Acta Scientific Neurology (ASNE) (ISSN: 2582-1121)

Research Article Volume 7 Issue 1

Impact of Thyroid Disease on Functional Outcome in Ischemic Stroke Secondary to Large Vessel Occlusion

Adel Mabrook AlSefari MD1, Omar Khaled Ameen MD2, Hanan AlHazmi MBBS MD1, Ali Mahmoud AlBalawi MD2, Fahmi AlSenani MBBS2, Jamal Muthana MD2, Mohammed Ahmed Melibari MD1 and Manhal N Redwan MD1

1Diabetic and Endocrine Center, AlNoor Specialist hospital, Makkah, Kingdom of Saudi Arabia
2Stroke Program, Neurology Department, National Neuroscience Institute, King Fahad Medical City, Riyadh, Kingdom of Saudi Arabia

*Corresponding Author: Omar Khaled Ameen, Stroke Program, Neurology Department, National Neuroscience Institute, King Fahad Medical City, Riyadh, Kingdom of Saudi Arabia.

Received: November 13, 2023; Published: December 12, 2023


Background: Hypothyroidism can cause hypertension, hypercholesterolemia, cardiac dysfunction, and both hypo- and hypercoagulability; all of which are risk factors for stroke.

Objectives: To explore the association between thyroid disease and occlusion of large vessels as well as functional outcome in patients with ischemic stroke.

Material and Methods: A retrospective study was conducted among all acute ischemic stroke patients, secondary to large vessel occlusion, admitted to King Fahad Medical City (KFMC), Riyadh, Kingdom of Saudi Arabia, provided that thyroid hormones were measured for those patients. The electronic charts of all eligible patients admitted between January 2021 and June 2022 were reviewed. Severity of stroke was measured through the National Institute of Heath Stroke scale (NIHSS). Functional disability one month after discharge was assessed using the modified Rankin scale (mRS). Levels of thyroid hormones (thyroxine “T4”, Triiodothyronine “T3” and thyroid stimulating hormone “TSH”), low density lipoprotein (LDL) as well as glycated hemoglobin (HbA1c) were extracted from patients` electronic files.

Results: A total of 177 patients included in the study. Their age ranged between 17 and 100 years (60.74 ± 15.55). Males represented 56.3% of patients. Almost half (47.1%) of cases were categorized as severe stroke while 39.1% were mild to moderate. None of the studied patients` characteristics (age, gender, TSH, T3, T4, LDL, HbA1c) was significantly associated with stroke severity. Concerning functional disability one month after discharge, moderately severe and severe disabilities were observed among 27.7% and 21.5% of patients, respectively whereas death was reported in 15.8% of cases. Patients` age was highest in patients of category 5 (severe disability) (69.0 ± 14.6 years) and lowest among those of category 0 (no disability), p = 0.001. LDL level was highest among patients of category 2 (slight disability) and lowest among those of category 6 (dead) (3.2 ± 1.4 and 2.2 ± 1.1, respectively), p = 0.031. There was a statistically significant association between severity of stroke based on NIHSS scale and impact on functional outcome based on modified ranking scale, p<0.001.

Conclusion: Thyroid disorders were not associated with severity of stroke. Older patients had more severe functional disability while LDL was lowest among dead patients. Stroke severity was associated with functional disability.

Keywords: Stroke; Thyroid Diseases; Functional Disability


  1. “Stroke Collaborators. Global, regional, and national burden of stroke, 1990-2016: a systematic analysis for the Global Burden of Disease Study 2016”. The Lancet Neurology 18.5 (2019): 439-458.
  2. Gao N., et al. “Carotid intima-media thickness in patients with subclinical hypothyroidism: a meta-analysis”. Atherosclerosis 227 (2013): 18-25.
  3. Iwen KA., et al. “Thyroid Hormones and the Metabolic Syndrome”. European Thyroid Journal 2 (2013): 83-92.
  4. Bai M-F., et al. “Effects of thyroid dysfunction on the severity of coronary artery lesions and its prognosis”. Journal of Cardiology 6 (2014): 496-500.
  5. Chen Q., et al. “Effect of hyperthyroidism on the hypercoagulable state and thromboembolic events in patients with atrial fibrillation”. Journal of Cardiology 127 (2014): 176-82.
  6. Akhoundi FH., et al. “Favorable functional outcomes in acute ischemic stroke patients with subclinical hypothyroidism”. Neurology4 (2014): 349-354.
  7. Wollenweber FA., et al. “Subclinical hyperthyroidism is a risk factor for poor functional outcome after ischemic stroke”. Stroke5 (2013): 1446-1448.
  8. Chen Z., et al. “Low TSH level predicts a poor clinical outcome in patients with anterior circulation ischemic stroke after endovascular thrombectomy”. Neurological Sciences 7 (2020): 1821-1828.
  9. NIH Stroke Scale. Approach to Human Subject Protection and Patient Safety.
  10. Adams HP., et al. “Baseline NIH Stroke Scale score strongly predicts outcome after stroke: A report of the Trial of Org 10172 in Acute Stroke Treatment (TOAST)”. Neurology1 (1999): 126.
  11. Runde D. “Calculated Decisions: NIH stroke scale/score (NIHSS)”. Emergency Medicine Practice 7 (2020): CD6-CD7.
  12. Know Stroke. “NIH Stroke Scale.
  13. Brott T., et al. “Measurements of acute cerebral infarction: a clinical examination scale”. Stroke 7 (1989): 864-870.
  14. Broderick JP., et al. “Evolution of the modified rankin scale and its use in future stroke trials”. Stroke 48 (2017): 2007-2012.
  15. Banks JL and Marotta CA. “Outcomes validity and reliability of the modified rankin scale: implications for stroke clinical trials - a literature review and synthesis”. Stroke 38 (2007): 1091-1096.
  16. Nunn A., et al. “Analysis of the modified Rankin scale in randomized controlled trials of acute ischaemic stroke: a systematic review”. Stroke Research and Treatment (2016).
  17. Bashyal S., et al. “Alteration of thyroid hormone among patients with ischemic stroke visiting a tertiary care hospital: A descriptive cross-sectional study”. Journal of Nepal Medical Association 240 (2021): 779-782.
  18. Alevizaki M., et al. “Hypothyroidism as a protective factor in acute stroke patients”. Clinical Endocrinology (Oxford) 3 (2006): 369-372.
  19. Zhang Y and Meyer MA. “Clinical analysis on alteration of thyroid hormones in the serum of patients with acute ischemic stroke”. Stroke Research and Treatment 2010 (2010): 290678.
  20. Sheu JJ., et al. “Hyperthyroidism and risk of ischemic stroke in young adults: a 5-year follow-up study”. Stroke 5 (2010): 961-966.
  21. Rasura M., et al. “A case series of young stroke in Rome”. European Journal of Neurology 2 (2006): 146-152.
  22. Yang Y., et al. “The disability rate of 5-year post-stroke and its correlation factors: a national survey in China”. PLoS ONE 11 (2016): e0165341.
  23. Go AS., et al. “Heart disease and stroke statistics-2014 update: a report from the American Heart Association”. Circulation 129 (2014): e28-292.
  24. Leonards CO., et al. “Thyroid-stimulating hormone, white matter hyperintensities, and functional outcome in acute ischemic stroke patients”. Cerebrovascular Diseases Extra 4 (2014): 61-68.
  25. Alevizaki M., et al. “Low triiodothyronine: A strong predictor of outcome in acute stroke patients”. European Journal of Clinical Investigation 37 (2007): 651-657.
  26. Bunevicius A., et al. “Neuroprotective actions of thyroid hormones and low-T3 syndrome as a biomarker in acute cerebrovascular disorders”. Expert Review of Neurotherapeutics 3 (2015): 315-326.
  27. O’Keefe LM., et al. “Thyroid hormones and functional outcomes after ischemic stroke”. Thyroid Research 8 (2015): 9.
  28. Astuti P., et al. “Depression and functional disability in stroke patients”. Journal of Public Health Research 2 (2020): 1835.
  29. Wang S., et al. “The Disability Rte of 5- Year Post Stroke and Its Correlation Factors: A National Survey in China”. PLoS One 11 (2016): e0165341.
  30. Ma C., et al. “Low-density lipoprotein cholesterol and risk of intracerebral hemorrhage: A prospective study”. Neurology5 (2019): e445-e457.
  31. Feigin VL., et al. “Global Burden of Disease Lifetime Risk of Stroke Collaborators: global, regional, and country-specific lifetime risks of stroke, 1990 and 2016”. The New England Journal of Medicine 379 (2018): 2429-2437.
  32. Feigin VL., et al. “Global burden of stroke and risk factors in 188 countries, during 1990-2013: a systematic analysis for the Global Burden of Disease Study 2013”. The Lancet Neurology 15 (2016): 913-924.
  33. Krishnamurthi RV., et al. “The global burden of hemorrhagic stroke: a summary of findings from the GBD 2010 study”. Global Heart9 (2014): 101-106.
  34. Bruckdorfer KR., et al. “The effect of partial replacements of membrane cholesterol by other steroids on the osmotic fragility and glycerol permeability of erythrocytes”. Biochimica et Biophysica Acta 183 (1969): 334-345.


Citation: Omar Khaled Ameen., et al. “Impact of Thyroid Disease on Functional Outcome in Ischemic Stroke Secondary to Large Vessel Occlusion". Acta Scientific Neurology 7.1 (2024): 15-21.


Copyright: © 2024 Omar Khaled Ameen., et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.


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