gms | German Medical Science

65th Annual Meeting of the German Society of Neurosurgery (DGNC)

German Society of Neurosurgery (DGNC)

11 - 14 May 2014, Dresden

Dynamics of thyroid hormones in the acute phase of subarachnoid hemorrhage

Meeting Abstract

  • Judith Scheitzach - Klinik und Poliklinik für Neurochirurgie, Universitätsklinikum Regensburg
  • Andreas Hochreiter - Klinik und Poliklinik für Neurochirurgie, Universitätsklinikum Regensburg
  • Elisabeth Bründl - Klinik und Poliklinik für Neurochirurgie, Universitätsklinikum Regensburg
  • Petra Schödel - Klinik und Poliklinik für Neurochirurgie, Universitätsklinikum Regensburg
  • Alexander Brawanski - Klinik und Poliklinik für Neurochirurgie, Universitätsklinikum Regensburg
  • Sylvia Bele - Klinik und Poliklinik für Neurochirurgie, Universitätsklinikum Regensburg

Deutsche Gesellschaft für Neurochirurgie. 65. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC). Dresden, 11.-14.05.2014. Düsseldorf: German Medical Science GMS Publishing House; 2014. DocMO.08.03

doi: 10.3205/14dgnc037, urn:nbn:de:0183-14dgnc0379

Published: May 13, 2014

© 2014 Scheitzach et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.



Objective: Thyroid hormones are probably important for neurological recovery after acute brain injury but the dynamics of these hormones after subarachnoid hemorrhage (SAH) are actually not well understood. This preliminary study was designed to evaluate a possible correlation between alteration of the thyroid hormones during the first days after SAH and the severity of the SAH as well as the clinical outcome at time of discharge. In addition we wanted to explore if low serum levels of triiodothyronine (T3) and thyroid-stimulating hormone (TSH) during the first days are a common side effect after SAH and if a special protection for the thyroid gland after contrast medium in CT is absolute essential.

Method: Prospectively, we included 13 patients (10 women and 3 men; mean age 47ys) with non-traumatic SAH in this study. Exclusion criteria were any endocrine disease (except diabetes mellitus). Serum concentrations of TSH, thyroxin (fT4) and T3 were measured once a day on day 1, 3, 5 and 10 after the onset of the bleeding. These were correlated to the severity of SAH (according to Hunt and Hess, HH), clinical course and neurological condition at admission and hospital discharge.

Results: On day 3 to day 5 after SAH most of the patients showed a decrease in TSH and abatement of T3 in serum concentration. Two of those patients showed a dramatic decline of TSH on day 3. These patients suffered more severe complications and had a prolonged hospital stay but so far no statistical significant difference in patient outcome at hospital discharge was found among the patients included in this study. According to clinical standards most of the patients with low TSH got sodium perchlorate (NaClO4) after administration of contrast medium during the first CT-scan although there was no known endocrine disease.

Conclusions: These preliminary results showed significant dynamics in TSH and T3 level after SAH. Patients with severe decrease of TSH and T3 had a more complicated and prolonged course. Thyroid hormones should be determined routinely in the acute phase after SAH since they might reflect the initial severity of the bleeding and be a predictor for patient outcome. Taken into account that none of the included patients had a history of an endocrine disease it seems likely that low TSH values are a side effect of the SAH and don’t represent hyperthyreosis. Thus the necessity of the administration of sodium perchlorate needs to be reassessed in those patients.