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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: 2] [Impact Index Per Article: 2.0] [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.
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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.)
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Xie C, Jiang Y, Shen X, Liu M, Xu Y, Zhong W, Ge Z, Qian M, Dong N, Gong C, Zhang G. Thyroid hormone levels paradox in acute ischemic stroke. Transl Neurosci 2023; 14:20220289. [PMID: 37303476 PMCID: PMC10251163 DOI: 10.1515/tnsci-2022-0289] [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: 01/06/2023] [Revised: 04/27/2023] [Accepted: 05/09/2023] [Indexed: 06/13/2023] Open
Abstract
Objective Accumulating evidence has suggested that thyroid hormone levels affect the prognosis of acute ischemic stroke (AIS), but the results have been inconsistent. Methods Basic data, neural scale scores, thyroid hormone levels, and other laboratory examination data of AIS patients were collected. The patients were divided into excellent and poor prognosis group at discharge and 90 days after discharge. Logistic regression models were applied to evaluate the relationship between thyroid hormone levels and prognosis. A subgroup analysis was performed based on stroke severity. Results A number of 441 AIS patients were included in this study. Those in the poor prognosis group were older, with higher blood sugar levels, higher free thyroxine (FT4) levels, and severe stroke (all p < 0.05) at baseline. Free thyroxine (FT4) showed a predictive value (all p < 0.05) for prognosis in the model adjusted for age, gender, systolic pressure, and glucose level. However, after adjustment for types and severity of stroke, FT4 showed insignificant associations. In the severe subgroup at discharge, the change in FT4 was statistically significant (p = 0.015), odds ratio (95% confidence interval) = 1.394 (1.068-1.820) but not in the other subgroups. Conclusions High-normal FT4 serum levels in patients with severe stroke receiving conservative medical treatment at admission may indicate a worse short-term prognosis.
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Affiliation(s)
- Chunhui Xie
- Department of Neurology, The Affiliated Lianyungang Hospital of Xuzhou Medical University, Lianyungang, China
- Department of Geriatrics, Lianyungang Hospital Affiliated to Jiangsu University (Lianyungang Second People’s Hospital), Lianyungang, China
| | - Yi Jiang
- Department of Geriatrics, Lianyungang Clinical College of Bengbu Medical College (Lianyungang Second People’s Hospital), Lianyungang, China
| | - Xiaozhu Shen
- Department of Geriatrics, Lianyungang Hospital Affiliated to Jiangsu University (Lianyungang Second People’s Hospital), Lianyungang, China
| | - Mengqian Liu
- Department of Geriatrics, Lianyungang Hospital Affiliated to Jiangsu University (Lianyungang Second People’s Hospital), Lianyungang, China
| | - Yiwen Xu
- Department of Geriatrics, Lianyungang Hospital Affiliated to Jiangsu University (Lianyungang Second People’s Hospital), Lianyungang, China
| | - Wen Zhong
- Department of Geriatrics, Lianyungang Hospital Affiliated to Jiangsu University (Lianyungang Second People’s Hospital), Lianyungang, China
| | - Zhonglin Ge
- Department of Neurology, Lianyungang Second People’s Hospital, Lianyungang, China
| | - Mingyue Qian
- Department of Neurology, Lianyungang Second People’s Hospital, Lianyungang, China
| | - Nan Dong
- Department of Neurology, Suzhou Industrial Park Xinghai Hospital, Suzhou, China
| | - Chen Gong
- Department of Geriatrics, Lianyungang Hospital Affiliated to Jiangsu University (Lianyungang Second People’s Hospital), Lianyungang, China
| | - Guanghui Zhang
- Department of Neurology, Lianyungang Hospital affiliated to Xuzhou Medical University, Lianyungang, China
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Dominguez LJ, Barbagallo M. Thyroid disorders. PATHY'S PRINCIPLES AND PRACTICE OF GERIATRIC MEDICINE 2022:1041-1058. [DOI: 10.1002/9781119484288.ch83] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
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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.
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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
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Said M, Gümüs M, Herten A, Dinger TF, Chihi M, Darkwah Oppong M, Deuschl C, Wrede KH, Kleinschnitz C, Sure U, Jabbarli R. Subarachnoid Hemorrhage Early Brain Edema Score (SEBES) as a radiographic marker of clinically relevant intracranial hypertension and unfavorable outcome after subarachnoid hemorrhage. Eur J Neurol 2021; 28:4051-4059. [PMID: 34293828 DOI: 10.1111/ene.15033] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Revised: 07/16/2021] [Accepted: 07/17/2021] [Indexed: 01/21/2023]
Abstract
BACKGROUND AND PURPOSE The severity of early brain edema (EBE) after aneurysm rupture was reported to be strongly associated with the risk of poor outcome after aneurysmal subarachnoid hemorrhage (SAH). Using the recently developed Subarachnoid Hemorrhage Early Brain Edema Score (SEBES), we analyzed the predictors of EBE and its impact on complications related to intracranial pressure (ICP) increase after SAH and on poor outcome. METHODS All consecutive SAH cases treated between January 2003 and June 2016 with assessable SEBES were included (n = 745). Data on demographic characteristics, medical history, initial severity of SAH, need for conservative ICP treatment and decompressive craniectomy, occurrence of cerebral infarctions and unfavorable outcome at 6 months (modified Rankin scale score > 2) were collected. Univariable and multivariable analyses were performed. RESULTS Younger age (<55 years; adjusted odds ratio [aOR] 3.16, 95% confidence interval [CI] 2.28-4.38), female sex (aOR 1.64, 95% CI 1.16-2.31), poor initial clinical condition (World Federation of Neurosurgical Societies score 4-5; aOR 1.74, 95% CI 1.23-2.46), presence of intracerebral hemorrhage (aOR 1.63, 95% CI 1.12-2.36), hypothyroidism (aOR 0.60, 95% CI 0.37-0.98) and renal comorbidity (aOR 0.29, 95% CI 0.11-0.78) were independently associated with SEBES (scores 3-4). There was an independent association between SEBES 3-4 and the need for conservative ICP treatment (aOR 2.43, 95% CI 1.73-3.42), decompressive craniectomy (aOR 2.68, 95% CI 1.84-3.89), development of cerebral infarcts (aOR 2.24, 95% CI 1.53-3.29) and unfavorable outcome (aOR 1.48, 95% CI 1.0-2.17). CONCLUSIONS SEBES is a reliable predictor of ICP-related complications and poor outcome of SAH. Our findings highlight the need for further research of the impact of patients' demographic characteristics and comorbidities on the severity of EBE after SAH.
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Affiliation(s)
- Maryam Said
- Department of Neurosurgery and Spine Surgery, University Hospital of Essen, Essen, Germany
| | - Meltem Gümüs
- Department of Neurosurgery and Spine Surgery, University Hospital of Essen, Essen, Germany
| | - Annika Herten
- Department of Neurosurgery and Spine Surgery, University Hospital of Essen, Essen, Germany
| | - Thiemo Florin Dinger
- Department of Neurosurgery and Spine Surgery, University Hospital of Essen, Essen, Germany
| | - Mehdi Chihi
- Department of Neurosurgery and Spine Surgery, University Hospital of Essen, Essen, Germany
| | - Marvin Darkwah Oppong
- Department of Neurosurgery and Spine Surgery, University Hospital of Essen, Essen, Germany
| | - Cornelius Deuschl
- Department of Diagnostic and Interventional Radiology, University Hospital of Essen, Essen, Germany
| | - Karsten H Wrede
- Department of Neurosurgery and Spine Surgery, University Hospital of Essen, Essen, Germany
| | - Christoph Kleinschnitz
- Department of Neurology and Center for Translational and Behavioral Neurosciences (C-TNBS), University Hospital of Essen, Essen, Germany
| | - Ulrich Sure
- Department of Neurosurgery and Spine Surgery, University Hospital of Essen, Essen, Germany
| | - Ramazan Jabbarli
- Department of Neurosurgery and Spine Surgery, University Hospital of Essen, Essen, Germany
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To Treat or Not to Treat Subclinical Hypothyroidism, What Is the Evidence? ACTA ACUST UNITED AC 2020; 56:medicina56010040. [PMID: 31963883 PMCID: PMC7022757 DOI: 10.3390/medicina56010040] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Revised: 01/13/2020] [Accepted: 01/14/2020] [Indexed: 12/11/2022]
Abstract
OBJECTIVE levothyroxine prescriptions have increased remarkably during the last decade, and it is most likely to be prescribed in subclinical hypothyroidism. The aim of this review was to present data on when levothyroxine treatment should be initiated, and the effects of treatment in subclinical hypothyroidism on symptoms such as weight, quality of life, vitality, cognition, and cardiovascular disease. We also discuss evidence for different thyroid-hormone medications. In addition, the option to withhold medication when there is uncertain diagnosis or lack of clinical improvement is discussed. METHODS a literature search in PubMed on the term "treatment of subclinical hypothyroidism" in combination with "quality of life", "weight", "cognition", and "cerebrovascular disease". RESULTS current research supports that levothyroxine should be initiated in patients with a thyroid stimulating hormone (TSH) >10 mIU/L. Treatment for hypothyroidism is becoming more frequent. Symptoms related to vitality, weight, and quality of life in subclinical disease often persist with levothyroxine treatment, and other causes should be explored. Patients with cardiovascular-risk factors may benefit from treatment, especially younger patients. Caution is necessary when treating elderly subjects with levothyroxine. CONCLUSION lifelong treatment with levothyroxine should normally only be considered in manifest hypothyroidism. However, in subclinical hypothyroidism with a TSH >10 mIU/L, therapy is indicated. In milder subclinical forms, a wait-and-see strategy is advocated to see if normalization occurs. Subgroups with cardiovascular risk and subclinical hypothyroidism may benefit from levothyroxine therapy.
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Zhang S, Zhao X, Xu S, Yuan J, Si Z, Yang Y, Qiao S, Xu X, Wang A. Low free triiodothyronineis predicts worsen neurological outcome of patients with acute ischemic stroke: a retrospective study with bioinformatics analysis. BMC Neurol 2019; 19:272. [PMID: 31690277 PMCID: PMC6833267 DOI: 10.1186/s12883-019-1509-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2019] [Accepted: 10/22/2019] [Indexed: 12/25/2022] Open
Abstract
Backgroud Patients with acute ischemic stroke (AIS) often experience low serum free triiodothyronine (FT3), but the association of low FT3 with stroke severity, subtype and prognosis has not yet been thoroughly studied, and the molecular events underlying these clinical observation were also unclear. Methods We retrospectively collected 221 cases of AIS and 182 non-AIS cases with detailed clinical data from our department. FT3 concentrations were measured on admission to predict functional outcome within 3 months using multivariable models adjusted for other risk factors. Receiver operating characteristic (ROC) curves were calculated to define the best cutoff value of FT3 of stroke severity, subtypes and neurological outcome. Gene set enrichment, pathway mapping and network analyses of deferentially expressed genes (DEGs) were performed. Results FT3 was significantly decreased in AIS patients with National Institutes of Health Stroke Scale (NIHSS) > 3 and 3-months modified Rankin Scale (mRS) > 2. The cut-off value of FT3 for NIHSS on admission was 4.30 pmol/L. Also, FT3 level was significantly lower in large artery atherosclerosis (LAA) group and cardioembolism (CE) group than that in small vessel occlusion (SVO). FT3 value served as an independent predictor for neurological outcomes for which the cut-off value of FT3 was 4.38 pmol/l. Gene ontology (GO) analysis showed that the biological function of DEGs was mainly enriched in multicellur organism, neuron differentiation and cellular response to hypoxia. The cellular components were involved in extracelluar region, exosome and matrix, and the molecular functions were transcriptional activator activity, DNA binding and nuclear hormone receptor binding. Signal pathways analysis was indicative of neuroactive ligand-receptor interaction, thyroid hormone signaling pathway, and protein digestion and absorption these DEGs were involved in. Six related gene were identified as hubs from the protein-protein interaction (PPI) networks. Three modules were selected from PPI, of which MMP4, ADRA2C and EIF3E were recognized as the seed genes. Conclusions Low FT3 value on admission was associated with stroke severity, subtype and prognosis. In addition, DEGs identified from bioinformatics analysis are likely to be candidates for elucidating clinical outcomes with low FT3, and provide us with therapeutic targets for improving stroke prognosis.
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Affiliation(s)
- Shanchao Zhang
- Department of Neurology, Shandong Provincial Qianfoshan Hospital, the First Hospital Affiliated with Shandong First Medical University, NO.16766 JingShi Road, Jinan, 250014, Shandong, China.
| | - Xia Zhao
- Department of Neurology, Shandong Provincial Qianfoshan Hospital, the First Hospital Affiliated with Shandong First Medical University, NO.16766 JingShi Road, Jinan, 250014, Shandong, China
| | - Shan Xu
- Department of Neurology, Shandong Provincial Qianfoshan Hospital, the First Hospital Affiliated with Shandong First Medical University, NO.16766 JingShi Road, Jinan, 250014, Shandong, China
| | - Jing Yuan
- Department of Neurology, Shandong Provincial Qianfoshan Hospital, the First Hospital Affiliated with Shandong First Medical University, NO.16766 JingShi Road, Jinan, 250014, Shandong, China
| | - Zhihua Si
- Department of Neurology, Shandong Provincial Qianfoshan Hospital, the First Hospital Affiliated with Shandong First Medical University, NO.16766 JingShi Road, Jinan, 250014, Shandong, China
| | - Yang Yang
- Department of Neurology, Shandong Provincial Qianfoshan Hospital, the First Hospital Affiliated with Shandong First Medical University, NO.16766 JingShi Road, Jinan, 250014, Shandong, China
| | - Shan Qiao
- Department of Neurology, Shandong Provincial Qianfoshan Hospital, the First Hospital Affiliated with Shandong First Medical University, NO.16766 JingShi Road, Jinan, 250014, Shandong, China
| | - Xuxu Xu
- Department of Neurology, Shandong Provincial Qianfoshan Hospital, the First Hospital Affiliated with Shandong First Medical University, NO.16766 JingShi Road, Jinan, 250014, Shandong, China
| | - Aihua Wang
- Department of Neurology, Shandong Provincial Qianfoshan Hospital, the First Hospital Affiliated with Shandong First Medical University, NO.16766 JingShi Road, Jinan, 250014, Shandong, China
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Zhang X, Gong P, Sheng L, Lin Y, Fan Q, Zhang Y, Bao Y, Li S, Du H, Chen Z, Ding C, Wang H, Xu P, Zhang M, Scalzo F, Liebeskind DS, Xie Y, Liu D. Prognostic value of subclinical thyroid dysfunction in ischemic stroke patients treated with intravenous thrombolysis. Aging (Albany NY) 2019; 11:6839-6850. [PMID: 31479421 PMCID: PMC6756908 DOI: 10.18632/aging.102215] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Accepted: 08/14/2019] [Indexed: 12/15/2022]
Abstract
Data regarding the association between subclinical thyroid dysfunction and clinical outcomes in ischemic stroke patients with intravenous thrombolysis (IVT) are limited. We aimed to investigate the predictive value of subclinical thyroid dysfunction in END, functional outcome and mortality at 3 months among IVT patients. We prospectively recruited 563 IVT patients from 5 stroke centers in China. Thyroid function status was classified as subclinical hypothyroidism, subclinical hyperthyroidism (SHyper) and euthyroidism. The primary outcome was END, defined as ≥ 4 point in the NIHSS score within 24 h after IVT. Secondary outcomes included 3-month functional outcome and mortality. Of the 563 participants, END occurred in 14.7%, poor outcome in 50.8%, and mortality in 9.4%. SHyper was an independent predictor of END [odd ratio (OR), 4.35; 95% confidence interval [CI], 1.86–9.68, P = 0.003], 3-month poor outcome (OR, 3.24; 95% CI, 1.43–7.33, P = 0.005) and mortality [hazard ratio, 2.78; 95% CI, 1.55–5.36, P = 0.003]. Subgroup analysis showed that there was no significant relationship between SHyper and clinical outcomes in IVT patients with endovascular therapy. In summary, SHyper is associated with increased risk of END, and poor outcome and mortality at 3 months in IVT patients without endovascular therapy.
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Affiliation(s)
- Xiaohao Zhang
- Department of Neurology, Jiangsu Provincial Second Chinese Medicine Hospital, Second Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China.,Department of Neurology, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, China
| | - Pengyu Gong
- Department of Neurology, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Lei Sheng
- Department of Neurology, Jiangsu Provincial Second Chinese Medicine Hospital, Second Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China
| | - Yanni Lin
- Department of Neurology, The First People's Hospital of Yulin, Yulin, Guangxi, China
| | - Qiqi Fan
- Department of Neurology, Jiangsu Provincial Second Chinese Medicine Hospital, Second Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China
| | - Yun Zhang
- Department of Neurology, Mianyang Central Hospital, Mianyang, Sichuan, China
| | - Yuanfei Bao
- Department of Neurology, The Third People's Hospital of Nantong, Nantong, Jiangsu, China
| | - Shizhan Li
- Department of Neurology, The First People's Hospital of Yulin, Yulin, Guangxi, China
| | - Hongcai Du
- Department of Neurology, Mianyang Central Hospital, Mianyang, Sichuan, China
| | - Zhonglun Chen
- Department of Neurology, Mianyang Central Hospital, Mianyang, Sichuan, China
| | - Caixia Ding
- Department of Neurology, Jiangsu Provincial Second Chinese Medicine Hospital, Second Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China
| | - Huaiming Wang
- Department of Neurology, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, China
| | - Pengfei Xu
- Department of Neurology, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, China
| | - Min Zhang
- Department of Endocrinology, Nanjing Xianlin Drum Tower Hospital, Nanjing, Jiangsu, China
| | - Fabien Scalzo
- Department of Neurology, Neurovascular Imaging Research Core, University of California Los Angeles, Los Angeles, CA 90095, USA
| | - David S Liebeskind
- Department of Neurology, Neurovascular Imaging Research Core, University of California Los Angeles, Los Angeles, CA 90095, USA
| | - Yi Xie
- Department of Neurology, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, China
| | - Dezhi Liu
- Department of Neurology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Lee SH, Jang MU, Kim Y, Park SY, Kim C, Kim YJ, Sohn JH. Subclinical Hyperthyroidism Could Predict Poor Outcomes in Patients With Acute Ischemic Stroke Treated With Reperfusion Therapy. Front Neurol 2019; 10:782. [PMID: 31379731 PMCID: PMC6652740 DOI: 10.3389/fneur.2019.00782] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 07/04/2019] [Indexed: 11/24/2022] Open
Abstract
Background: Evidence for the effect of subclinical thyroid dysfunction on the prognosis of patients suffering from acute ischemic stroke and receiving reperfusion therapy remains controversial. We aimed to investigate the association between subclinical thyroid dysfunction and the outcomes of patients with acute ischemic stroke who were treated with reperfusion therapy. Methods: One hundred fifty-six consecutively recruited patients with acute ischemic stroke receiving reperfusion therapy (intravenous thrombolysis, intraarterial thrombectomy and combined intravenous thrombolysis and intraarterial thrombectomy) were included in this prospective observational study. We divided patients with subclinical thyroid dysfunction into the following 2 groups and defined a euthyroid group: subclinical hyperthyroidism (a thyroid-stimulating hormone level <0.35 μU/mL), subclinical hypothyroidism (a thyroid-stimulating hormone level >4.94 μU/mL), and a euthyroid state (0.35 μU/mL ≤ thyroid-stimulating hormone level ≤ 4.94 μU/mL). Patients with overt thyroid dysfunction were excluded. The primary outcome was functional disability at 3 months (modified Rankin Scale, mRS), and the secondary outcome was successful reperfusion. A multivariate analysis was performed to evaluate the associations between subclinical thyroid dysfunction and the primary and secondary outcomes. Results: The subclinical hyperthyroidism group appeared to have poor functional outcomes, but the differences were not significant. However, compared with patients in the euthyroid state, patients with subclinical hyperthyroidism had an increased risk of poor functional outcomes at 3 months after a stroke (adjusted odds ratio [OR] 2.50, 95% confidence interval [CI] 1.01–6.14 for a mRS score of 3 to 6) and a decreased rate of successful reperfusion after reperfusion therapy (OR 0.13, 95% CI 0.04–0.43). Conclusion: Subclinical hyperthyroidism may be independently associated with a poor prognosis at 3 months and unsuccessful reperfusion in patients with acute ischemic stroke receiving reperfusion therapy.
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Affiliation(s)
- Sang-Hwa Lee
- Department of Neurology, Chuncheon Sacred Heart Hospital, College of Medicine, Hallym University, Chuncheon, South Korea
| | - Min Uk Jang
- Department of Neurology, Dongtan Sacred Heart Hospital, College of Medicine, Hallym University, Hwaseong, South Korea
| | - Yerim Kim
- Department of Neurology, Kangdong Sacred Heart Hospital, College of Medicine, Hallym University, Seoul, South Korea
| | - So Young Park
- Department of Endocrinology and Metabolism, Kyung Hee University Hospital, Seoul, South Korea
| | - Chulho Kim
- Department of Neurology, Chuncheon Sacred Heart Hospital, College of Medicine, Hallym University, Chuncheon, South Korea
| | - Yeo Jin Kim
- Department of Neurology, Chuncheon Sacred Heart Hospital, College of Medicine, Hallym University, Chuncheon, South Korea
| | - Jong-Hee Sohn
- Department of Neurology, Chuncheon Sacred Heart Hospital, College of Medicine, Hallym University, Chuncheon, South Korea
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Taroza S, Rastenytė D, Podlipskytė A, Kazlauskas H, Mickuvienė N. Nonthyroidal Illness Syndrome in Ischaemic Stroke Patients is Associated with Increased Mortality. Exp Clin Endocrinol Diabetes 2019; 128:811-818. [PMID: 31158897 DOI: 10.1055/a-0915-2015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
BACKGROUND Results of studies on associations between triiodothyronine serum levels and mortality after acute ischemic stroke (AIS) are inconsistent. Therefore, the aim of this prospective study was to evaluate links between serum levels of thyroid axis associated hormones and all-cause mortality during 1 year after AIS. METHODS AND RESULTS This study involved 255 patients with AIS. Patients were divided into two groups: those who survived 1 year after their index stroke and those who not, and by quartiles of free triiodothyronine (FT3) and ΔFT3 (difference between basal FT3 and repeated FT3 on discharge) hormone serum concentrations. To assess serum levels of thyroid stimulating hormone (TSH), FT3 and free tetraiodothyronine (FT4), venous blood was taken from all included patients on admission to hospital. On discharge, blood tests were repeated for 178 (69.8%) patients. Study endpoints were overall mortality within 30, 90 and 365 days after AIS. RESULTS Compared with the survivals, those who died had significantly lower mean FT3, FT3/FT4 ratio in all periods and lower median TSH within 30 days. Higher FT3 serum levels versus lower, even after adjustment for included important variables, remained significant for lower odds of death within 365 days after AIS (OR=0.57; 95% CI: 0.33-0.97, p=0.04), but added insignificant additional predictive value to the NIHSS score or age. Kaplan-Meier survival curves demonstrated that the first FT3 quartile was significantly associated with increased mortality compared with all other quartiles within 365 days after AIS. With ΔFT3 quartiles no such association was found. CONCLUSIONS Higher FT3 levels on admission versus lower are significantly associated with lower mortality within 365 days after AIS. FT3 serum levels changes over time didn't show any association with mortality within first year.
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Affiliation(s)
- Saulius Taroza
- Laboratory of Behavioral Medicine (Palanga), Neuroscience Institute, Lithuanian University of Health Sciences, Lithuania
| | - Daiva Rastenytė
- Department of Neurology, Medical Academy, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Aurelija Podlipskytė
- Laboratory of Behavioral Medicine (Palanga), Neuroscience Institute, Lithuanian University of Health Sciences, Lithuania
| | | | - Narseta Mickuvienė
- Laboratory of Behavioral Medicine (Palanga), Neuroscience Institute, Lithuanian University of Health Sciences, Lithuania
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Dominguez LJ, Barbagallo M. Thyroid Disorders in Old Age. REFERENCE MODULE IN BIOMEDICAL SCIENCES 2019. [DOI: 10.1016/b978-0-12-801238-3.11338-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
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12
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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.
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Diagnosis and Management of Hypothyroidism: Addressing the Knowledge-Action Gaps. Adv Ther 2018; 35:1519-1534. [PMID: 30171491 DOI: 10.1007/s12325-018-0744-7] [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: 04/24/2018] [Indexed: 01/08/2023]
Abstract
Hypothyroidism presents a large epidemiological burden in India. As a result of subtle and nonspecific clinical symptoms and signs, the condition often goes undiagnosed and is not adequately treated when it is detected. There is heterogeneity in the diagnostic and treatment approaches to hypothyroidism. As a result of the physiological changes in thyroid hormones with age and illness, it is important to tailor the diagnosis and management of this condition in specific populations including pregnant women, infants, children, geriatric patients, and those with comorbid conditions. Enhanced understanding and education of physicians and patients can help to improve the outcomes of treatment in hypothyroidism which should be focused on patient-centered care. Policies and reforms should be crafted and implemented at the national level to curb public health challenges of hypothyroidism. This publication summarizes the recommendations of a national advisory board meeting to identify and bridge the gaps in understanding of the diagnosis and treatment of hypothyroidism in India. As a complement to clinical judgment, these recommendations will foster the diagnosis and management of hypothyroidism in the community and clinics for the benefit of the patients. FUNDING Merck Ltd, India.
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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.
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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.
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Jia F, Tian J, Deng F, Yang G, Long M, Cheng W, Wang B, Wu J, Liu D. Subclinical hypothyroidism and the associations with macrovascular complications and chronic kidney disease in patients with Type 2 diabetes. Diabet Med 2015; 32:1097-103. [PMID: 25683250 DOI: 10.1111/dme.12724] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/09/2015] [Indexed: 01/20/2023]
Abstract
AIMS The prevalence of subclinical hypothyroidism (SCH) is high among patients with diabetes, although the relationship between SCH and diabetic vascular complications is unknown. This study aimed to determine the relationship between SCH and vascular complications in patients with Type 2 diabetes. METHODS In this cross sectional study, 991 patients with Type 2 diabetes were screened for thyroid function at their admission to the Second Affiliated Hospital of Chongqing Medical University. We compared the prevalence of coronary heart disease (CHD), ischaemic stroke and chronic kidney disease (CKD) with the prevalence of euthyroidism and SCH. RESULTS Among the 991 patients, 126 (12.7%) patients had SCH. The prevalence of CHD was significantly higher in the SCH group than in the euthyroid group (22.2% and 15.0%, respectively; P = 0.039). In the logistic regression analyses, SCH was associated with CHD [odds ratio (OR): 1.993; 95% confidence interval (CI): 1.135-3.497; P = 0.016]. This association was stronger in patients aged ≥ 65 years than in younger patients [2.474 (1.173-5.220); P = 0.017]. No significant association was found between SCH and ischaemic stroke. Patients with severe SCH had a high risk of CKD [1.842 (1.120-3.029); P = 0.016]. CONCLUSIONS This study provides evidence that SCH in patients with Type 2 diabetes is associated with a high prevalence of CHD (and CKD in severe SCH), although not with ischaemic stroke.
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Affiliation(s)
- F Jia
- Department of Endocrinology and Metabolism, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - J Tian
- Department of Endocrinology and Metabolism, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - F Deng
- Department of Cardiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - G Yang
- Department of Endocrinology and Metabolism, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - M Long
- Department of Endocrinology and Metabolism, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - W Cheng
- Department of Endocrinology and Metabolism, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - B Wang
- Department of Endocrinology and Metabolism, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - J Wu
- Department of Endocrinology and Metabolism, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - D Liu
- Department of Endocrinology and Metabolism, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
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Gu F, Qin J, Chen R, Xu X. Post-thrombolysis hemorrhage in a patient with hypothyroidism and acute ischemic stroke: Case report. Neurol Neurochir Pol 2015; 49:290-4. [DOI: 10.1016/j.pjnns.2015.05.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Revised: 04/29/2015] [Accepted: 05/05/2015] [Indexed: 11/17/2022]
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Sadana P, Coughlin L, Burke J, Woods R, Mdzinarishvili A. Anti-edema action of thyroid hormone in MCAO model of ischemic brain stroke: Possible association with AQP4 modulation. J Neurol Sci 2015; 354:37-45. [PMID: 25963308 DOI: 10.1016/j.jns.2015.04.042] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2014] [Revised: 04/13/2015] [Accepted: 04/23/2015] [Indexed: 01/12/2023]
Abstract
The use of neuroprotective strategies to mitigate the fatal consequences of ischemic brain stroke is a focus of robust research activity. We have previously demonstrated that thyroid hormone (T3; 3,3',5-triiodo-l-thyronine) possesses neuroprotective and anti-edema activity in pre-stroke treatment regimens when administered as a solution or as a nanoparticle formulation. In this study we have extended our evaluation of thyroid hormone use in animal models of brain stroke. We have used both transient middle cerebral artery occlusion (t-MCAO) and permanent (p-MCAO) models of ischemic brain stroke. A significant reduction of tissue infarction and a concurrent decrease in edema were observed in the t-MCAO model of brain stroke. However, no benefit of T3 was observed in p-MCAO stroke setting. Significant improvement of neurological outcomes was observed upon T3 treatment in t-MCAO mice. Further, we tested T2 (3,5-diiodo-l-thyronine) a natural deiodination metabolite of T3 in MCAO model of brain stroke. T2 potently decreased infarct size as well as edema formation. Additionally, we report here that T3 suppresses the expression of aquaporin-4 (AQP4) water channels which could be a likely mechanism of its anti-edema activity. Our studies provide evidence to stimulate clinical development of thyroid hormones for use in ischemic brain stroke.
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Affiliation(s)
- Prabodh Sadana
- Department of Pharmaceutical Sciences, College of Pharmacy, Northeast Ohio Medical University, Rootstown, OH 44272, USA.
| | - Lucy Coughlin
- Department of Pharmaceutical Sciences, College of Pharmacy, Northeast Ohio Medical University, Rootstown, OH 44272, USA
| | - Jamie Burke
- Department of Pharmaceutical Sciences, College of Pharmacy, Northeast Ohio Medical University, Rootstown, OH 44272, USA
| | - Robert Woods
- Department of Pharmaceutical Sciences, College of Pharmacy, Northeast Ohio Medical University, Rootstown, OH 44272, USA
| | - Alexander Mdzinarishvili
- Department of Rehabilitation Sciences, College of Allied Health, The University of Oklahoma, Health Sciences Center, Oklahoma City, OK 73117-1215, USA.
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Thyroid function tests and early outcomes of acute ischemic stroke in older euthyroid patients. Exp Gerontol 2015; 61:8-14. [DOI: 10.1016/j.exger.2014.11.011] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2014] [Revised: 11/05/2014] [Accepted: 11/16/2014] [Indexed: 11/23/2022]
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Abstract
Endobiogeny is a global systems approach to human biology that may offer an advancement in clinical medicine based in scientific principles of rigor and experimentation and the humanistic principles of individualization of care and alleviation of suffering with minimization of harm. Endobiogeny is neither a movement away from modern science nor an uncritical embracing of pre-rational methods of inquiry but a synthesis of quantitative and qualitative relationships reflected in a systems-approach to life and based on new mathematical paradigms of pattern recognition.
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Affiliation(s)
- Jean-Claude Lapraz
- Société internationale de médecine endobiogénique et de physiologie intégrative, Paris, France
| | - Kamyar M Hedayat
- American society of endobiogenic medicine and integrative physiology, San Diego, California, United States
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Tognini S, Pasqualetti G, Calsolaro V, Polini A, Caraccio N, Monzani F. Cardiovascular risk and quality of life in elderly people with mild thyroid hormone deficiency. Front Endocrinol (Lausanne) 2014; 5:153. [PMID: 25339939 PMCID: PMC4188129 DOI: 10.3389/fendo.2014.00153] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2014] [Accepted: 09/12/2014] [Indexed: 01/06/2023] Open
Abstract
Subclinical hypothyroidism (sHT) is a common condition in the general population, the prevalence increases with age, especially in women. An association between sHT and increased coronary heart disease (CHD) and heart failure (HF) risk and mortality has been described. However, this association is far to be established in older people (>65 years), especially in the oldest old (>85 years). Individuals with sHT may experience symptoms that resemble those observed in the overt form of the disease, leading to an impaired quality of life (QoL). Although very old people are frequently frail and potentially more susceptible to the effects of a disease, few studies were designed to assess the effect of sHT on QoL in this subset of population. Interestingly, the serum TSH concentration curve of general population has a skewed distribution with a "tail" toward higher values, which is amplified with aging. Thus, the diagnosis of sHT and the interpretation of its potential effects on CV function and QoL in older people may be a challenge for the clinician. Giving these premises, we reviewed the English scientific literature available on National Library of Medicine (www.pubmed.com) since 1980 regarding hypothyroidism, sHT, elderly, cardiovascular risk, CHD or HF events and mortality, health-related QoL, and LT4 therapy. Consistent results among large prospective cohort studies suggest an age-independent relationship between sHT and HF progression, while an impact of sHT on CHD events and mortality is essentially reported in young adults (aged below 65-70 years) with long-lasting disease. Scanty data are available on QoL of older people with sHT (>65 years) and, generally, no significant alterations are described.
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Affiliation(s)
- Sara Tognini
- Geriatrics Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Giuseppe Pasqualetti
- Geriatrics Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Valeria Calsolaro
- Geriatrics Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Antonio Polini
- Geriatrics Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Nadia Caraccio
- Geriatrics Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Fabio Monzani
- Geriatrics Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
- *Correspondence: Fabio Monzani, Geriatrics Unit, Department of Clinical and Experimental Medicine, University of Pisa, Via Paradisa, Pisa 56100, Italy e-mail:
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Intracerebral Hemorrhage with Hypothyroidism. J Stroke Cerebrovasc Dis 2013; 22:e602-9. [DOI: 10.1016/j.jstrokecerebrovasdis.2013.07.040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2013] [Revised: 07/08/2013] [Accepted: 07/27/2013] [Indexed: 11/19/2022] Open
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Wollenweber FA, Zietemann V, Gschwendtner A, Opherk C, Dichgans M. Subclinical Hyperthyroidism Is a Risk Factor for Poor Functional Outcome After Ischemic Stroke. Stroke 2013; 44:1446-8. [DOI: 10.1161/strokeaha.113.000833] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- Frank Arne Wollenweber
- From the Institute for Stroke and Dementia Research (F.A.W., V.Z., A.G., C.O., M.D.), Department of Neurology (C.O.), Interdisciplinary Stroke Center (C.O., M.D.), Klinikum der Universität München, Ludwig-Maximilians-University, Munich, Germany; and Munich Cluster for Systems Neurology (SyNergy), Munich, Germany (M.D.)
| | - Vera Zietemann
- From the Institute for Stroke and Dementia Research (F.A.W., V.Z., A.G., C.O., M.D.), Department of Neurology (C.O.), Interdisciplinary Stroke Center (C.O., M.D.), Klinikum der Universität München, Ludwig-Maximilians-University, Munich, Germany; and Munich Cluster for Systems Neurology (SyNergy), Munich, Germany (M.D.)
| | - Andreas Gschwendtner
- From the Institute for Stroke and Dementia Research (F.A.W., V.Z., A.G., C.O., M.D.), Department of Neurology (C.O.), Interdisciplinary Stroke Center (C.O., M.D.), Klinikum der Universität München, Ludwig-Maximilians-University, Munich, Germany; and Munich Cluster for Systems Neurology (SyNergy), Munich, Germany (M.D.)
| | - Christian Opherk
- From the Institute for Stroke and Dementia Research (F.A.W., V.Z., A.G., C.O., M.D.), Department of Neurology (C.O.), Interdisciplinary Stroke Center (C.O., M.D.), Klinikum der Universität München, Ludwig-Maximilians-University, Munich, Germany; and Munich Cluster for Systems Neurology (SyNergy), Munich, Germany (M.D.)
| | - Martin Dichgans
- From the Institute for Stroke and Dementia Research (F.A.W., V.Z., A.G., C.O., M.D.), Department of Neurology (C.O.), Interdisciplinary Stroke Center (C.O., M.D.), Klinikum der Universität München, Ludwig-Maximilians-University, Munich, Germany; and Munich Cluster for Systems Neurology (SyNergy), Munich, Germany (M.D.)
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Dominguez LJ, Belvedere M, Barbagallo M. Thyroid Disorders. PATHY'S PRINCIPLES AND PRACTICE OF GERIATRIC MEDICINE 2012:1183-1197. [DOI: 10.1002/9781119952930.ch98] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
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Lipid abnormalities and cardiometabolic risk in patients with overt and subclinical thyroid disease. J Lipids 2011; 2011:575840. [PMID: 21789282 PMCID: PMC3140027 DOI: 10.1155/2011/575840] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2011] [Revised: 05/17/2011] [Accepted: 05/17/2011] [Indexed: 02/03/2023] Open
Abstract
Dyslipidemia is a common finding in patients with thyroid disease, explained by the adverse effects of thyroid hormones in almost all steps of lipid metabolism. Not only overt but also subclinical hypo- and hyperthyroidism, through different mechanisms, are associated with lipid alterations, mainly concerning total and LDL cholesterol and less often HDL cholesterol, triglycerides, lipoprotein (a), apolipoprotein A1, and apolipoprotein B. In addition to quantitative, qualitative alterations of lipids have been also reported, including atherogenic and oxidized LDL and HDL particles. In thyroid disease, dyslipidemia coexists with various metabolic abnormalities and induce insulin resistance and oxidative stress via a vice-vicious cycle. The above associations in combination with the thyroid hormone induced hemodynamic alterations, might explain the increased risk of coronary artery disease, cerebral ischemia risk, and angina pectoris in older, and possibly ischemic stroke in younger patients with overt or subclinical hyperthyroidism.
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Ng YY, Wu SC, Lin HD, Hu FH, Hou CC, Chou YY, Chiu SM, Sun YH, Cho SSY, Yang WC. Prevalence of clinical and subclinical thyroid disease in a peritoneal dialysis population. Perit Dial Int 2011; 32:86-93. [PMID: 21532003 DOI: 10.3747/pdi.2010.00202] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
AIMS We investigated dialysis duration, dose of erythropoietin (EPO), and clinical manifestations in peritoneal dialysis (PD) patients with subclinical hypothyroidism. METHODS This cross-sectional study, performed in 3 centers, assessed 122 adult patients on PD for more than 6 months with regard to demographic data, dialysis duration, thyroid function, biochemical data, EPO dose, and clinical manifestations. Thyroid dysfunction was determined by serum thyroid-stimulating hormone, free thyroxine, total thyroxine, total triiodothyronine, antithyroid peroxidase antibodies, and auto-antibodies against thyroglobulin. RESULTS Of the 122 study patients, 98 (80.3%) were assessed as having euthyroidism; 19 (15.6%), subclinical hypothyroidism; and 5 (4.1%), subclinical hyperthyroidism. The proportion of women (74.2% vs. 57.1%, p = 0.038), the mean duration of PD (58.1 months vs. 37.9 months, p = 0.032), and the weighted mean monthly EPO dose (1.22 μg/kg vs. 1.64 μg/kg, p = 0.009) were significantly higher in the subclinical hypothyroidism group than in the euthyroidism group, but the prevalences of coronary artery disease and cerebrovascular disease were not. From the multivariate model, PD duration was more significant than sex as a risk factor for subclinical hypothyroidism (p = 0.0132). CONCLUSIONS Subclinical hypothyroidism is frequent in PD patients, especially female patients and patients with a longer PD duration. Compared with euthyroid patients, patients with subclinical hyperthyroidism need a higher dose of EPO to maintain a stable hemoglobin level.
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Affiliation(s)
- Yee Yung Ng
- Division of Nephrology, Taipei Veterans General Hospital, Taipei, Taiwan.
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Zhang Y, Meyer MA. Clinical analysis on alteration of thyroid hormones in the serum of patients with acute ischemic stroke. Stroke Res Treat 2010; 2010. [PMID: 20847898 PMCID: PMC2935184 DOI: 10.4061/2010/290678] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2010] [Revised: 06/13/2010] [Accepted: 07/12/2010] [Indexed: 12/14/2022] Open
Abstract
Low T3 has been associated with increased short-term mortality in intensive care unit and long-term mortality in cardiovascular disease. The objective of this retrospective study is to investigate associations of thyroid hormone status with clinical severity and outcome in acute ischemic stroke, and whether there is association between the pituitary axis abnormality and the anterior/posterior circulation involvement. Patients with no history of thyroid abnormality who presented first ever stroke were studied. Total T3, T4, TSH levels, basic and clinical characteristics were collected and categorized. Neurological impairment was assessed using NIHSS and modified Rankin Scale. Twenty-nine patients (61%) had T3 ≤ 75 ng/dL. Low T3 group had significant higher NIHSS compared to normal T3 group. There was a significant negative correlation between T3 levels and NIHSS scores on admission. A significantly smaller percentage of patients with low T3 showed favorable neurological function improvement by both NIHSS and mRS measures compared to those with normal T3. There was no significant difference for anterior or posterior circulation involvement between low T3 and normal T3 groups. It is suggested that low T3 is associated with worse neurological outcome. The severity of low T3 may be a predictor of functional improvement in acute ischemic stroke.
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Affiliation(s)
- Yonghua Zhang
- Jacobs Neurological Institute, Department of Neurology, The State University of New York at Buffalo, 100 High Street, Buffalo, NY 14203, USA
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