Elevated thyroid autoantibodies and intracranial stenosis in stroke at an early age

Authors


  • Contributors: Z. S. and M. L. designed the study. Z. S., X. Z., Z. C., and M. L. participated in the data collection and extraction. Z. S. did the statistical analysis with guidance from Z. C. and M. L. Z. S. wrote the first draft of the report, and M. L. and D. S. L. did the major revision. All other authors commented on the draft and approved the final version. We thank Dr. Yihong Zhu for the help with the statistical analysis.
  • Competing interests: None declared.
  • Funding: Dr. Lou is supported by grants from Zhejiang Provincial Natural Science Foundation of China [grant number LR12H09001]; the National Natural Science Foundation of China [grant number 81171095]; and the Health Bureau of Zhejiang Province [grant number WKJ2010-2-010].
  • Ethics approval: Institutional Review Board, The 2nd Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, China.
  • Provenance and peer review: Not commissioned; externally peer reviewed.

Abstract

Background

Previous studies have shown that hyperthyroidism was related to Moyamoya disease and intracranial artery stenosis. However, it is not clear whether thyroid hormone or thyroid autoantibodies was associated with them.

Aims and/or hypothesis

Thyroid autoimmunity was previously shown to be associated with Moyamoya disease. Our study aimed to investigate the association between thyroid autoantibodies and intracranial large artery stenosis in young ischemic stroke patients with apparent euthyroid states.

Methods

We retrospectively reviewed first-onset ischemic stroke patients (age ≤55 years old) consecutively admitted to a single academic center. Intracranial large artery stenosis was defined as ≥50% luminal diameter narrowing. We compared demographic profiles, risk factors (age, hypertension, diabetes, current smoker, atrial fibrillation, hyperlipidemia), thyroid function test, and thyroid autoantibodies including antithyroperoxidase antibody and antithyroglobulin antibody between patients with and without intracranial large artery stenosis. We also performed multivariate logistic regression analysis to evaluate the association between thyroid autoantibodies and intracranial large artery stenosis.

Results

A total of 351 patients were analyzed. The mean age of the patients was 47·0 ± 7·7 (range, 10–55 years), and 252 (71·8%) patients were male. We identified intracranial large artery stenosis in 121 (34·5%) patients. Patients with intracranial large artery stenosis showed a higher frequency of elevated antithyroperpxidase antibody levels in comparison with nonintracranial large artery stenosis group (16·5% vs. 3·9%, P < 0·001). After adjusting for covariates, the presence of elevated antithyroperpxidase antibody levels (odds ratio: 5·318; 95% confidence interval: 2·157–13·110, P < 0·001), age (odds ratio: 1·037; 95% confidence interval: 1·002–1·073, P = 0·039), and atrial fibrillation (odds ratio: 0·091; 95% confidence interval: 0·011–0·756, P = 0·027) was independently associated with intracranial large artery stenosis.

Conclusions

Thyroid autoantibodies may be associated with the presence of intracranial large artery stenosis in young stroke patients, potentially providing insight on immune pathogenesis of intracranial large artery stenosis.

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