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Abstract
Objective To investigate whether thyroid function profiles can predict poststroke fatigue (PSF) in patients with acute ischemic stroke.
Methods Patients with stroke were consecutively recruited within 3 days of onset in Jinling Hospital. Serum levels of thyroid hormones, thyroid antibodies, hematologic indexes, and biochemical indexes were measured on admission. Fatigue was scored using the Fatigue Severity Scale. Associations were analyzed with multivariate regression and restricted cubic splines.
Results Of the 704 patients with stroke, 292 (41.5%) were diagnosed with fatigue in the acute stage and 224 (35.3%) 6 months after the index stroke. The serum levels of thyroid-stimulating hormone (TSH) were inversely associated with the risk of PSF in both the acute phase and at follow-up evaluations after adjusting for potential confounders (odds ratio 0.30, 95% confidence interval 0.24–0.37 in the acute phase, and odds ratio 0.70, 95% confidence interval 0.58–0.84 at follow-up). The subgroup analysis indicated that in the acute phase of ischemic stroke, TSH was associated with severity of PSF in the groups with euthyroidism (β = −0.70, p < 0.001), subclinical hypothyroidism (β = −0.44, p < 0.001), and low-T3 syndrome (β = −0.34, p = 0.008). Higher TSH was associated with better Fatigue Severity Scale scores in patients with low-T3 syndrome 6 months after the index stroke (β = −0.35, p = 0.01). Furthermore, in the group with low-T3 syndrome, FT3 serum level could also indicate a higher risk of PSF (β = −2.54, p < 0.001 in the acute phase, and β = −2.67, p < 0.001 at follow-up).
Conclusion Thyroid function profiles may predict fatigue after acute ischemic stroke, suggesting that neuroendocrine responses could have a role in PSF.
Glossary
- AIS=
- acute ischemic stroke;
- BMI=
- body mass index;
- CI=
- confidence interval;
- FSS=
- Fatigue Severity Scale;
- FT3=
- low free triiodothyronine;
- HAMA=
- Hamilton Anxiety Scale;
- HAMD=
- Hamilton Depression Scale;
- ICD-11=
- International Classification of Diseases, Eleventh Revision;
- MMSE=
- Mini-Mental State Examination;
- OR=
- odds ratio;
- PSF=
- poststroke fatigue;
- TOAST=
- Trial of Org 10172 in Acute Stroke Treatment;
- TSH=
- thyroid-stimulating hormone
Footnotes
↵* These authors contributed equally to this work.
Go to Neurology.org/N for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.
CME Course: NPub.org/cmelist
- Received October 20, 2017.
- Accepted in final form August 13, 2018.
- © 2018 American Academy of Neurology
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