Endocrinology, Diabetes and Metabolism Unit, Athens University School of Medicine, Evgenideion Hospital (M. Alevizaki, T. Pappa); Acute Stroke and Endocrine Units, Department of Medical Therapeutics, Alexandra Hospital, Athens University School of Medicine, Athens Greece (M. Synetou, K. Xynos, T. Pappa, K. N. Vemmos).
Low triiodothyronine: a strong predictor of outcome in acute stroke patients
Version of Record online: 28 JUN 2007
European Journal of Clinical Investigation
Volume 37, Issue 8, pages 651–657, August 2007
How to Cite
Alevizaki, M., Synetou, M., Xynos, K., Pappa, T. and Vemmos, K. N. (2007), Low triiodothyronine: a strong predictor of outcome in acute stroke patients. European Journal of Clinical Investigation, 37: 651–657. doi: 10.1111/j.1365-2362.2007.01839.x
- Issue online: 28 JUN 2007
- Version of Record online: 28 JUN 2007
- Received 2 December 2006; accepted 24 April 2007
- euthyroid sick syndrome;
- low-T3 syndrome;
- non-thyroidal illness;
Background Low triiodothyronine (T3) has been associated with increased short-term mortality in intensive care unit patients and long-term mortality in patients with heart disease. The objective of this study was to investigate possible associations of thyroid hormone status with clinical outcome in patients admitted for acute stroke.
Materials and methods A total of 737 consecutive patients with acute first ever stroke who presented within 24 h from symptoms’ onset were studied. Total T3, thyroxin (T4) and thyroid-stimulating hormone (TSH) levels were assessed in the morning following admission. Cases with T3 values ≤ 78 ng dL−1 (1·2 nmol L−1) (median) were characterized as ‘low T3’. Cases with T4 values ≤ 4·66 µg dL−1 (60 nmol L−1) were characterized as ‘low T4’. Basic and clinical characteristics, stroke risk factors, and brain imaging were evaluated. Neurological impairment was assessed using the Scandinavian Stroke Scale.
Results Four hundred and seventeen (56%) patients had T3 values ≤ 78 ng dL−1 and 320 had normal T3 values. The 1-year mortality was 27·34% for low T3 and 19·37% for normal T3 cases (P = 0·006). A smaller percentage of patients with low T3 values were independent at 1 year compared to those with normal T3 values [54·2% vs. 68·7%, χ2 = 12·09, P < 0·001, odds ratio (OR) = 0·53, 95% confidence interval (CI) 0·37–0·76]. Cox regression analysis revealed that increased age, haemorrhagic stroke, low Scandinavian Stroke Scale score, increased glucose and low T3 values (hazards ratio 0·69, CI = 0·48–0·98, P = 0·041) were significant predictors of 1-year mortality.
Conclusions A high proportion of patients with acute stroke were found soon after the event with low T3 values. The low-T3 syndrome is an independent predictor of early and late survival in patients with acute stroke, and predicts handicap at 1 year.