Evidence map›Paper›PMID 34137866›Full record

Observational studyThe Journal of clinical endocrinology and metabolism2021

Thyroid Hormone Therapy and Incident Stroke.

Maria Papaleontiou, Deborah A Levine, David Reyes-Gastelum, Sarah T Hawley, Mousumi Banerjee, Megan R Haymart

Open access · bronzeAbstract readObservational Study
PubMed Full text at PMC Publisher
In one paragraph

Observational study in The Journal of clinical endocrinology and metabolism, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 22 papers, 2 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
22citing papers in PubMed, 2 pooled it
3.8field-weighted citation impact, top 5% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

22 citing papers in PubMed, 2 syntheses or guidelines pooled it, 38 citations in OpenAlex.

  1. Guideline
  2. Pooled it
  3. Article
  4. Approach to the Patient Considering Thyroid Hormone Deprescribing.The Journal of clinical endocrinology and metabolism · 2026
    Review
  5. A Qualitative Study of Clinician Barriers and Facilitators to De-escalation of Thyroid Stimulating Hormone Suppression in Thyroid Cancer Survivors.Endocrine practice : official journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists · 2026
    Article
  6. Measuring Hypothyroidism Disease Control Using a TSH-based "Time-in-range".The Journal of clinical endocrinology and metabolism · 2026
    Article
  7. Article
  8. Review
  9. Article
  10. Article
  11. Article
  12. Article
  13. Article
  14. Article
  15. Article
  16. Article
  17. Review
  18. Towards De-Implementation of low-value thyroid care in older adults.Current opinion in endocrinology, diabetes, and obesity · 2022
    Review
  19. Suboptimal Thyroid Hormone Replacement Is Associated With Worse Hospital Outcomes.The Journal of clinical endocrinology and metabolism · 2022
    Article
  20. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

6 authors at 1 institution in 1 country.

Maria PapaleontiouDivision of Metabolism, Endocrinology and Diabetes, Department of Internal Medicine, University of Michigan, Ann Arbor, MI 48109, USA.ORCID 0000-0003-2276-0046
Deborah A LevineDepartment of Internal Medicine, University of Michigan, Ann Arbor, MI 48109, USA.
David Reyes-GastelumDivision of Metabolism, Endocrinology and Diabetes, Department of Internal Medicine, University of Michigan, Ann Arbor, MI 48109, USA.
Sarah T HawleyDivision of General Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI 48109, USA.
Mousumi BanerjeeSchool of Public Health, Department of Biostatistics, University of Michigan, Ann Arbor, MI 48109, USA.
Megan R HaymartDivision of Metabolism, Endocrinology and Diabetes, Department of Internal Medicine, University of Michigan, Ann Arbor, MI 48109, USA.ORCID 0000-0002-1083-1575
University of Michigan · US

Funding

Treatment decision making in low-risk thyroid cancerR01CA201198 · NCI · UNIVERSITY OF MICHIGAN AT ANN ARBOR · PI HAYMART, MEGAN RIST · 2016 to 2019
$2.4M
Imaging Practices and Overdiagnosis of Thyroid CancerR01HS024512 · AHRQ · UNIVERSITY OF MICHIGAN AT ANN ARBOR · PI HAYMART, MEGAN RIST · 2016 to 2019
$861k
The Effect of Inappropriate Use of Thyroid Hormone Replacement in Older MenK08AG049684 · NIA · UNIVERSITY OF MICHIGAN AT ANN ARBOR · PI PAPALEONTIOU, MARIA · 2016 to 2022
$809k
AHRQ HHS R01 HS024512NCI NIH HHS R01 CA201198NIA NIH HHS K08 AG049684NIH HHS
6 · The paper itself

Abstract

contextStroke is a leading cause of death and disability and there is a need to identify modifiable risk factors.

objectiveWe aimed to determine the relationship between thyroid hormone treatment intensity and incidence of atrial fibrillation and stroke.

methodsWe conducted a retrospective cohort study using data from the Veterans Health Administration between 2004 and 2017, with a median follow-up of 59 months. The study population comprised 733 208 thyroid hormone users aged ≥18 years with at least 2 thyroid stimulating hormone (TSH) measurements between thyroid hormone initiation and incident event (atrial fibrillation or stroke) or study conclusion (406 030 thyroid hormone users with at least 2 free thyroxine [T4] measurements).

resultsOverall, 71 333/643 687 (11.08%) participants developed incident atrial fibrillation and 41 931/663 809 (6.32%) stroke. In multivariable analyses controlling for pertinent factors such as age, sex, and prior history of atrial fibrillation, higher incidence of stroke was associated with low TSH or high free T4 levels (ie, exogenous hyperthyroidism; eg, TSH <0.1 mIU/L; OR 1.33; 95% CI, 1.24-1.43; free T4>1.9 ng/dL, OR 1.17, 95% CI 1.06-1.30) and high TSH or low free T4 levels (ie, exogenous hypothyroidism; eg, TSH >5.5 mIU/L; OR 1.29; 95% CI, 1.26-1.33; free T4 <0.7 ng/dL; OR 1.29; 95% CI, 1.22-1.35) compared with euthyroidism (TSH >0.5-5.5 mIU/L and free T4 0.7-1.9 ng/dL). Risk of developing atrial fibrillation and stroke was cumulative over time for both patients with exogenous hyperthyroidism and hypothyroidism.

conclusionBoth exogenous hyper- and hypothyroidism were associated with increased risk of stroke, highlighting the importance of patient medication safety.

Indexed as

AdolescentAdultAgedAged, 80 and overAtrial FibrillationCohort StudiesFemaleHormone Replacement TherapyHumansHypothyroidismIncidenceMaleMiddle AgedRetrospective StudiesRisk FactorsStrokeThyroid Hormonesatrial fibrillationstrokethyroid hormone therapy

Identifiers

PMID34137866
PMCPMC8475197
OpenAlexW3169976372

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.