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Elevated FT4 is associated with prevalent stroke in euthyroid adults: a cross‑sectional study
Wenmei Sun1, Mengsi Zhou1,2, Weiling Zhou1,3
1Department of Neurology, Gucheng County People's Hospital, Hengshui, 053800, China.
Scientific Reports
|July 18, 2026
Summary
Elevated free thyroxine (FT4) is a direct marker for prevalent stroke in euthyroid adults. Thyroid function quality index (TFQI) effects were partially mediated by glucose and blood pressure, unlike FT4.
Area of Science:
- Endocrinology
- Neurology
- Epidemiology
Background:
- Inconsistent findings exist regarding the association between normal-range thyroid function and stroke risk.
- Euthyroid individuals, those with normal thyroid hormone levels, may still be at risk for stroke.
- Understanding thyroid hormone sensitivity is crucial for stroke prevention strategies.
Purpose of the Study:
- To investigate the association between thyroid hormone sensitivity indices and prevalent stroke in euthyroid adults.
- To determine if factors like glucose, blood pressure, or cholesterol mediate these associations.
- To validate findings in an independent cohort.
Main Methods:
- Cross-sectional study of 6,932 euthyroid adults from NHANES 2007-2012.
- Multivariable logistic regression, subgroup, mediation, and sensitivity analyses were employed.
- Independent clinical validation was performed on a separate cohort.
Main Results:
- Free thyroxine (FT4) was positively associated with prevalent stroke (OR=1.11 per pmol/L).
- Thyroid Function Quality Index (TFQI) was also associated with prevalent stroke (OR=1.97 per unit).
- FT4's association was direct, while TFQI's was partially mediated by glucose and blood pressure.
Conclusions:
- Elevated FT4 is a direct and robust marker for prevalent stroke in euthyroid adults.
- TFQI's association with stroke is partly explained by metabolic factors.
- Further prospective studies are required to establish causality between FT4 and stroke.
