Stroke as a Very Rare Complication of Multile Bee Sting: A Case Report

Background: According to recent studies, thyroid hormones may have various effects on stroke severity, course and outcome, but underlying mechanisms of this association are still unclear.

Objective: The aim was to determine the relationship of thyroid hormones during stroke onset with stroke severity and outcome in clinical study.

Methods: In this study 168 adult patients with acute ischemic stroke were enrolled. Concentrations of free T3 (fT3), free T4 (fT4), TSH and basic stroke risk factors were assessed during 24h from symptoms onset. Neurological deficit was assessed by Scandinavian Stroke Scale (SSS). Disabling deficit was defined as mRs score ≥3 at 6 months after stroke.

Results: ANOVA showed that SSS scores were significantly higher in patients with fT3 level in 4th quartile (≥5.35 pmol/l) compared to 2-3rd quartile (SSS median 48 vs. 37, p=0,0481) and especially to 1st quartile (≤3,4050 pmol/l, SSS median 48 vs. 30, p=0,0018). In patients without prior stroke (n=124) baseline SSS-score was independently affected by fT3 (corrected R2 = 0.49, p < 0.0001). According to ROC-analysis, fT3 level <4,44 pmol/l was a predictor of disabling deficit (AUC = 0.727, specificity - 96.4%, sensitivity - 66.8%, p = 0.003). Univariate analysis showed association between poor outcome and low fT3, in multiple regression this association became insignificant only after correction for baseline SSS-score, but no other stroke risk factors

Conclusion: The study showed that a low serum free triiodothyronine level during stroke onset negatively affects the stroke severity in firsttime stroke patients and may be predictor of its unfavorable outcome. There was a trend for association between low free triiodothyronine and unfavorable stroke outcome after 6 months. Beneficial effects of additional fT3 supplement during stroke should be assessed in future studies.

Keywords: Ischemic stroke; Outcome; Thyroid hormones; Triiodothyronine

Abbreviations: AIS: Acute Ischemic Stroke; fT3: Free Triiodothyronine; fT4: Free Thyroxine; TSH: Thyroid-Stimulating Hormone; CRP: C-Reactive Protein; CI: Confidential Interval; ATP: Adenosine Diphosphate; SSS: Scandinavian Stroke Scale; mRs: Modified Rankin Scale