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

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dc.citation.issue11
dc.citation.volume101
dc.contributor.authorChaker, Layal
dc.contributor.authorBaumgartner, Christine
dc.contributor.authorden Elzen, Wendy P. J.
dc.contributor.authorCollet, Tinh-Hai
dc.contributor.authorIkram, M. Arfan
dc.contributor.authorBlum, Manuel R.
dc.contributor.authorDehghan, Abbas
dc.contributor.authorDrechsler, Christiane
dc.contributor.authorLuben, Robert N.
dc.contributor.authorPortegies, Marileen L. P.
dc.contributor.authorLervasi, Giorgio
dc.contributor.authorMedici, Marco
dc.contributor.authorStott, David J.
dc.contributor.authorDullaart, Robin P.
dc.contributor.authorFord, Ian
dc.contributor.authorBremner, Alexandra
dc.contributor.authorNewman, Anne B.
dc.contributor.authorWanner, Christoph
dc.contributor.authorSgarbi, José Augusto [UNIFESP]
dc.contributor.authorDorr, Marcus
dc.contributor.authorLongstreth, W. T., Jr.
dc.contributor.authorPsaty, Bruce M.
dc.contributor.authorFerrucci, Luigi
dc.contributor.authorMaciel, Rui Monteiro de Barros [UNIFESP]
dc.contributor.authorWestendorp, Rudi G.
dc.contributor.authorJukema, J. Wouter
dc.contributor.authorCeresini, Graziano
dc.contributor.authorImaizumi, Misa
dc.contributor.authorHofman, Albert
dc.contributor.authorBakker, Stephan J. L.
dc.contributor.authorFranklyn, Jayne A.
dc.contributor.authorKhaw, Kay-Tee
dc.contributor.authorBauer, Douglas C.
dc.contributor.authorWalsh, John P.
dc.contributor.authorRazvi, Salman
dc.contributor.authorGussekloo, Jacobijn
dc.contributor.authorVolzke, Henry
dc.contributor.authorFranco, Oscar H.
dc.contributor.authorCappola, Anne R.
dc.contributor.authorRodondi, Nicolas
dc.contributor.authorPeeters, Robin P.
dc.coverageCary
dc.date.accessioned2020-07-31T12:47:22Z
dc.date.available2020-07-31T12:47:22Z
dc.date.issued2016
dc.description.abstractContext: 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 T-4, 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.en
dc.description.affiliationErasmus Univ, Med Ctr, Dept Internal Med, NL-3000 DR Rotterdam, Netherlands
dc.description.affiliationErasmus Filed Ctr, Rotterdam Thyroid Ctr, NL-3000 CA Rotterdam, Netherlands
dc.description.affiliationErasmus Filed Ctr, Dept Radiol & Neurol, NL-3000 CA Rotterdam, Netherlands
dc.description.affiliationUniv Bern, Bern Univ Hosp, Inselspital, Dept Gen Internal Med, CH-3010 Bern, Switzerland
dc.description.affiliationUniv Lausanne Hosp, Serv Endocrinol Diabet & Metab, CH-1011 Lausanne, Switzerland
dc.description.affiliationLeiden Univ, Med Ctr, Dept Clin Chem & Lab Med, NL-2300 RC Leiden, Netherlands
dc.description.affiliationLeiden Univ, Med Ctr, Dept Publ Hlth & Primary Care, NL-2300 RC Leiden, Netherlands
dc.description.affiliationLeiden Univ, Med Ctr, Dept Cardiol, NL-2300 RC Leiden, Netherlands
dc.description.affiliationUniv Calif San Francisco, Dept Med, San Francisco, CA 94143 USA
dc.description.affiliationUniv Calif San Francisco, Dept Epidemiol & Biostat, San Francisco, CA 94143 USA
dc.description.affiliationUniv Penn, Sch Med, Dept Med, Div Endocrinol Diabet & Metab, Philadelphia, PA 19104 USA
dc.description.affiliationHarvard TH Chan Sch Publ Hlth, Dept Epidemiol, Boston, MA 02115 USA
dc.description.affiliationGateshead Hlth Fdn Natl Hlth Serv Mast, Dept Endocrinol, Gateshead SE18 4QH, England
dc.description.affiliationSir Charles Gairdner Hosp, Dept Endocrinol & Diabet, Nedlands, WA 6009, Australia
dc.description.affiliationUniv Western Australia, Sch Med & Pharmacol, Crawley, WA 6009, Australia
dc.description.affiliationUniv Western Australia, Sch Populat Hlth, Crawley, WA 6009, Australia
dc.description.affiliationNatl Council Res Inst ot Clin Physiol, I-56124 Pisa, Italy
dc.description.affiliationUniv Glasgow, Fac Med, Robertson Ctr Biostat, Glasgow G12 8TA, Lanark, Scotland
dc.description.affiliationUniv Glasgow, Fac Med, Inst Cardiovasc & Med Sci, Glasgow G12 8TA, Lanark, Scotland
dc.description.affiliationUniv Pittsburgh, Dept Epidemiol, Pittsburgh, PA 15260 USA
dc.description.affiliationUniv Groningen, Univ Med Ctr Groningen, Dept Internal Med, NL-9700 AB Groningen, Netherlands
dc.description.affiliationUniv Hosp Wurzburg, Div Nephrol, Dept Med, D-97070 Wurzburg, Germany
dc.description.affiliationComprehens Heart Failure Ctr, D-97070 Wurzburg, Germany
dc.description.affiliationRadiat Eftects Res Fdn, Dept Clin Studies, Nagasaki 8508555, Japan
dc.description.affiliationUniv Parma, Dept Clin & Expt Med, I-143100 Parma, Italy
dc.description.affiliationNIA, Baltimore, MD 21225 USA
dc.description.affiliationGerman Ctr Cardiovasc Res, Clin Epidemiol Res, Study Hlth Pomerania, Inst Community Med,Univ Med, D-17187 Greifswald, Germany
dc.description.affiliationGerman Ctr Cardiovasc Res, Dept Internal Med, D-17187 Greifswald, Germany
dc.description.affiliationGerman Ctr Cardiovasc Res, Univ Med, D-17187 Greifswald, Germany
dc.description.affiliationUniv Washington, Dept Neurol, Seattle, WA 98108 USA
dc.description.affiliationUniv Washington, Dept Epidemiol, Seattle, WA 98108 USA
dc.description.affiliationUniv Washington, Cardiovasc Hlth Res Unit, Dept Med, Seattle, WA 98108 USA
dc.description.affiliationUniv Washington, Cardiovasc Hlth Res Unit, Dept Epidemiol, Seattle, WA 98108 USA
dc.description.affiliationUniv Washington, Cardiovasc Hlth Res Unit, Dept Hlth Serv, Seattle, WA 98108 USA
dc.description.affiliationGrp Hlth Cooperat Puget Sound, Grp Hlth Res Inst, Seattle, WA 98101 USA
dc.description.affiliationUniv Fed Sao Paulo, Dept Med, Div Endocrinol, BR-05150890 Sao Paulo, Brazil
dc.description.affiliationFau Med Marilia, Div Endocrinol, Marilia, Brazil
dc.description.affiliationUniv Cambridge, Dept Publ Hlth & Primary Care, Cambridge CB2 1TN, England
dc.description.affiliationInteruniv Cardiol Inst Netherlands, NL-3508 GA Utrecht, Netherlands
dc.description.affiliationUniv Birmingham, Coll Med & Dent Sci, Sch Clin & Expt Med, Birmingham B15 2TT, W Midlands, England
dc.description.affiliationUniv Copenhagen, Fac Hlth & Med Sci, Dept Publ Hlth, DK-2400 Copenhagen, Denmark
dc.description.affiliationUniv Copenhagen, Fac Hlth & Med Sci, Ctr Hlth Ageing, DK-2400 Copenhagen, Denmark
dc.description.affiliationUnifespDepartment of Medicine, Universidade Federal de São Paulo (UNIFESP), 05508-900 São Paulo, Brazil
dc.description.sourceWeb of Science
dc.description.sponsorshipErasmus Medical Center MRACE grant
dc.description.sponsorshipZonMW TOP grant
dc.description.sponsorshipGenzyme B.V.
dc.description.sponsorshipSwiss National Science Foundation
dc.description.sponsorshipLoll LifeCor
dc.description.sponsorshipJohnson Johnson
dc.description.sponsorshipNational Institute on Aging
dc.description.sponsorshipNational Heart, Lung, and Blood Institute
dc.description.sponsorshipNational Institute of Neurological Disorders and Stroke
dc.description.sponsorshipNational Institute of Nursing Research
dc.description.sponsorshipIntramural Research Program of the National Institutes of Health, National Institute on Aging
dc.description.sponsorshipResearch Network of Community Medicine of the University Medicine Greifswald
dc.description.sponsorshipGerman Research Foundation
dc.description.sponsorshipJapanese Ministry of Health, Labor, and Welfare
dc.description.sponsorshipUS Department of Energy
dc.description.sponsorshipRadiation Effects Research Foundation
dc.description.sponsorshipFundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)
dc.description.sponsorshipDutch Kidney Foundation
dc.description.sponsorshipUniversity Medical Center Groningen
dc.description.sponsorshipDutch Heart Foundation
dc.description.sponsorshipNational Institutes of Health
dc.description.sponsorshipNational Institute of Arthritis and Musculoskeletal and Skin Diseases
dc.description.sponsorshipNational Center for Advancing Translational Sciences
dc.description.sponsorshipNational Institutes of Health Roadmap for Medical Research
dc.description.sponsorshipIDZonMW TOP grant: 91212044
dc.description.sponsorshipIDSwiss National Science Foundation: PBLAP3-145870
dc.description.sponsorshipIDSwiss National Science Foundation: P3SMP3-155318
dc.description.sponsorshipIDSwiss National Science Foundation: SNSF 320030-138267
dc.description.sponsorshipIDSwiss National Science Foundation: 320030-150025
dc.description.sponsorshipIDNational Institute on Aging: R01AG032317
dc.description.sponsorshipIDNational Institute on Aging: K24AG042765
dc.description.sponsorshipIDNational Institute on Aging: AG023629
dc.description.sponsorshipIDNational Institute on Aging: N01-AG-6-2101
dc.description.sponsorshipIDNational Institute on Aging: N01-AG-6-2103
dc.description.sponsorshipIDNational Institute on Aging: N01-AG-6-2106
dc.description.sponsorshipIDNational Institute on Aging: R01-AG028050
dc.description.sponsorshipIDNational Heart, Lung, and Blood Institute: HHSN268 201200036C
dc.description.sponsorshipIDNational Heart, Lung, and Blood Institute: HHSN268200800007C
dc.description.sponsorshipIDNational Heart, Lung, and Blood Institute: N01HC55222
dc.description.sponsorshipIDNational Heart, Lung, and Blood Institute: N01HC 85079
dc.description.sponsorshipIDNational Heart, Lung, and Blood Institute: N01HC85080
dc.description.sponsorshipIDNational Heart, Lung, and Blood Institute: N01HC85081
dc.description.sponsorshipIDNational Heart, Lung, and Blood Institute: N01HC85082
dc.description.sponsorshipIDNational Heart, Lung, and Blood Institute: N01HC8 5083
dc.description.sponsorshipIDNational Heart, Lung, and Blood Institute: N01HC285086
dc.description.sponsorshipIDNational Heart, Lung, and Blood Institute: HL080295
dc.description.sponsorshipIDNational Institute of Nursing Research: R01-NR012459
dc.description.sponsorshipIDGerman Research Foundation: DFG Vo 955/12-2
dc.description.sponsorshipIDRadiation Effects Research Foundation: A3-13
dc.description.sponsorshipIDFAPESP: 6/59737-9
dc.description.sponsorshipIDDutch Kidney Foundation: E.033
dc.description.sponsorshipIDDutch Heart Foundation: 2001-005
dc.description.sponsorshipIDNational Institutes of Health Roadmap for Medical Research: U01 AG027810
dc.description.sponsorshipIDNational Institutes of Health Roadmap for Medical Research: U01 AG042124
dc.description.sponsorshipIDNational Institutes of Health Roadmap for Medical Research: U01 AG04 2139
dc.description.sponsorshipIDNational Institutes of Health Roadmap for Medical Research: U01 AG042140
dc.description.sponsorshipIDNational Institutes of Health Roadmap for Medical Research: U01 AG042143
dc.description.sponsorshipIDNational Institutes of Health Roadmap for Medical Research: U01 AG042145
dc.description.sponsorshipIDNational Institutes of Health Roadmap for Medical Research: U01 AG042168
dc.description.sponsorshipIDNational Institutes of Health Roadmap for Medical Research: U01 AR066160
dc.description.sponsorshipIDNational Institutes of Health Roadmap for Medical Research: UL1 TR000128
dc.format.extent4270-4282
dc.identifierhttp://dx.doi.org/10.1210/jc.2016-2255
dc.identifier.citationJournal Of Clinical Endocrinology & Metabolism. Cary, v. 101, n. 11, p. 4270-4282, 2016.
dc.identifier.doi10.1210/jc.2016-2255
dc.identifier.issn0021-972X
dc.identifier.urihttps://repositorio.unifesp.br/handle/11600/56774
dc.identifier.wosWOS:000390948600047
dc.language.isoeng
dc.publisherOxford Univ Press Inc
dc.relation.ispartofJournal Of Clinical Endocrinology & Metabolism
dc.rightsinfo:eu-repo/semantics/openAccess
dc.titleThyroid Function Within the Reference Range and the Risk of Stroke: An Individual Participant Data Analysisen
dc.typeinfo:eu-repo/semantics/article
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