3 subgroup tended to have higher disease severity during hospitalization and worse outcome in follow-up visits, represented by higher chances of intense care unit (ICU) admission (P < 0.001), longer hospital stay (P < 0.001), greater maximum mRS scores during hospitalization (P = 0.011), lower rates of getting clinical improvement within 4 weeks of starting treatment (P = 0.006), and higher percentages of poor 1-year outcome (P = 0.002). The level of FT3 was an independent factor correlated with ICU admission (P = 0.002) and might be a potential predictor for 1-year outcome. Our preliminary results suggest that the FT3 may be a risk factor involved in the evolution and progression of anti-NMDAR encephalitis, whereas the underline mechanisms remain to be explored. Attention should be paid to these patients with relatively low FT3 upon admission, which might possibly aid clinical prediction and guide clinical decision-making.
Collapse
|
13
|
Zhang N, Zhang L, Wang Q, Zhao J, Liu J, Wang G. Cerebrovascular risk factors associated with ischemic stroke in a young non-diabetic and non-hypertensive population: a retrospective case-control study. BMC Neurol 2020; 20:424. [PMID: 33225904 PMCID: PMC7681954 DOI: 10.1186/s12883-020-02005-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 11/17/2020] [Indexed: 02/08/2023] Open
Abstract
Background Globally, rates of ischemic stroke (IS) have been rising among young adults. This study was designed to identify risk factors associated with IS incidence in young adults unaffected by hypertension or diabetes. Methods This was a retrospective case-control study of early-onset IS patients without diabetes and hypertension. Control patients were matched with healthy individuals based upon sex, age (±2 years), and BMI (±3 kg/m2) at a 1:3 ratio. Sociodemographic, clinical, and risk factor-related data pertaining to these patients was collected. The association between these risk factors and IS incidence was then assessed using conditional logistic regression models. Results We recruited 60 IS patients and 180 controls with mean ages of 44.37 ± 4.68 and 44.31 ± 4.71 years, respectively, for this study. Relative to controls, IS patients had significantly higher total cholesterol (TG), homocysteine (HCY), white blood cell (WBC), absolute neutrophil count (ANC), systolic blood pressure (SBP), and diastolic blood pressure (DBP) levels, and significantly lower high-density lipoprotein cholesterol (HDL-C) and triglyceride cholesterol (TC), free triiodothyronine (FT3), and free thyroxine (FT4) levels (all P < 0.05). After controlling for potential confounding factors, HCY and ANC were found to be significantly positively associated with IS incidence (OR 1.518, 95%CI 1.165–1.977, P = 0.002 and OR 2.418, 95%CI 1.061–5.511, P = 0.036, respectively), whereas HDL-C and FT3 levels were negatively correlated with IS incidence (OR 0.001, 95%CI 0.000–0.083, P = 0.003 and OR 0.053, 95%CI 0.008–0.326, P = 0.002, respectively). Conclusions In young non-diabetic and non-hypertensive patients, lower HDL-C and FT3 levels and higher HCY and ANC levels may be associated with an elevated risk of IS. Additional prospective studies of large patient cohorts will be essential to validate these findings.
Collapse
Affiliation(s)
- Nan Zhang
- Department of Endocrinology, Beijing Chao-yang Hospital, Capital Medical University, Beijing, 100020, China
| | - Lin Zhang
- Department of Endocrinology, Beijing Chao-yang Hospital, Capital Medical University, Beijing, 100020, China
| | - Qiu Wang
- Department of Endocrinology, Beijing Chao-yang Hospital, Capital Medical University, Beijing, 100020, China
| | - Jingwei Zhao
- Department of Endocrinology, Beijing Chao-yang Hospital, Capital Medical University, Beijing, 100020, China
| | - Jia Liu
- Department of Endocrinology, Beijing Chao-yang Hospital, Capital Medical University, Beijing, 100020, China.
| | - Guang Wang
- Department of Endocrinology, Beijing Chao-yang Hospital, Capital Medical University, Beijing, 100020, China.
| |
Collapse
|
14
|
Rauš Balind S, Manojlović-Stojanoski M, Šošić-Jurjević B, Selaković V, Milošević V, Petković B. An Extremely Low Frequency Magnetic Field and Global Cerebral Ischemia Affect Pituitary ACTH and TSH Cells in Gerbils. Bioelectromagnetics 2019; 41:91-103. [PMID: 31828821 DOI: 10.1002/bem.22237] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Accepted: 11/28/2019] [Indexed: 11/10/2022]
Abstract
The neuroendocrine system can be modulated by a magnetic field and cerebral ischemia as external and internal stressors, respectively. This study deals with the separate or combined effects of an extremely low frequency (ELF) magnetic field (50 Hz, average magnetic field of 0.5 mT) for 7 days and global cerebral ischemia for 10 min on the morpho-functional features of pituitary adrenocorticotrophic (ACTH) and thyrotrophic (TSH) cells in 3-month-old gerbils. To determine the immediate and delayed effects of the applied stressors, measurements were made on the 7th and 14th days after the onset of the experiment. The ELF magnetic field and 10-min global cerebral ischemia, separately and particularly in combination, decreased (P < 0.05) the volume density of ACTH cells, while only in combination were intracellular ACTH content and plasma ACTH concentration increased (P < 0.05) on day 7. The ELF magnetic field elevated serum TSH concentration on day 7 and intracellular TSHβ content on day 14 (P < 0.05). Also, 10-min global cerebral ischemia alone increased serum TSH concentration (P < 0.05), while in combination with the ELF magnetic field it elevated (P < 0.05) intracellular TSHβ content on day 14. In conclusion, an ELF magnetic field and/or 10-min global cerebral ischemia can induce immediate and delayed stimulation of ACTH and TSH synthesis and secretion. Bioelectromagnetics. 2020;41:91-103. © 2019 Bioelectromagnetics Society.
Collapse
Affiliation(s)
- Snežana Rauš Balind
- Department of Neurophysiology, Institute for Biological Research "Siniša Stanković"-National Institute of Republic of Serbia, University of Belgrade, Belgrade, Serbia
| | - Milica Manojlović-Stojanoski
- Department of Cytology, Institute for Biological Research "Siniša Stanković"-National Institute of Republic of Serbia, University of Belgrade, Belgrade, Serbia
| | - Branka Šošić-Jurjević
- Department of Cytology, Institute for Biological Research "Siniša Stanković"-National Institute of Republic of Serbia, University of Belgrade, Belgrade, Serbia
| | - Vesna Selaković
- Institute for Medical Research, Military Medical Academy (MMA), Medical Faculty MMA, University of Defence, Belgrade, Serbia
| | - Verica Milošević
- Department of Cytology, Institute for Biological Research "Siniša Stanković"-National Institute of Republic of Serbia, University of Belgrade, Belgrade, Serbia
| | - Branka Petković
- Department of Neurophysiology, Institute for Biological Research "Siniša Stanković"-National Institute of Republic of Serbia, University of Belgrade, Belgrade, Serbia
| |
Collapse
|
15
|
Zhu J, Chen M, Li N, Yang S, Xu L, Wang Y, Li H. Correlation analysis of serum thyroid stimulating hormone with acute cerebrovascular disease. Eur J Med Res 2019; 24:35. [PMID: 31651357 PMCID: PMC6813055 DOI: 10.1186/s40001-019-0395-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2019] [Accepted: 10/16/2019] [Indexed: 02/06/2023] Open
Abstract
Background Acute cerebrovascular disease (ACVD) could cause abnormal metabolism of thyroid hormones (TH), mostly represented as a euthyroid sick syndrome or low T3 syndrome. However, the changes in serum thyroid-stimulating hormone (TSH) are controversial. The aim of this study is to investigate the clinical significance of TSH alteration in patients with ACVD. Method Patients with ACVD admitted in our hospitals between January 2013 and September 2017 were enrolled in this study (n = 245, including 176 cerebral infarctions and 69 cerebral hemorrhages). Their thyroid hormones were measured and compared with healthy individuals (n = 75). The correlation of TSH with severity and prognosis of ACVD were analyzed by receiver operating characteristic curve. Results Serum TSH in ACVD group was higher than the control group (1.64 ± 1.08 vs. 1.26 ± 0.36 μIU/mL, P < 0.05). The TSH levels in intermediate and severe patients with ACVD were higher than in mild patients (1.72 ± 1.18 vs. 2.71 ± 0.93 vs. 1.02 ± 0.47 μIU/mL, P < 0.05). Receiver Operating Characteristic curve (ROC) of TSH in determining the severity of patients were 0.863 (Area under the curve, AUC), 1.496 μIU/L (optimal threshold), 76.5% (sensitivity) and 87.3% (specificity). TSH levels in improved and unchanged groups were significantly higher than the primarily healing group (2.27 ± 1.11 vs. 2.88 ± 1.07 vs. 0.86 ± 0.46 μIU/mL, P < 0.05). ROC of TSH in determining the prognosis of patients was 0.910 (AUC), 1.681 mIU/L (optimal threshold), 79.8% (sensitivity) and 90.5% (specificity) correspondingly. Conclusion Since elevated TSH in ACVD patients affects the outcome of thyroid function evaluation, it is preferable to re-check after the acute period. A correlation between a high TSH level and the severity and prognosis of ACVD was detected, but the mechanism of this correlation needs to be further studied.
Collapse
Affiliation(s)
- Jian Zhu
- Department of Neurology, Dachang Hospital of Baoshan District, Shanghai, 200444, China
| | - Ming Chen
- Department of Endocrinology and Metabolism, Shanghai Tenth People's Hospital, Tongji University School of Medicine, No. 301, Middle Yan Chang Road, Shanghai, 200072, China
| | - Nan Li
- Department of Endocrinology and Metabolism, Shanghai Tenth People's Hospital, Tongji University School of Medicine, No. 301, Middle Yan Chang Road, Shanghai, 200072, China
| | - Shaoling Yang
- Department of Endocrinology and Metabolism, Shanghai Tenth People's Hospital, Tongji University School of Medicine, No. 301, Middle Yan Chang Road, Shanghai, 200072, China
| | - Lu Xu
- Department of Endocrinology and Metabolism, Shanghai Tenth People's Hospital, Tongji University School of Medicine, No. 301, Middle Yan Chang Road, Shanghai, 200072, China
| | - Yanru Wang
- Department of Endocrinology and Metabolism, Shanghai Tenth People's Hospital, Tongji University School of Medicine, No. 301, Middle Yan Chang Road, Shanghai, 200072, China
| | - Hong Li
- Department of Endocrinology and Metabolism, Shanghai Tenth People's Hospital, Tongji University School of Medicine, No. 301, Middle Yan Chang Road, Shanghai, 200072, China.
| |
Collapse
|
16
|
Talhada D, Santos CRA, Gonçalves I, Ruscher K. Thyroid Hormones in the Brain and Their Impact in Recovery Mechanisms After Stroke. Front Neurol 2019; 10:1103. [PMID: 31681160 PMCID: PMC6814074 DOI: 10.3389/fneur.2019.01103] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Accepted: 10/02/2019] [Indexed: 12/23/2022] Open
Abstract
Thyroid hormones are of fundamental importance for brain development and essential factors to warrant brain functions throughout life. Their actions are mediated by binding to specific intracellular and membranous receptors regulating genomic and non-genomic mechanisms in neurons and populations of glial cells, respectively. Among others, mechanisms include the regulation of neuronal plasticity processes, stimulation of angiogenesis and neurogenesis as well modulating the dynamics of cytoskeletal elements and intracellular transport processes. These mechanisms overlap with those that have been identified to enhance recovery of lost neurological functions during the first weeks and months after ischemic stroke. Stimulation of thyroid hormone signaling in the postischemic brain might be a promising therapeutic strategy to foster endogenous mechanisms of repair. Several studies have pointed to a significant association between thyroid hormones and outcome after stroke. With this review, we will provide an overview on functions of thyroid hormones in the healthy brain and summarize their mechanisms of action in the developing and adult brain. Also, we compile the major thyroid-modulated molecular pathways in the pathophysiology of ischemic stroke that can enhance recovery, highlighting thyroid hormones as a potential target for therapeutic intervention.
Collapse
Affiliation(s)
- Daniela Talhada
- Laboratory for Experimental Brain Research, Division of Neurosurgery, Department of Clinical Sciences, Lund University, Lund, Sweden
- CICS-UBI-Health Sciences Research Centre, Faculdade de Ciências da Saúde, Universidade da Beira Interior, Covilha, Portugal
- LUBIN Lab-Lunds Laboratorium för Neurokirurgisk Hjärnskadeforskning, Division of Neurosurgery, Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Cecília Reis Alves Santos
- CICS-UBI-Health Sciences Research Centre, Faculdade de Ciências da Saúde, Universidade da Beira Interior, Covilha, Portugal
| | - Isabel Gonçalves
- CICS-UBI-Health Sciences Research Centre, Faculdade de Ciências da Saúde, Universidade da Beira Interior, Covilha, Portugal
| | - Karsten Ruscher
- Laboratory for Experimental Brain Research, Division of Neurosurgery, Department of Clinical Sciences, Lund University, Lund, Sweden
- LUBIN Lab-Lunds Laboratorium för Neurokirurgisk Hjärnskadeforskning, Division of Neurosurgery, Department of Clinical Sciences, Lund University, Lund, Sweden
| |
Collapse
|
17
|
Low triiodothyronine syndrome is associated with hemorrhagic transformation in patients with acute ischaemic stroke. Aging (Albany NY) 2019; 11:6385-6397. [PMID: 31454331 PMCID: PMC6738409 DOI: 10.18632/aging.102195] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Accepted: 08/10/2019] [Indexed: 12/23/2022]
Abstract
Hemorrhagic transformation (HT) is a severe complication occurring in acute ischemic stroke (AIS) patients. We explored the association between low triiodothyronine (T3) syndrome and HT in AIS patients. A total of 208 consecutive participants with HT and 208 age- and sex-matched stroke patients without HT were enrolled in this study. HT was diagnosed by follow-up imaging assessment, and was radiologically classified as hemorrhagic infarction (HI) type 1 or 2 or parenchymal hematoma (PH) type 1 or 2. HT was also classified into asymptomatic or symptomatic. The incidence of low T3 syndrome was significantly higher among patients who developed HT than among those without HT. Moreover, the more severe the HT, the lower the detected T3 levels. Multivariate-adjusted binary logistic regression showed that low T3 syndrome was an independent risk factor for HT and symptomatic HT in AIS patients. Low T3 syndrome was also significantly associated with a higher risk of PH, but not with the risk of HI. Thus, low T3 syndrome was independently associated with the risk of HT, symptomatic HT, and severe HT (PH) in AIS patients, which suggests monitoring T3 could be a useful means of preventing HT in patients with ischemic stroke.
Collapse
|
18
|
Li LQ, Xu XY, Li WY, Hu XY, Lv W. The prognostic value of total T3 after acute cerebral infarction is age-dependent: a retrospective study on 768 patients. BMC Neurol 2019; 19:54. [PMID: 30953462 PMCID: PMC6451203 DOI: 10.1186/s12883-019-1264-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2018] [Accepted: 02/28/2019] [Indexed: 11/24/2022] Open
Abstract
Background Serum triiodothyronine (T3) concentration was reported to be associated with the prognosis after acute ischemic stroke. The aim of this study was to evaluate the effect of age on the prognostic value of thyroid-related hormones after an acute ischemic stroke. Methods This was a retrospective study involving the review of 1072 ischemic stroke patients who had been consecutively admitted to the hospital within 72 h of symptom onset. Total triiodothyronine (T3), total thyroxine (T4), free T3, free T4, and thyroid-stimulating hormone (TSH) were assessed to determine their values for predicting functional outcome at the first follow-up clinic visits, which usually occurred 2 to 4 weeks after discharge from the hospital. Results A total of 768 patients were finally included in the study and divided into two age groups: a younger group (age < 65 years) and an older group (age ≥ 65 years). On univariate analysis, four factors—lower total T3, free T3 concentrations, higher scores on the National Institute of Health Stroke Scale (NIHSS) and the presence of atrial fibrillation—were associated with poor functional outcomes in both groups. In addition, older age, female gender, higher free T4, and lower TSH levels were also associated with poor function in the older group. On multiple logistic regression analysis, higher NIHSS scores (odds ratio [OR] =1.95; 95% confidence interval [CI], 1.66–2.30; P ≤ .001) and lower total T3 concentrations (OR = 0.06; 95% CI, 0.01–0.68; P = .024) remained independently associated with poor functional outcome in the older group. However, the independent association with poor function of lower total T3 was not confirmed in the younger group. Conclusions The prognostic value of low total T3 is age-associated and more meaningful in an older population.
Collapse
Affiliation(s)
- Lei-Qing Li
- Department of Intensive Care Unit, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, 310009, China
| | - Xiao-Yan Xu
- Department of Neurology, the Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Zhejiang, 310016, Hangzhou, China
| | - Wen-Yu Li
- Department of Neurology, the Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Zhejiang, 310016, Hangzhou, China
| | - Xing-Yue Hu
- Department of Neurology, the Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Zhejiang, 310016, Hangzhou, China
| | - Wen Lv
- Department of Neurology, the Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Zhejiang, 310016, Hangzhou, China.
| |
Collapse
|
19
|
TDP-43 proteinopathy in aging: Associations with risk-associated gene variants and with brain parenchymal thyroid hormone levels. Neurobiol Dis 2019; 125:67-76. [PMID: 30682540 DOI: 10.1016/j.nbd.2019.01.013] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Revised: 01/13/2019] [Accepted: 01/19/2019] [Indexed: 02/08/2023] Open
Abstract
TDP-43 proteinopathy is very prevalent among the elderly (affecting at least 25% of individuals over 85 years of age) and is associated with substantial cognitive impairment. Risk factors implicated in age-related TDP-43 proteinopathy include commonly inherited gene variants, comorbid Alzheimer's disease pathology, and thyroid hormone dysfunction. To test parameters that are associated with aging-related TDP-43 pathology, we performed exploratory analyses of pathologic, genetic, and biochemical data derived from research volunteers in the University of Kentucky Alzheimer's Disease Center autopsy cohort (n = 136 subjects). Digital pathologic methods were used to discriminate and quantify both neuritic and intracytoplasmic TDP-43 pathology in the hippocampal formation. Overall, 46.4% of the cases were positive for TDP-43 intracellular inclusions, which is consistent with results in other prior community-based cohorts. The pathologies were correlated with hippocampal sclerosis of aging (HS-Aging) linked genotypes. We also assayed brain parenchymal thyroid hormone (triiodothyronine [T3] and thyroxine [T4]) levels. In cases with SLCO1A2/IAPP or ABCC9 risk associated genotypes, the T3/T4 ratio tended to be reduced (p = .051 using 2-tailed statistical test), and in cases with low T3/T4 ratios (bottom quintile), there was a higher likelihood of HS-Aging pathology (p = .025 using 2-tailed statistical test). This is intriguing because the SLCO1A2/IAPP and ABCC9 risk associated genotypes have been associated with altered expression of the astrocytic thyroid hormone receptor (protein product of the nearby gene SLCO1C1). These data indicate that dysregulation of thyroid hormone signaling may play a role in age-related TDP-43 proteinopathy.
Collapse
|
20
|
Chen H, Wu Y, Huang G, He W, Lin S, Zhang X, He J. Low Tri-iodothyronine Syndrome Is Associated With Cognitive Impairment in Patients With Acute Ischemic Stroke: A Prospective Cohort Study. Am J Geriatr Psychiatry 2018; 26:1222-1230. [PMID: 30236902 DOI: 10.1016/j.jagp.2018.07.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Revised: 07/16/2018] [Accepted: 07/16/2018] [Indexed: 12/30/2022]
Abstract
OBJECTIVE Low tri-iodothyronine (T3) syndrome is a predictor of poor prognosis in patients with stroke. Poststroke cognitive impairment (PSCI) is a common and important complication after stroke. The association between low T3 syndrome and PSCI is unclear. We aimed to explore the potential relationship between low T3 syndrome and PSCI in the acute phase of ischemic stroke at a 1-month follow-up visit. METHODS In total, 314 ischemic stroke patients were consecutively enrolled in the study and followed up at 1 month. Thyroid hormones were measured within 24 hours after admission. Cognitive function was evaluated by the Mini-Mental State Exam (MMSE) 1 month after acute ischemic stroke. Cognitive impairment was defined as an MMSE score of less than 27. Cognitive impairment severity was categorized as severe, mild, or none (MMSE score <23, 23-26, or ≥27, respectively). RESULTS According to the MMSE score, 182 participants (58.0%) had cognitive impairment 1 month after stroke. Patients with low T3 syndrome were more prone to have cognitive impairment than patients with normal levels of T3 (p < 0.001). After adjusting for potential confounders in our logistic model, low T3 syndrome was independently associated with PSCI (odds ratio 4.319, 95% confidence interval 1.553-12.013, p = 0.005). CONCLUSION Low T3 syndrome in the acute phase of ischemic stroke was associated with a higher prevalence of 1-month PSCI, independently of established risk factors.
Collapse
Affiliation(s)
- Huijun Chen
- Department of Neurology, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China
| | - Yuemin Wu
- Department of Neurology, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China
| | - Guiqian Huang
- Department of Neurology, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China
| | - Weilei He
- Department of Neurology, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China
| | - Shasha Lin
- Department of Neurology, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China
| | - Xingru Zhang
- Department of Neurology, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China
| | - Jincai He
- Department of Neurology, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China..
| |
Collapse
|
21
|
Reverse triiodothyronine (rT3) attenuates ischemia-reperfusion injury. Biochem Biophys Res Commun 2018; 506:597-603. [PMID: 30366665 DOI: 10.1016/j.bbrc.2018.10.031] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Accepted: 10/05/2018] [Indexed: 01/09/2023]
Abstract
Hypothyroidism has been associated with better recovery from cerebral ischemia-reperfusion (IR) injury in humans. However, any therapeutic advantage of inducing hypothyroidism for mitigating IR injury without invoking the adverse effect of whole body hypothyroidism remains a challenge. We hypothesize that a deiodinase II (D2) inhibitor reverse triiodothyronine (rT3) may render brain specific hypometabolic state to ensue reduced damage during an acute phase of cerebral ischemia without affecting circulating thyroid hormone levels. Preclinical efficacy of rT3 as a neuroprotective agent was determined in rat model of middle cerebral artery occlusion (MCAO) induced cerebral IR and in oxygen glucose deprivation/reoxygenation (OGD/R) model in vitro. rT3 administration in rats significantly reduced neuronal injury markers, infarct size and neurological deficit upon ischemic insult. Similarly, rT3 increased cellular survival in primary cerebral neurons under OGD/R stress. Based on our results from both in vivo as well as in vitro models of ischemia reperfusion injury we propose rT3 as a novel therapeutic agent in reducing neuronal damage and improving stroke outcome.
Collapse
|
22
|
Low Free Triiodothyronine Predicts 3-Month Poor Outcome After Acute Stroke. J Stroke Cerebrovasc Dis 2018; 27:2804-2809. [PMID: 30056971 DOI: 10.1016/j.jstrokecerebrovasdis.2018.06.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Revised: 05/17/2018] [Accepted: 06/08/2018] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND AND PURPOSE The association between thyroid hormone levels and long-term clinical outcome in patients with acute stroke has not yet been thoroughly studied. The purpose of the present study was to test the hypothesis that thyroid hormone levels are associated with 3-month functional outcome and mortality after acute stroke. METHODS We retrospectively analyzed 702 consecutive patients with acute stroke (251 women; median age, 73 years) who were admitted to our department. General blood tests, including thyroid stimulating hormone (TSH), free triiodothyronine (FT3), and free thyroxine (FT4), were performed on admission. Neurological severity was evaluated using National Institutes of Health Stroke Scale (NIHSS) scores on admission and modified Rankin Scale (mRS) scores at 3 months after stroke onset. Poor outcome was defined as an mRS score of 3-5 or death. The impact of thyroid function on 3-month outcome was evaluated using multiple logistic regression analysis. RESULTS Poor functional outcome was observed in 295 patients (42.0%). Age (P < .0001), female sex (P < .0001), admission NIHSS score (P < .0001), smoking (P = .0026), arterial fibrillation (P = .0002), preadmission mRS (P < .0001), estimated glomerular filtration rate (P = .0307), and ischemic heart disease (P = .0285) were significantly associated with poor functional outcome, but no relationship between FT4, TSH, and poor functional outcome was found. A multivariate logistic regression analysis showed that low FT3 values (<2.00 pg/mL) were independently associated with poor functional outcome (odds ratio [OR], 3.16; 95% confidence interval [CI], 1.60-6.24) and mortality (OR, 2.55; 95% CI, 1.33-4.91) at 3 months after stroke onset. CONCLUSIONS Our data suggest that a low FT3 value upon admission is associated with a poor 3-month functional outcome and mortality in patients with acute stroke.
Collapse
|
23
|
Guarnizo-Poma M, Paico-Palacios S, Pantoja-Torres B, Lazaro-Alcantara H, Urrunaga-Pastor D, Benites-Zapata VA. Association between free thyroid hormones values and the lipid profile in middle-aged women with chronic symptoms. Diabetes Metab Syndr 2018; 12:531-535. [PMID: 29610063 DOI: 10.1016/j.dsx.2018.03.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Accepted: 03/26/2018] [Indexed: 02/08/2023]
Abstract
AIMS To determine the association between the thyroid hormones(FT3, FT4 and TSH) and the lipid profile markers(HDL-c, LDL-c and triglycerides) values in middle-aged women with no metabolic disorders and recurrent chronic symptomatology. MATERIALS AND METHODS We carried out an analytical cross-sectional study in euthyroid women with recurrent chronic symptoms of at least six months with no apparent diagnosis who attended the endocrinological gynaecology outpatient service of a private clinic in Lima-Peru during 2012-2014. Participants who met the eligibility criteria were evaluated according to their thyroid hormones(FT3, FT4 and TSH) and lipid profile markers(HDL-c, LDL-c and triglycerides) values. We elaborated univariate/multivariate linear regression models to evaluate the association between the thyroid markers and the lipid profile levels. The reported association measure was the beta coefficient(β) with its respective p-value. RESULTS We analyzed 211 participants, the average age was 44.9 ± 14.0(SD) years, the FT3 and FT4 mean levels were 3.2 ± 0.4 pg/mL and 1.2 ± 0.2 ng/dL respectively, while the TSH median was 2.8(IQR:1.9-4.0) μU/mL. The mean or median levels of LDL-c, HDL-c and triglycerides were of 137.5 ± 37.9 mg/dL, 54.0 ± 15.0 mg/dL and 118.5(IQR:79.5-169.5) mg/dL respectively. In the multivariate linear regression model between the FT3 and LDL-c levels, we found that for each increase in a FT3 unit, the LDL-c values decreased on average 30.85 mg/dL(p < 0.01). We found no statistically significant associations in the other multivariate models of linear regression, among the other thyroid hormones and lipid markers. CONCLUSION We found an inverse association between the FT3 and LDL-c values in women with chronic gynaecological symptoms.
Collapse
|
24
|
Jiang X, Xing H, Wu J, Du R, Liu H, Chen J, Wang J, Wang C, Wu Y. Prognostic value of thyroid hormones in acute ischemic stroke - a meta analysis. Sci Rep 2017; 7:16256. [PMID: 29176727 PMCID: PMC5701186 DOI: 10.1038/s41598-017-16564-2] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Accepted: 11/14/2017] [Indexed: 11/24/2022] Open
Abstract
Previous studies on the association between thyroid hormones and prognosis of acute ischemic stroke (AIS) reported conflicting results. We conducted a meta-analysis to assess the prognostic value of thyroid hormones in AIS. The PubMed, EMBASE, and Cochrane library databases were searched through May 12, 2017 to identify eligible studies on this subject. Out of 2,181 studies retrieved, 11 studies were finally included with a total number of 3,936 acute stroke patients for analysis. Odds ratio (OR) for predicting poor outcome or standardized mean difference (SMD) of thyroid hormone levels with 95% confidence intervals (95% CI) obtained from the studies were pooled using Review Manager 5.3. From the results, in AIS, patients with a poor outcome had lower levels of triiodothyronine (T3) and higher thyroxine (T4). Pooled OR confirmed the same association. Our study provides statistical evidence supporting the utility of thyroid hormone levels in prognosis of acute stroke.
Collapse
Affiliation(s)
- Xingjun Jiang
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Hongyi Xing
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Jing Wu
- School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Ruofei Du
- University of New Mexico Comprehensive Cancer Center, Albuquerque, 87131, USA
| | - Houfu Liu
- School of Public Health, Shandong University, Jinan, 250100, China
| | - Jixiang Chen
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Ji Wang
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Chen Wang
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Yan Wu
- Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.
| |
Collapse
|
25
|
Suda S, Aoki J, Shimoyama T, Suzuki K, Sakamoto Y, Katano T, Okubo S, Nito C, Nishiyama Y, Mishina M, Kimura K. Low Free Triiodothyronine at Admission Predicts Poststroke Infection. J Stroke Cerebrovasc Dis 2017; 27:397-403. [PMID: 29031498 DOI: 10.1016/j.jstrokecerebrovasdis.2017.09.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Revised: 08/11/2017] [Accepted: 09/11/2017] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Poststroke infection (PSI) is common and is usually associated with a severe prognosis. We investigated the association between PSI and thyroid hormones, which are critical to immune regulation, in patients with acute stroke. METHODS We retrospectively enrolled 520 consecutive patients with acute ischemic stroke (326 men; age, 71.9 ± 13.2 years) admitted to our department between September 2014 and June 2016. The impact of serum thyroid hormone levels measured at admission (thyroid-stimulating hormone [TSH], free triiodothyronine [FT3], and free thyroxine [FT4]) on the PSI was evaluated using multivariate logistic regression analysis. RESULTS We diagnosed 107 patients (20.6%; pneumonia, 65; urinary tract infection, 19; others, 23) with PSIs. While age (P <.001), body mass index (P = .0012), preadmission modified Rankin scale score (P = .0001), National Institutes of Health Stroke Scale score on admission (P <.001), admission FT3 level (P <.001), atrial fibrillation (P <.001), and ischemic heart disease (P = .0451) were significantly associated with PSI, we found no relationship among TSH levels, FT4 levels, and PSI occurrence. After multivariate adjustment, patients with PSIs were more frequently in the Q1 quartile (≤2.25 pg/mL) than in the Q2 (2.26-2.55 pg/mL; P = .0251), Q3 (2.56-2.89 pg/mL; P = .0007), or Q4 (≥2.90 pg/mL; P = .0010) quartiles of FT3 levels. Moreover, low FT3 levels (<2.29 pg/mL) were independently associated with PSI occurrence (P = .0013). CONCLUSIONS Low FT3 levels at admission are independently associated with PSI occurrence.
Collapse
Affiliation(s)
- Satoshi Suda
- Department of Neurological Science, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan.
| | - Junya Aoki
- Department of Neurological Science, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
| | - Takashi Shimoyama
- Department of Neurological Science, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
| | - Kentaro Suzuki
- Department of Neurological Science, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
| | - Yuki Sakamoto
- Department of Neurological Science, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
| | - Takehiro Katano
- Department of Neurological Science, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
| | - Seiji Okubo
- Department of Neurological Science, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
| | - Chikako Nito
- Department of Neurological Science, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
| | - Yasuhiro Nishiyama
- Department of Neurological Science, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
| | - Masahiro Mishina
- Department of Neurological Science, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
| | - Kazumi Kimura
- Department of Neurological Science, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
| |
Collapse
|
26
|
Impact of Thyroid Hormone Levels on Functional Outcome in Neurological and Neurosurgical Early Rehabilitation Patients. BIOMED RESEARCH INTERNATIONAL 2017; 2017:4719279. [PMID: 28900623 PMCID: PMC5576392 DOI: 10.1155/2017/4719279] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Accepted: 07/12/2017] [Indexed: 11/18/2022]
Abstract
Background Neurological and neurosurgical early rehabilitation (NNER) is a specialized treatment option for patients with severe neurological disorders. The present study investigated whether thyroid hormone levels on admission have an impact on the outcome of NNER patients. Method The study included 500 NNER patients who were admitted to the BDH-Clinic Hessisch Oldendorf between 2009 and 2010. Data such as age, sex, diagnoses, comorbidities, Glasgow Coma Scale score, length of stay, and thyroid hormone levels (obtained as part of clinical routine care) were analyzed retrospectively. Improvement in the Early Rehabilitation Barthel Index (ERBI) at the end of the NNER treatment was defined as outcome parameter. Results Most patients made functional progress during treatment, as reflected in significant enhancements of the ERBI. Approximately half of the patients were transferred to further rehabilitation treatment. Young age, early onset of NNER treatment, low functional impairment on admission, and, in particular, low total T3 levels were independently associated with a good outcome. Conclusion Age, severity of disease, and time between injury and admission are known to predict outcome. The present study confirms the influence of these general factors. In addition, an association between thyroid hormones and functional outcome was demonstrated for NNER patients.
Collapse
|
27
|
Ischemic Stroke and Impact of Thyroid Profile at Presentation: A Systematic Review and Meta-analysis of Observational Studies. J Stroke Cerebrovasc Dis 2017; 26:2926-2934. [PMID: 28821377 DOI: 10.1016/j.jstrokecerebrovasdis.2017.07.015] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2017] [Revised: 07/11/2017] [Accepted: 07/15/2017] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Stroke is the fifth leading cause of mortality in the United States and a leading cause of disability. A complex relationship between thyroid hormone levels and severity of, and outcome after, stroke has been described. AIM Our objective is to identify the association between baseline thyroid function profile and outcome after acute ischemic stroke. METHODS Studies looking at the association between thyroid function and functional stroke outcomes were identified from available electronic databases from inception to December 16, 2016. Study-specific risk ratios were extracted and combined with a random effects model meta-analysis. RESULTS In the analysis of 12 studies with 5218 patients, we found that subclinical hypothyroidism was associated with better modified Rankin scale scores at 1 and 3 months (odds ratio [OR] 2.58, 95% confidence interval [CI] 1.13-5.91, P = .03 and OR 2.28, 95% CI 1.13-3.91, P = .003, respectively) compared with the euthyroid cases. Likewise, patients with higher initial thyrotropin-releasing hormone (TSH) and fT3 or T3 levels had favorable outcomes at discharge (mean differences of TSH .12 [95% CI .03-.22, P = .009] and of fT3 .36 (CI .20-.53, P < .0001]) and at 3 months (mean differences of TSH .25 [95% CI .03-.47, P = .03] and of T3 8.60 [CI 4.58-12.61, P < .0001]). CONCLUSIONS Elevated initial TSH (clinical or subclinical hypothyroidism) may correspond to better functional outcomes, whereas low initial T3/fT3 might correlate with worse outcomes in acute ischemic stroke among clinically euthyroid patients. This complex relation merits further well-designed investigations. Whether correcting thyroid profile with hormone supplementation or antagonism may lead to improved outcomes will require large, prospective, interventional studies.
Collapse
|
28
|
Sifuentes MM, Lechleiter JD. Thyroid Hormone Stimulation of Adult Brain Fatty Acid Oxidation. VITAMINS AND HORMONES 2017; 106:163-193. [PMID: 29407434 DOI: 10.1016/bs.vh.2017.05.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
Thyroid hormone is a critical modulator of brain metabolism, and it is highly controlled in the central nervous system. Recent research has uncovered an important role of thyroid hormone in the regulation of fatty acid oxidation (FAO), an energetic process essential for neurodevelopment that continues to support brain metabolism during adulthood. Thyroid hormone stimulation of FAO has been shown to be protective in astrocytes and mouse models of brain injury, yet a clear mechanism of this relationship has not been elucidated. Thyroid hormone interacts with multiple receptors located in the nucleus and the mitochondria, initiating rapid and long-term effects via both genomic and nongenomic pathways. This has complicated efforts to isolate and study-specific interactions. This chapter presents the primary signaling pathways that have been identified to play a role in the thyroid hormone-mediated increase in FAO. Investigation of the impact of thyroid hormone on FAO in the adult brain has challenged classical models of brain metabolism and widened the window of potential neuroprotective strategies. A detailed understanding of these pathways is essential for any researchers aiming to expand the field of neuroenergetics.
Collapse
|
29
|
Chen DW, Du Z, Zhang CZ, Zhang WH, Cao YF, Sun HZ, Zhu ZT, Yang K, Liu YZ, Zhao ZW, Fu ZW, Gu WQ, Yu Y, Fang ZZ. The inhibition of UDP-glucuronosyltransferases (UGTs) by tetraiodothyronine (T4) and triiodothyronine (T3). Xenobiotica 2017; 48:250-257. [DOI: 10.1080/00498254.2017.1304593] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Da-Wei Chen
- Department of Thyroid and Neck Tumor, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, China,
- Department of Toxicology, School of Public Health, Tianjin Medical University, Tianjin, China,
| | - Zuo Du
- Department of Toxicology, School of Public Health, Tianjin Medical University, Tianjin, China,
| | - Chun-Ze Zhang
- Department of Colorectal Surgery, Tianjin Union Medical Center, Tianjin, China, and
| | - Wei-Hua Zhang
- Department of Colorectal Surgery, Tianjin Union Medical Center, Tianjin, China, and
| | - Yun-Feng Cao
- Key Laboratory of Liaoning Tumor Clinical Metabolomics (KLLTCM), Jinzhou, Liaoning, China
| | - Hong-Zhi Sun
- Key Laboratory of Liaoning Tumor Clinical Metabolomics (KLLTCM), Jinzhou, Liaoning, China
| | - Zhi-Tu Zhu
- Key Laboratory of Liaoning Tumor Clinical Metabolomics (KLLTCM), Jinzhou, Liaoning, China
| | - Kun Yang
- Department of Toxicology, School of Public Health, Tianjin Medical University, Tianjin, China,
| | - Yong-Zhe Liu
- Department of Toxicology, School of Public Health, Tianjin Medical University, Tianjin, China,
| | - Ze-Wei Zhao
- Department of Toxicology, School of Public Health, Tianjin Medical University, Tianjin, China,
| | - Zhi-Wei Fu
- Department of Toxicology, School of Public Health, Tianjin Medical University, Tianjin, China,
| | - Wen-Qing Gu
- Department of Thyroid and Neck Tumor, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, China,
| | - Yang Yu
- Department of Thyroid and Neck Tumor, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin, China,
| | - Zhong-Ze Fang
- Department of Toxicology, School of Public Health, Tianjin Medical University, Tianjin, China,
| |
Collapse
|
30
|
Li H, Chen J, Shi B, Chen X, Wu D, Wang Y. Pretransplant serum FT3 levels in recipients predict early non-relapse mortality after myeloablative allogeneic haematopoietic cell transplantation from matched sibling donors. ACTA ACUST UNITED AC 2017. [PMID: 28651453 DOI: 10.1080/10245332.2017.1345098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVES Although decreased thyroid function is negatively correlated with clinical outcomes in critically ill patients, its role in allogeneic haematopoietic cell transplantation (allo-HCT) has not been sufficiently described. METHODS The associations between pre-conditioning thyroid hormone concentrations and transplant-related complications in 474 adult patients with haematologic malignancies who underwent myeloablative allo-HCT were assessed. RESULTS A receiver-operating characteristic curve showed that the baseline serum-free triiodothyronine 3 (FT3) level had an excellent predictive value for non-relapse mortality (NRM) within 100 days in sibling HCT with an area under the curve of 0.73 [95% confidence interval (CI), 0.64-0.82]. With a cut-off value of 4.7 pmol/l, the sensitivity and specificity for early NRM were 68% and 73%, respectively. The cumulative incidences of early NRM within 100 days after sibling HCT were 14% (95% CI, 10-18%) in the low FT3 group and 6% (95% CI, 4-8%) in the high-FT3 group (p = 0.033). In multivariate analysis, a lower FT3 level was significantly associated with high early NRM (HR = 3.19, 95% CI, 1.13-9.03, p = 0.029). The difference was also significant at 3 years after HCT (24% vs. 14%, p = 0.046). Recipients with lower FT3 levels also had a trend towards a lower OS at 3 years after HCT (66% vs. 72%, p = 0.235), although the difference did not reach statistical significance. CONCLUSION A low FT3 level before conditioning may be a useful predictive biomarker for higher early NRM among patients undergoing myeloablative sibling transplantation.
Collapse
Affiliation(s)
- Huijuan Li
- a Department of Endocrinology , The First Affiliated Hospital of Soochow University , Suzhou , People's Republic of China
| | - Jia Chen
- b Jiangsu Institute of Hematology , The First Affiliated Hospital of Soochow University , Suzhou , People's Republic of China
| | - Bimin Shi
- a Department of Endocrinology , The First Affiliated Hospital of Soochow University , Suzhou , People's Republic of China
| | - Xingbo Chen
- a Department of Endocrinology , The First Affiliated Hospital of Soochow University , Suzhou , People's Republic of China
| | - Depei Wu
- b Jiangsu Institute of Hematology , The First Affiliated Hospital of Soochow University , Suzhou , People's Republic of China.,c Collaborative Innovation Center of Hematology , Soochow University , Suzhou , People's Republic of China
| | - Ying Wang
- b Jiangsu Institute of Hematology , The First Affiliated Hospital of Soochow University , Suzhou , People's Republic of China.,c Collaborative Innovation Center of Hematology , Soochow University , Suzhou , People's Republic of China
| |
Collapse
|