Research Paper Volume 11, Issue 16 pp 6385—6397

Low triiodothyronine syndrome is associated with hemorrhagic transformation in patients with acute ischaemic stroke

Gui-Qian Huang1, *, , Ya-Ying Zeng1, *, , Qian-Qian Cheng2, , Hao-Ran Cheng1, , Yi-Ting Ruan1, , Cheng-Xiang Yuan1, , Yun-Bin Chen1, , Wei-Lei He1, , Hui-Jun Chen1, , Jin-Cai He1, ,

  • 1 Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China
  • 2 School of Mental Health, Wenzhou Medical University, Wenzhou 325000, China
* Co-first authors

Received: July 1, 2019       Accepted: August 10, 2019       Published: August 27, 2019
How to Cite

Copyright © 2019 Huang et al. This is an open-access article distributed under the terms of the Creative Commons Attribution (CC BY) 3.0 License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.


Hemorrhagic transformation (HT) is a severe complication occurring in acute ischemic stroke (AIS) patients. We explored the association between low triiodothyronine (T3) syndrome and HT in AIS patients. A total of 208 consecutive participants with HT and 208 age- and sex-matched stroke patients without HT were enrolled in this study. HT was diagnosed by follow-up imaging assessment, and was radiologically classified as hemorrhagic infarction (HI) type 1 or 2 or parenchymal hematoma (PH) type 1 or 2. HT was also classified into asymptomatic or symptomatic. The incidence of low T3 syndrome was significantly higher among patients who developed HT than among those without HT. Moreover, the more severe the HT, the lower the detected T3 levels. Multivariate-adjusted binary logistic regression showed that low T3 syndrome was an independent risk factor for HT and symptomatic HT in AIS patients. Low T3 syndrome was also significantly associated with a higher risk of PH, but not with the risk of HI. Thus, low T3 syndrome was independently associated with the risk of HT, symptomatic HT, and severe HT (PH) in AIS patients, which suggests monitoring T3 could be a useful means of preventing HT in patients with ischemic stroke.


AIS: acute ischemic stroke; asHT: asymptomatic hemorrhagic transformation; CI: confidence interval; DBP: diastolic blood pressure; HT: hemorrhagic transformation; HI-1: hemorrhagic infarct type 1; HI-2: hemorrhagic infarct type 2; PH-1: parenchymal hematoma type 1; PH-2: parenchymal hematoma type 2; NIHSS: National Institutes of Health Stroke Scale score; OR: odds ratio; SBP: systolic blood pressure; sHT: symptomatic hemorrhagic transformation; T3: triiodothyronine; T4: total thyroxine; TSH: thyroid stimulating hormone.