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Original Research ARTICLE Provisionally accepted The full-text will be published soon. Notify me

Front. Neurol. | doi: 10.3389/fneur.2019.00782

Subclinical Hyperthyroidism Could Predict Poor Outcomes in Acute Ischemic Stroke Treated with Reperfusion Therapy

 Sang-Hwa Lee1, Min Uk Jang2,  Yerim Kim3, So Young Park4, Chulho Kim1,  Yeo Jin Kim1 and  Jong-Hee Sohn1*
  • 1Chuncheon Sacred Heart Hospital, South Korea
  • 2Hallym University Dongtan Sacred Heart Hospital, South Korea
  • 3Hangang Sacred Heart Hospital, Hallym University, South Korea
  • 4Kyung Hee University Hospital at Gangdong, Kyung Hee University, South Korea

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.

Keywords: Subclinical thyroid dysfunction, Subclinical hyper- and hypothyroidism, Poor outcome, Reperfusion therapy, Acute ischemic stroke

Received: 14 May 2019; Accepted: 04 Jul 2019.

Edited by:

Maurizio Acampa, Azienda Ospedaliera Universitaria Senese, Italy

Reviewed by:

Xabier Urra, Hospital Clínic de Barcelona, Spain
Alessandro P. Delitala, Azienda Ospedaliero Universitaria Sassari, Italy  

Copyright: © 2019 Lee, Jang, Kim, Park, Kim, Kim and Sohn. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

* Correspondence: Dr. Jong-Hee Sohn, Chuncheon Sacred Heart Hospital, Chuncheon, South Korea, deepfoci@hallym.or.kr