Low TSH level predicts a poor clinical outcome in patients with anterior circulation ischemic stroke after endovascular
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ORIGINAL ARTICLE
Low TSH level predicts a poor clinical outcome in patients with anterior circulation ischemic stroke after endovascular thrombectomy Zhongyun Chen 1 & Yijia Sun 1 & Yingbo Zhang 2 & Yanbo He 3 & Hongbo Chen 4 & Yingying Su 1 Received: 15 July 2019 / Accepted: 3 February 2020 # Fondazione Società Italiana di Neurologia 2020
Abstract Objective To determine the correlation of thyroid hormone status with hemorrhagic transformation (HT) and short-term clinical outcomes in patients with acute ischemic stroke (AIS) after endovascular thrombectomy (EVT) Methods A retrospective analysis was conducted on AIS patients who underwent EVT at our hospital from 2016 to 2019. Thyroid-stimulating hormone (TSH), total triiodothyronine (TT3), free triiodothyronine (FT3), total thyroxine (TT4), and free thyroxine (FT4) levels were assessed, and logistic regression analyses were performed with HT incidence and functional outcome at 3 months. Results A total of 199 patients (148 males; mean age 62.9 ± 13.1 years) were included in the study. The number of patients with HT and unfavorable functional outcomes at 3 months were 74 (37.2%) and 129 (64.8%), respectively. Multiple logistic regression analysis showed that low TSH level (OR = 0.609; 95% CI 0.402–0.920, = 0.019) was an independent risk factor of poor functional outcome, while none of the thyroid hormones were significantly associated with HT risk. The optimal cutoff value of TSH that best distinguished both unfavorable outcome (sensitivity 31%, specificity 88.6%, area under the curve (AUC) 0.586) and mortality at 3 months (sensitivity 47.4%, specificity 78.3%, AUC 0.606) was 0.485 uIU/ml. Conclusion A lower TSH value upon admission may predict an unfavorable functional outcome in AIS patients after EVT, but thyroid hormone levels have no bearing on the risk of HT. Keywords Acute ischemic stroke . Thyroid hormone . Endovascular thrombectomy . Hemorrhagic transformation . Outcome
Introduction Acute ischemic stroke (AIS) is accompanied by high morbidity and mortality. The therapeutic approach to AIS primarily
* Yingying Su [email protected] 1
Department of Neurology, Xuanwu Hospital, Capital Medical University, No. 45, Changchun Street, Xicheng District, Beijing 100053, China
2
Department of Neurology, Beijing Tsinghua Changgung Hospital, Tsinghua University, No. 168, Litang Road, Changping District, Beijing 102200, China
3
Department of Neurology, The Beijing Moslem People Hospital, No. 11, Youanmennei Street, Xicheng District, Beijing 100054, China
4
Department of Neurology, Liangxiang Hospital, No. 45 Gongchen North Street, Gongchen Street Office, Fangshan District, Beijing 102246, China
involves early opening of the occluded vessels to protect the ischemic penumbra. Endovascular thrombectomy (EVT) is an effective treatment option for AIS caused by the occlusion of large cerebral arteries [1]. Although EVT reduces mortality and improves the functional outcome in AIS patients, more than 50% of the patients still have unfavorable outcomes and nearly o
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