scholarly journals Subclinical thyroid dysfunction and autoantibodies in acute ischemic and hemorrhagic stroke patients: relation to long term stroke outcome

2022 ◽  
Vol 58 (1) ◽  
Author(s):  
Rania S. Nageeb ◽  
Amr M. Azmy ◽  
Heba F. Tantawy ◽  
Ghada S. Nageeb ◽  
Alaa A. Omran
Keyword(s):  
Atrial Fibrillation ◽  
Subclinical Hypothyroidism ◽  
Thyroid Dysfunction ◽  
Hemorrhagic Stroke ◽  
Thyroid Autoantibodies ◽  
Stroke Outcome ◽  
Subclinical Hyperthyroidism ◽  
Stroke Patients ◽  
Nihss Score

Abstract Background Data regarding the relation between both subclinical thyroid dysfunction, thyroid autoantibodies and clinical outcomes in stroke patients are limited. This study aimed to evaluate subclinical thyroid dysfunction and thyroid autoantibodies production in acute stroke patients and their relation to long term stroke outcome. We recruited 138 patients who were subjected to thorough general, neurological examination and brain imaging. Blood samples were collected for measurement of levels of serum thyroid function [free tri-iodothyronine (FT3), free thyroxin (FT4), thyroid stimulating hormone (TSH)], thyroid autoantibodies within 48 h after hospital admission. FT4 and TSH after 1 year were done. The stroke severity was assessed at admission by the National Institutes of Health Stroke Scale (NIHSS). The stroke outcome was assessed at 3 months and after 1 year by the modified Rankin Scale (mRS). We divided the patients into two groups according to thyroid autoantibodies (positive and negative groups). Results Subclinical hyperthyroidism was found in 23% of patients, and subclinical hypothyroidism in 10% of patients. Euthyroidism was detected in 67% of patients. 34% patients had positive thyroid autoantibody. Positive thyroid autoantibodies were commonly found in those with subclinical hyperthyroidism (28%), followed by subclinical hypothyroidism (21%) and euthyroidism (14%). 73% and 59% of stroke patients had poor outcomes (mRS was > 2) at 3 months and 1 year respectively with no significant difference between ischemic and hemorrhagic stroke patients. In the positive group final TSH level, NIHSS score at admission, and disability at 1 year were significantly higher compared with the negative group. Poor outcome was significantly associated with higher NIHSS score at admission, positive thyroid autoantibodies, subclinical hyperthyroidism, and atrial fibrillation. Conclusions Subclinical thyroid dysfunction could be found in stroke patients with positive thyroid autoantibodies. Subclinical hyperthyroidism and thyroid autoantibodies were associated with a poor outcome at 1 year in first-ever acute stroke patients especially in those presented with atrial fibrillation and higher NIHSS score at admission.

Abstract 176: Long Term Mortality in Acute Ischemic Stroke Patients with Nonvalvular Atrial Fibrillation According to Location and Burden of Cerebral Microbleeds

Stroke ◽  
2014 ◽  
Vol 45 (suppl_1) ◽  
Author(s):  
Tae-Jin Song ◽  
Jinkwon Kim ◽  
Dongbeom Song ◽  
Yong-Jae Kim ◽  
Hyo Suk Nam ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Ischemic Stroke ◽  
Acute Ischemic Stroke ◽  
Hemorrhagic Stroke ◽  
Independent Predictor ◽  
Stroke Patients ◽  
Risk Of Death ◽  
Long Term Mortality

Background: Cerebral microbleeds (CMBs) were predictive of mortality in elderly and considered as a putative marker for risk of intracranial hemorrhage. Stroke patients with non valvular atrial fibrillation (NVAF) require anticoagulation, which increases the risk of hemorrhages. We investigated association of CMBs with the long term mortality in acute ischemic stroke patients with NVAF. Methods: During 6 years , consecutive ischemic stroke patients who had NVAF and who had undergone brain MRI with a gradient-recalled echo sequence were enrolled. Long-term mortality and causes of death were identified using data from Korean National Statistical Office. Survival analysis was performed whether the presence, number and location of CMBs were related with all causes, cardiovascular, and cerebrovascular mortality during follow-up. Results: Total 506 patients were enrolled during the study period and were followed up for median 2.5 years. CMBs were found in 30.8% of patients (156/506). Oral anticoagulation with warfarin was prescribed at discharge in 477 (82.7%) patients. During follow up, 177 (35%) patients died and cerebrovascular death was noted in 93 patients (81 ischemic stroke and 12 hemorrhagic stroke). After adjusting age, sex and significant variables in univariate analysis (p<0.1), multiple CMBs (≥5) were the independent predictor for all-cause, cardiovascular and ischemic stroke mortalities. The strictly lobar CMBs were associated with hemorrhagic stroke mortality in multivariate Cox regression analysis (HR 4.776, p=0.032) (Figure 1). Conclusions: Multiple CMBs were the independent predictor for the long term mortality in stroke patients with NVAF. Among them, patients with strictly lobar CMBs had a high risk of death due to hemorrhagic stroke. Our findings suggest that detection of CMBs in stroke patients with NVAF are of clinical relevance for predicting long term outcome and that particular concern is necessary in those with strictly lobar CMBs for their increased risk of death due to hemorrhagic stroke. Figure 1.

Abstract 204: Echocardiographic Evidence for Systemic Atherosclerosis, Atrial Fibrillation, and Long-Term Prognosis in Stroke Patients

2016 ◽  
Vol 9 (suppl_2) ◽  
Author(s):  
Justin Pieper ◽  
Michael Ashamalla ◽  
Neil Yager ◽  
Daniel Sedhom ◽  
Khetan Gate ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Hemorrhagic Stroke ◽  
Normal Sinus Rhythm ◽  
Medical Center ◽  
Academic Medical Center ◽  
Stroke Patients ◽  
Long Term Prognosis ◽  
Echocardiographic Evidence

Background: Echocardiography is routinely performed for evaluation of cardiac embolic causes in stroke patients. We sought to examine the association of echocardiographic evidence of atherosclerosis with atrial fibrillation and long-term outcomes. Materials and methods: Retrospective chart review was performed in 756 consecutive patients treated for non-hemorrhagic stroke at a single academic medical center. Transthoracic echocardiograms were reviewed for presence of mitral annular calcifications, aortic valve sclerosis, or aortic atherosclerosis. Admission ECG and telemetry recordings were evaluated for documented dysrhythmias. Mean follow up length was 46+/- 20 months. Results: A significant number (57.7%) of patients with non-hemorrhagic stroke diagnosed with atrial fibrillation had evidence of cardiac and systemic atherosclerosis on transthoracic echocardiogram, which was less likely in patients with normal sinus rhythm (35.4%) or non-sinus non-atrial fibrillation rhythms (37.1%, p<0.05). Findings of cardiac and systemic atherosclerosis were more common in older patients (75+/- 11 vs 60+/- 16 years old, p<.001), with lower BMI (27.4+/- 6.0 vs. 29+/- 6.5, p<.001), and hypertension (71.9% vs. 59.2 %, p=.002). Patients with findings of cardiac and systemic atherosclerosis were more likely to die during follow-up (56.1% vs. 43.9%, p<.001). Conclusion: In patients with non-hemorrhagic stroke, cardiac and systemic evidence of atherosclerosis was strongly associated with atrial fibrillation and portended poor long-term prognosis. In stroke patients with cardiac and systemic evidence of atherosclerosis and rhythms other than atrial fibrillation, extended ECG monitoring may be warranted.

scholarly journals Subclinical thyroid dysfunction and incident atrial fibrillation - a systematic review and meta-analysis

EP Europace ◽  
2021 ◽  
Vol 23 (Supplement_3) ◽  
Author(s):  
H Singh ◽  
MZ Shahid ◽  
SL Harrison ◽  
DA Lane ◽  
GYH Lip ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Systematic Review ◽  
Subgroup Analysis ◽  
Subclinical Hypothyroidism ◽  
Thyroid Dysfunction ◽  
Meta Analysis ◽  
Risk Of Bias ◽  
Subclinical Hyperthyroidism ◽  
Quality Of Evidence

Abstract Funding Acknowledgements Type of funding sources: Other. Main funding source(s): This project was supported by the MRes programme in the Institute of Life Course and Medical Sciences at The University of Liverpool. Thyroid hormones can act directly and indirectly on the cardiovascular system and studies have demonstrated associations between overt and subclinical thyroid dysfunction and adverse cardiovascular outcomes including heart failure, myocardial infarction, and coronary heart disease. The aim of this study was to assess the association between subclinical thyroid dysfunction and atrial fibrillation (AF).  The protocol was registered on PROSPERO (CRD42020221565). MEDLINE and Scopus were searched from inception to 13th November 2020 for studies investigating subclinical thyroid dysfunction and incident AF. Risk of bias was assessed using the Risk of Bias Assessment Tool (RoBANS). The quality of evidence was assessed using the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) tool. Subgroup analysis was performed for post-operative and non-post-operative AF. 5413 records were identified. Nine cohort studies were suitable for inclusion in the systematic review, of which seven studies were included in the meta-analysis. The meta-analysis comprised 595,058 patients. Subclinical hyperthyroidism was associated with a 99% increase in the risk of incident AF (Risk ratio (RR): 1.99; 95% confidence intervals (CI); 1.43 to 2.77; p &lt; 0.0001; I² = 67%). Subclinical hypothyroidism was also associated with a greater risk of AF (RR: 1.24; 95% CI; 1.05 to 1.47; p = 0.01; I² = 65%). Subgroup analysis demonstrated a 76% increase in the risk of post-operative AF in patients with subclinical hypothyroidism compared to euthyroid post-operative patients (RR: 1.76; 95% CI; 1.36 to 2.28; p &lt; 0.0001; I² = 0%). Six studies were rated as low risk of bias and three as medium risk of bias according to the RoBANS tool. The quality of evidence for AF in subclinical hyper- and hypothyroid patients was low. Subclinical hyperthyroidism and subclinical hypothyroidism were associated with a higher risk of incident AF and post-operative AF, respectively. The quality of the current evidence is low and ideally a randomised controlled trial should be conducted to confirm these associations and assess impacts of treatments. Abstract Figure.

scholarly journals Subclinical Thyroid Function and Cardiovascular Events in patients with Atrial Fibrillation

2021 ◽  
Author(s):  
Elisavet Moutzouri ◽  
Christina Lyko ◽  
Martin Feller ◽  
Manuel Raphael Blum ◽  
Luise Adam ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Subclinical Hypothyroidism ◽  
Thyroid Dysfunction ◽  
Total Mortality ◽  
Composite Endpoint ◽  
Community Dwelling ◽  
Sensitivity Analyses ◽  
Subclinical Hyperthyroidism ◽  
Increased Risk ◽  
Multivariable Adjustment

Objective: To evaluate if subclinical thyroid dysfunction is associated with cardiovascular (CV) risk in patients with atrial fibrillation (AF). Methods: Swiss-AF is a prospective cohort of community-dwelling participants aged ≥ 65 years with AF. Primary outcome was a composite endpoint of CV events (myocardial infarctions, stroke/transitory ischemic events, systemic embolism, heart failure (HF) hospitalizations, CV deaths). Secondary outcomes were component endpoints, total mortality and AF-progression. Exposures were thyroid dysfunction categories, TSH and fT4. Sensitivity analyses were performed for amiodarone use, thyroid hormones use and competing events. Results: 2415 patients were included (mean age 73.2 years; 27% women). 196 (8.4%) had subclinical hypothyroidism and 53 (2.3%) subclinical hyperthyroidism. Subclinical thyroid dysfunction was not associated with CV events, during a median follow-up of 2.1 years (max 5 years): age- and sex- adjusted hazard ratio (adjHR) of 0.99 (95% confidence interval (CI) 0.69-1.41) for subclinical hypothyroidism; and 0.55 (95%CI 0.23-1.32) for subclinical hyperthyroidism. Results remained robust following multivariable adjustment and sensitivity analyses. In euthyroid patients, fT4 levels were associated with an increased risk for the composite endpoint and HF (adjHR 1.46 95%CI 1.04- 2.05; adjHR 1.70 95%CI 1.08-2.66, respectively, for the highest quintile versus the middle quintile). Results remained similar following multivariable adjustment. Results remained significant for HF in sensitivity analyses. No association between subclinical thyroid dysfunction and total mortality or AF-progression was found. Conclusions: Subclinical hypothyroidism was not associated with increased CV risk in AF patients. Higher levels of fT4 with normal TSH were associated with higher risk for HF.

Abstract WP379: Sex-specific Effects of Comorbid Diabetes and Depression on Post-stroke Mortality in Individuals With Atrial Fibrillation

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Jodi Edwards ◽  
Jessica Colby-Milley ◽  
Jiming Fang ◽  
Limei Zhou ◽  
Baiju R Shah ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Hospital Mortality ◽  
Recurrent Stroke ◽  
Stroke Patients ◽  
Comorbid Depression ◽  
Term Care ◽  
Post Stroke ◽  
Specific Effects ◽  
Long Term Mortality

Background: Comorbid diabetes and depression are highly prevalent in atrial fibrillation (AF) and increase the risk of stroke. Women with AF show higher mortality rates and have worse functional outcomes post-stroke. However, the sex-specific effects of comorbid diabetes and depression on mortality and other adverse outcomes in stroke patients with a history of AF is unclear. Methods: Prospectively collected consecutive patients with ischemic stroke and known AF presenting to designated stroke centres in Ontario (2003-2013). Multinomial regression was used to determine sex-specific associations between diabetes and depression and in-hospital mortality post-stroke in individuals with AF. Cox proportional hazards regression was used to estimate the adjusted hazard of long-term mortality post-stroke and competing risks models to estimate hazards of recurrent stroke/TIA, admission to long-term care, and incident dementia post-discharge. Results: Among 5082 stroke patients with known AF (median age=80, IQR:73-85), female patients were more likely to have comorbid depression than males (63.5% vs. 36.5%) and those with comorbid diabetes and depression were younger (77 yrs) and had more vascular history (HTN, CAD, hyperlipidemia) than those with AF only. For males, comorbid diabetes increased the likelihood of in-hospital mortality post-stroke by 53% (OR=1.53, 95% CI=1.16-2.02), after adjustment for stroke severity, demographic and clinical factors, while comorbid depression did not significantly impact in-hospital mortality and neither diabetes or depression affected in-hospital mortality post-stroke for females. However, diabetes was independently associated with increased hazard of long-term mortality for both female (HR=1.15, 95%CI=1.02-1.29) and male AF stroke patients (HR=1.35, 95%CI=1.19-1.53). No associations with recurrent stroke/TIA, institutionalization or dementia post-stroke were observed for either females or males. Conclusion: In stroke patients with known AF, comorbid diabetes but not depression was independently associated with increased in-hospital mortality for males and increased long-term mortality post-stroke for both females and males.

scholarly journals Impact of the Total Number of Carotid Plaques on the Outcome of Ischemic Stroke Patients with Atrial Fibrillation

2019 ◽  
Vol 8 (11) ◽  
pp. 1897 ◽  
Author(s):  
Hyungjong Park ◽  
Minho Han ◽  
Young Dae Kim ◽  
Joonsang Yoo ◽  
Hye Sun Lee ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Ischemic Stroke ◽  
Intima Media Thickness ◽  
Major Adverse Cardiovascular Events ◽  
Stroke Patients ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Increased Risk ◽  
Prognostic Utility

Background: Atrial fibrillation (AF) shares several risk factors with atherosclerosis. We investigated the association between total carotid plaque number (TPN) and long-term prognosis in ischemic stroke patients with AF. Methods: A total of 392 ischemic stroke patients with AF who underwent carotid ultrasonography were enrolled. TPN was assessed using B-mode ultrasound. The patients were categorized into two groups according to best cutoff values for TPN (TPN ≤ 4 vs. TPN ≥ 5). The long-term risk of major adverse cardiovascular events (MACE) and mortality according to TPN was investigated using a Cox hazard model. Results: After a mean follow-up of 2.42 years, 113 patients (28.8%) had developed MACE and 88 patients (22.4%) had died. MACE occurred more frequently in the TPN ≥ 5 group than in the TPN ≤ 4 group (adjusted hazard ratio [HR], 1.50; 95% confidence interval [CI], 1.01–2.21; p < 0.05). Moreover, the TPN ≥ 5 group showed an increased risk of all-cause mortality (adjusted HR, 2.69; 95% CI, 1.40–5.17; p < 0.05). TPN along with maximal plaque thickness and intima media thickness showed improved prognostic utility when added to the variables of the CHAD2DS2-VASc score. Conclusion: TPN can predict the long-term outcome of ischemic stroke patients with AF. Adding TPN to the CHAD2DS2-VASc score increases the predictability of outcome after stroke.

scholarly journals Evaluation of thyroid dysfunction among type 2 diabetic patients

2014 ◽  
Vol 6 (3) ◽  
pp. 33-37
Author(s):  
Pranav Kumar Raghuwanshi ◽  
Devendra Pratap Singh Rajput ◽  
Bhupendra Kumar Ratre ◽  
Roopesh Jain ◽  
Narmada Patel ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Subclinical Hypothyroidism ◽  
Thyroid Dysfunction ◽  
Diabetic Patients ◽  
Subclinical Hyperthyroidism ◽  
Type 2 Diabetic Patients ◽  
Type 2 Diabetic

Background: Diabetes mellitus is a very common endocrinal disorders and incidence of thyroid dysfunction also rising in India and world over. Thyroid hormones directly control insulin secretion and insulin clearance. Diabetes also may affect the thyroid function to variable extent first at the level of hypothalamic control of TSH release and second at peripheral tissue by converting T4 to T3. Aims and Objectives: The present study was carried out aiming to evaluate thyroid dysfunction among type 2 diabetes mellitus patients. Material and Methods: Study included total 80 subjects. Thyroid dysfunction was evaluated by investigating the subjects for Total tri-iodo-thyronine (T3), Total thyroxine (T4) and thyroid stimulating hormone (TSH). Plasma glucose was estimated by- GOD-POD method and Thyroid profile was estimated by- CLIA (chemiluminescence immunoassay) system. Statistical analysis was performed using software statistical package for social sciences (SPSS) version 20, unpaired T test, Pearson’s correlation. Results: In type 2 diabetic patients the prevalence of hypothyroidism and subclinical hypothyroidism was found to be 4(10.00%) and 6(15.00%) respectively, while the prevalence of subclinical hyperthyroidism and hyperthyroidism was found to be 0(0.0%) and 1(2.5%) respectively. In non diabetic healthy subjects the prevalence of hypothyroidism and subclinical hypothyroidism was found to be 1(2.5%) and 3(7.5%) respectively while the prevalence of subclinical hyperthyroidism and hyperthyroidism was found to be 0(0.0%) and 0(0.0%) respectively. Conclusion: The prevalence of thyroid dysfunction was found to be higher in type 2 diabetes mellitus subjects as compared to non-diabetic subjects. DOI: http://dx.doi.org/10.3126/ajms.v6i3.10814Asian Journal of Medical Sciences Vol.6(3) 2015 33-37  

scholarly journals The Association with Subclinical Thyroid Dysfunction and Uric Acid

2021 ◽  
Vol 2021 ◽  
pp. 1-13
Author(s):  
Yuling Xing ◽  
Linlin Yang ◽  
Jing Liu ◽  
Huijuan Ma
Keyword(s):  
Uric Acid ◽  
Subclinical Hypothyroidism ◽  
Thyroid Dysfunction ◽  
Meta Analysis ◽  
Serum Levels ◽  
Subclinical Hyperthyroidism ◽  
Funnel Plot ◽  
Different Types ◽  
Standardized Mean Difference ◽  
The Relationship

The relationship between subclinical thyroid dysfunction and uric acid was not well established. This study aimed to determine if subclinical thyroid dysfunction is associated with hyperuricemia risk and to evaluate the levels of uric acid in patients with different forms of subclinical thyroid dysfunction. A systematic search was conducted in 4 databases to obtain relevant studies on subclinical thyroid dysfunction (subclinical hyperthyroidism and subclinical hypothyroidism) and uric acid. The standardized mean difference (SMD) or odds ratio (OR) and 95% confidence interval (95% CI) were used for evaluation, and the sensitivity analysis was conducted. Publication bias was estimated by funnel plot, Egger’s test, and Begg’s test. A total of 73 studies were included in this meta-analysis. The results demonstrated that serum levels of uric acid in patients with subclinical hypothyroidism were significantly higher than those of controls and patients with subclinical hyperthyroidism. Patients with subclinical thyroid dysfunction had a higher prevalence of hyperuricemia compared with normal clinical thyroid function. Subclinical thyroid dysfunction was associated with the prevalence of hyperuricemia. Different types of subclinical thyroid dysfunction had varied effects on serum levels of uric acid.

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