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Neurology. 2014 May 6;82(18):1650. doi: 10.1212/WNL.0000000000000394. Epub 2014 Apr 9.

Comment: does L-thyroxine prevent or cause stroke in hypothyroidism?

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  • 1From the Research Center on Thromboembolic Disorders and Antithrombotic Therapies (A.S.), Department of Clinical Medicine, University of Insubria, Varese, Italy; and Department of Internal Medicine (V.E.A.G.), Slotervaart Hospital, Amsterdam, the Netherlands.


The association between overt hypothyroidism and atherosclerotic risk factors, especially hypertension and dyslipidemia, is clear. To date, only a few small and methodologically flawed epidemiologic studies have investigated the relationship between hypothyroidism and stroke, precluding definitive conclusions. In the current issue of Neurology®, Karch and Thomas(1) present a large well-designed case-control study investigating this relationship. They compared 34,907 patients with autoimmune thyroiditis on treatment with l-thyroxine and 149,632 matched individuals without autoimmune thyroiditis from a UK primary care electronic health record system. They found a slight increase in the risk of stroke in patients with autoimmune thyroiditis (adjusted relative risk = 1.10, 95% confidence interval: 1.01-1.20) compared with controls. Some of this increased risk of stroke was independent of cardiovascular risk factors.

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