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Associations of Free and Reverse Triiodothyronine with Long-Term All-Cause Mortality After Acute Ischemic Stroke and

Saulius Taroza1, Julius Burkauskas1, Aurelija Podlipskytė1

  • 1Laboratory of Behavioral Medicine, Neuroscience Institute, Lithuanian University of Health Sciences, LT-00135 Palanga, Lithuania.

Journal of Clinical Medicine
|March 17, 2025
PubMed

Insights

Lower free triiodothyronine (fT3) in acute ischemic stroke (aIS) and higher reverse T3 (rT3) in acute myocardial infarction (aMI) predict one-year mortality. These thyroid hormone associations with mortality did not persist over five years in arterial thrombosis patients.

Area of Science:

  • Endocrinology
  • Cardiovascular Medicine
  • Neurology

Background:

  • Arterial thrombosis (AT), encompassing ischemic heart disease (IHD) and ischemic stroke (IS), is linked to altered thyroid hormone levels.
  • Specifically, lowered free triiodothyronine (fT3) and elevated reverse T3 (rT3) have been observed in acute ischemic stroke (aIS) and acute myocardial infarction (aMI).
  • Previous research indicated these hormonal changes correlate with worse one-year outcomes, but long-term associations and the role of rT3 in aIS remain unclear.

Purpose of the Study:

  • To investigate the impact of fT3 and rT3 on all-cause mortality in patients with aIS and aMI over a five-year period.
  • To determine if the one-year associations between fT3, rT3, and mortality persist beyond five years.
  • To assess the prognostic value of rT3 in aIS outcomes over the extended follow-up.

Main Methods:

  • A cohort study including 241 aIS and 289 aMI patients from Lithuania.
  • Serum levels of fT3, rT3, free thyroxine, and thyroid-stimulating hormone were measured upon intensive care unit admission.
  • All-cause mortality was tracked over one and five years post-event.

Main Results:

  • Lower fT3 was independently associated with increased one-year all-cause mortality in aIS patients (OR = 0.41).
  • Higher rT3 was independently associated with increased one-year all-cause mortality in aMI patients (OR = 1.69).
  • No significant associations were found between fT3 or rT3 levels and all-cause mortality at the five-year follow-up for either aIS or aMI.

Conclusions:

  • Reduced fT3 levels in aIS and elevated rT3 levels in aMI are significant predictors of one-year all-cause mortality.
  • These thyroid hormone-mortality associations appear to be transient, diminishing by the five-year mark.
  • Thyroid hormone status may serve as a short-term prognostic marker in acute arterial thrombotic events.

Keywords:
free T3ischemic strokemortalitymyocardial infarctionreverse T3

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