gms | German Medical Science

Objective: The incidence of subarachnoid hemorrhage (SAH) has increased in the last years and vasospasm-induced cerebral infarction is a significant cause of poor outcome after aneurysmal subarachnoid hemorrhage. Although the mechanisms and pathophysiology of cerebral vasospasm (CVS) are not completely understood, some risk factors have been established while others remain unknown. The duration of CVS additionally increases the length of stay on the intensive care unit (ICU), increasing the likelihood of ICU-related complications leading to poor outcome. The aim of this study was to correlate thyroid hormone alterations and duration of CVS in patients with SAH.

Method: Data of all patients with SAH after aneurysm rupture between January 2014 and October 2015 was included in a retrospective monocentric study. The beginning and the end of CVS were expressed in days after ictus and confirmed by computer tomography angiography and/or digital subtraction angiography. Thyroid hormones were measured at patients’ admission and during the period of CVS. Alterations of thyroid hormones were defined as derangement of TSH, fT3, or fT4. Data values are reported as mean ± SEM. Unpaired t-test with Welch correction was used for statistical comparisons. p < 0.05 was considered significant.

Results: 67 patients (73.6%) with CVS were identified and divided into two groups. Group 1 represents the patients with normal thyroid hormones (29 patients; 43.3%) and group 2 the patients with thyroid hormones alterations (38 patients; 56.7%) during CVS treatment. Regarding the beginning of CVS, no significant differences were observed between group 1 and group 2 (5.2 days ± 0.5 versus 5.3 days ± 0.4; p = 0.90, respectively). The duration of CVS in group 1 was significantly shorter compared to group 2 (11.3 days ± 1.1 versus 14.3 days ± 0.8, respectively; p = 0.028).

Conclusions: SAH patients with thyroid hormone alterations had a higher risk for longer duration of CVS. Therefore, thyroid hormone alterations could be a risk factor for long-lasting CVS. Treatment of thyroid hormone alterations could represent a therapeutic approach. However, more studies are needed to understand the correlation between the duration of CVS and thyroid hormone dysfunction and to identify a therapeutic benefit.