Thyroid function within the reference range and the risk of stroke: an individual participant data analysis

Chaker, L. et al. (2016) Thyroid function within the reference range and the risk of stroke: an individual participant data analysis. Journal of Clinical Endocrinology and Metabolism, 101(11), pp. 4270-4282. (doi:10.1210/jc.2016-2255) (PMID:27603906)

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Abstract

Context: The currently applied reference ranges for thyroid function are under debate. Despite evidence that thyroid function within the reference range is related with several cardiovascular disorders, its association with the risk of stroke has not been evaluated previously. Design and Setting: We identified studies through a systematic literature search and the Thyroid Studies Collaboration, a collaboration of prospective cohort studies. Studies measuring baseline TSH, free T4, and stroke outcomes were included, and we collected individual participant data from each study, including thyroid function measurements and incident all stroke (combined fatal and nonfatal) and fatal stroke. The applied reference range for TSH levels was between 0.45 and 4.49 mIU/L. Results: We collected individual participant data on 43 598 adults with TSH within the reference range from 17 cohorts, with a median follow-up of 11.6 years (interquartile range 5.1–13.9), including 449 908 person-years. Age- and sex-adjusted pooled hazard ratio for TSH was 0.78 (95% confidence interval [CI] 0.65–0.95 across the reference range of TSH) for all stroke and 0.83 (95% CI 0.62–1.09) for fatal stroke. For the free T4 analyses, the hazard ratio was 1.08 (95% CI 0.99–1.15 per SD increase) for all stroke and 1.10 (95% CI 1.04–1.19) for fatal stroke. This was independent of cardiovascular risk factors including systolic blood pressure, total cholesterol, smoking, and prevalent diabetes. Conclusion: Higher levels of TSH within the reference range may decrease the risk of stroke, highlighting the need for further research focusing on the clinical consequences associated with differences within the reference range of thyroid function.

Item Type:Articles
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:Stott, Professor David J and Ford, Professor Ian
Authors: Chaker, L., Baumgartner, C., den Elzen, W. P.J., Collet, T.-H., Ikram, M. A., Blum, M. R., Dehghan, A., Drechsler, C., Luben, R. N., Portegies, M. L. P., Iervasi, G., Medici, M., Stott, D. J., Dullaart, R. P., Ford, I., Bremner, A., Newman, A. B., Wanner, C., Sgarbi, J. A., Dörr, M., Longstreth, W.T., Psaty, B. M., Ferrucci, L., Maciel, R. M.B., Westendorp, R. G., Jukema, J. W., Ceresini, G., Imaizumi, M., Hofman, A., Bakker, S. J.L., Franklyn, J. A., Khaw, K.-T., Bauer, D. C., Walsh, J. P., Razvi, S., Gussekloo, J., Völzke, H., Franco, O. H., Cappola, A. R., Rodondi, N., and Peeters, R. P.
College/School:College of Medical Veterinary and Life Sciences > Institute of Cardiovascular and Medical Sciences
College of Medical Veterinary and Life Sciences > Institute of Health and Wellbeing > Robertson Centre
Journal Name:Journal of Clinical Endocrinology and Metabolism
Publisher:Endocrine Society
ISSN:0021-972X
ISSN (Online):1945-7197
Published Online:07 September 2016
Copyright Holders:Copyright © 2016 The Endocrine Society
First Published:First published in Journal of Clinical Endocrinology and Metabolism 101(11): 4270-4282
Publisher Policy:Reproduced in accordance with the publisher copyright policy

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