Thyroid replacement therapy and atrial fibrillation in acute ischemic stroke.

摘要

Atrial fibrillation is a risk factor for ischemic stroke.1 Hyperthy-roidism is a cause of atrial fibrillation. Subclinical hyperthyroid-ism, also associated with atrial fibrillation, may result from excess thyroid replacement therapy. However, it is unclear whether thyroid replacement therapy is a risk factor for atrial fibrillation in patients with acute ischemic stroke. In this case-control study, we sought to determine the association between thyroid replacement therapy and atrial fibrillation in patients presenting with ischemic. stroke.Methods. The study protocol was approved by the local Institu-tional Research Board at Stanford University Medical Center. We identified consecutive patients with ischemic stroke with atrial fibrillation (cases) and without atrial fibrillation (controls) admitted to the Stanford Stroke Center between 1996 and 2004 through a local stroke registry database. The stroke registry (3,276- sub-jects) includes patients presenting with ischemic stroke, TIA, hemorrhagie stroke, and patients in whom stroke was suspected but excluded. Cases and controls were frequency matched for age (within 5 years) and gender. To improve our power to detect associations, we sought to select two controls for each case. The following data were abstracted from the electronic admission records by one investigator, using a standardized case report form: age, gender, known atrial fibrillation or atrial fibrillation diagnosed during hospital admission, stroke subtype (attending clinician using TOAST criteria), thyroid replacement therapy use on admission, diabetes mellitus, hypercholesterolemia, smoking, hypertension, coronary heart disease, amiodarone use, and preadmission anti-thrombotic therapy.