Alteration of Thyroid Hormone among Patients with Ischemic Stroke visiting a Tertiary Care Hospital: A Descriptive Cross-sectional Study

Abstract

Introduction: Stroke is broadly classified as cerebral infarction, intracerebral hemorrhage and subarachnoid hemorrhage. Neuroendocrine profile is altered in acute ischemic stroke and there is a link between hypothyroidism and atherosclerosis which in turn may lead to stroke. The objective of this study was to find out the prevalence of alteration of thyroid hormones in patients with ischemic stroke in a tertiary care center. Methods: This descriptive cross-sectional study was conducted from June to December 2019 in a tertiary care center. Ethical approval was taken from Institutional review board of National Academy of Medical Sciences (reference number: IM 175). Patients with a diagnosis of stroke, without evidence of cardioembolic source, history of liver disease, renal failure and thyroid disease and who do not use thyroidal supplementation within 180 days prior the event were included. Convenience sampling was done. Data was entered in Microsoft Excel and analyzed using Statistical Package for the Social Sciences version 22. Point estimate at 90% Confidence Interval was calculated along with frequency and percentage for binary data. Results: The prevalence of altered thyroid levels among 73 patients was 13 (17.8%) (90% Confidence Interval= 10.44-25.16). Among them 11 (15.1%) were hypothyroid and 2 (2.7%) were hyperthyroid. Among severity of hypothyroid cases, subclinical hypothyroidism grade IA was seen in 51 (70%), subclinical hypothyroidism grade IB was seen in 22 (30%), Conclusions: The prevalence of altered thyroid levels among patients undergoing ischemic stroke was similar to the findings of other international studies.

Cardiovascular and Neuronal Consequences of Thyroid Hormones Alterations in the Ischemic Stroke

“…To date, clinical studies on alterations of THs levels and stroke have focused mainly on the correlation between the low T3 syndrome and a worsened clinical outcome. In acute stroke patients, the incidence of low T3 levels varied from 15.1% [ 94 ] to 37% [ 73 ]. These studies have demonstrated the association between lower T3 levels with greater stroke severity [ 74 , 95 ], infections [ 96 ], more complicated in-hospital clinical course [ 95 ], greater mortality rates [ 74 , 95 ] and a higher risk of poor functional outcome [ 73 , 74 , 76 , 77 , 95 , 97 , 98 ].…”

Association between thyroid hormone levels in the acute stage of stroke and risk of poststroke depression: A meta‐analysis

“…Stroke could cause changes in thyroid function in nonthyroidal illness, at least in the acute phase (Theodoropoulou et al., 2006 ). A cross‐sectional study revealed that the prevalence of thyroid hormone alterations among acute ischemic stroke patients without known thyroid diseases was 17.8% (13/73) (Bashyal et al., 2021 ). Low T3 syndrome is characterized by low free T3 (FT3) level together with normal‐to‐low free T4 (FT4) and TSH levels (Gao et al., 2018 ), and it is reported that low T3 syndrome affects 32%–62% of patients undergoing acute cerebrovascular diseases (Bunevicius et al., 2015 ).…”