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Thyroid Hormone Therapy and Incident Stroke.

Maria Papaleontiou1, Deborah A Levine2, David Reyes-Gastelum1

  • 1Division of Metabolism, Endocrinology and Diabetes, Department of Internal Medicine, University of Michigan, Ann Arbor, MI 48109, USA.

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Summary
This summary is machine-generated.

Thyroid hormone treatment intensity impacts stroke risk. Both too much and too little thyroid hormone (exogenous hyper- and hypothyroidism) increase stroke incidence, emphasizing medication safety.

Keywords:
atrial fibrillationstrokethyroid hormone therapy

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Area of Science:

  • Endocrinology
  • Cardiovascular Medicine
  • Public Health

Background:

  • Stroke is a major cause of death and disability worldwide.
  • Identifying modifiable risk factors for stroke is crucial for prevention.
  • Thyroid hormone levels are critical for metabolic regulation and cardiovascular health.

Purpose of the Study:

  • To investigate the association between thyroid hormone treatment intensity and the risk of developing atrial fibrillation and stroke.
  • To determine if deviations from euthyroid state in thyroid hormone users correlate with adverse cardiovascular events.

Main Methods:

  • Retrospective cohort study utilizing Veterans Health Administration data (2004-2017).
  • Included 733,208 thyroid hormone users (≥18 years) with at least two thyroid-stimulating hormone (TSH) or free thyroxine (T4) measurements.
  • Median follow-up of 59 months to track incident atrial fibrillation and stroke.

Main Results:

  • Higher stroke incidence was linked to both low TSH/high free T4 (exogenous hyperthyroidism) and high TSH/low free T4 (exogenous hypothyroidism) compared to euthyroid states.
  • Specific odds ratios (OR) indicated increased stroke risk for both conditions (e.g., TSH <0.1 mIU/L: OR 1.33; TSH >5.5 mIU/L: OR 1.29).
  • The risk for atrial fibrillation and stroke accumulated over time in patients with exogenous hyperthyroidism and hypothyroidism.

Conclusions:

  • Both exogenous hyperthyroidism and hypothyroidism are associated with an elevated risk of stroke.
  • Maintaining appropriate thyroid hormone levels is essential for patient medication safety and stroke prevention.
  • This study underscores the importance of careful monitoring of thyroid hormone levels in treated patients.