Thyroid Function Within the Reference Range and the Risk of Stroke: An Individual Participant Data Analysis.

Chaker, Layal; Baumgartner, Christine; den Elzen, Wendy P J; Collet, Tinh-Hai; Ikram, M Arfan; Blum, Manuel; Dehghan, Abbas; Drechsler, Christiane; Luben, Robert N; Portegies, Marileen L P; Iervasi, Giorgio; Medici, Marco; Stott, David J; Dullaart, Robin P; Ford, Ian; Bremner, Alexandra; Newman, Anne B; Wanner, Christoph; Sgarbi, José A; Dörr, Marcus; ... (2016). Thyroid Function Within the Reference Range and the Risk of Stroke: An Individual Participant Data Analysis. The Journal of clinical endocrinology and metabolism, 101(11), pp. 4270-4282. The Endocrine Society 10.1210/jc.2016-2255

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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:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of General Internal Medicine (DAIM) > Clinic of General Internal Medicine
04 Faculty of Medicine > Department of General Internal Medicine (DAIM) > Clinic of General Internal Medicine > Centre of Competence for General Internal Medicine
04 Faculty of Medicine > Medical Education > Institute of General Practice and Primary Care (BIHAM)

UniBE Contributor:

Baumgartner, Christine; Blum, Manuel and Rodondi, Nicolas

Subjects:

600 Technology > 610 Medicine & health
300 Social sciences, sociology & anthropology > 360 Social problems & social services

ISSN:

1945-7197

Publisher:

The Endocrine Society

Language:

English

Submitter:

Jacques Donzé

Date Deposited:

16 Feb 2017 11:22

Last Modified:

16 Feb 2017 11:22

Publisher DOI:

10.1210/jc.2016-2255

PubMed ID:

27603906

BORIS DOI:

10.7892/boris.94662

URI:

https://boris.unibe.ch/id/eprint/94662

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