Free triiodothyronine in intracranial aneurysms: a sex-specific association with unruptured disease and a non-thyroidal illness signal after rupture.

Authors

Maximilian Bschorer, Maximilian Middelkamp, Marius Mader, Shiva Sophia Nicolay, Miriam Heise, Patrick Czorlich, Lasse Dührsen, Thomas Sauvigny, Jennifer Sauvigny

Published in

Frontiers in neurology. Volume 17. Pages 1873351. Epub Sep 23, 2026.

Abstract

Thyroid dysfunction has been implicated in neurovascular pathologies, but its role in intracranial aneurysm formation and rupture is uncertain. Materials and.
This is a retrospective single-centre case-control study of patients with unruptured (UIA) or ruptured intracranial aneurysms (RIA) and aneurysm-free controls. Low free triiodothyronine (fT3) was defined as below 3.5 pmol/L. Multivariable logistic regression was adjusted for age, sex, hypertension, alcohol abuse, and smoking.
The cohort comprised 1,100 patients (60.0% female), including UIA (n = 213), RIA (n = 629), and controls (CTRL, n = 258). Low fT3 was observed in 58.8% of RIA patients (p < 0.001). In multivariable logistic regression analysis including age, sex, hypertension, alcohol abuse, and smoking, female sex (OR 4.90; 95% CI 2.70-8.92) and low fT3 (OR 3.05; 95% CI 1.28-7.28) were independently associated with UIA. Low fT3 was less frequent in UIA (3.8%) than in CTRL (14.0%) but was independently associated with UIA after risk-factor adjustment. Low fT3 was strongly associated with ruptured-aneurysm status (OR 38.0; 95% CI 15.90-90.89), a contrast likely driven by acute non-thyroidal illness syndrome after haemorrhage rather than a rupture-risk estimate. The fT3-UIA association was sex-dependent (interaction p = 0.030; females OR 2.43, p = 0.003; males OR 1.02, p = 0.938).
Reduced fT3 in RIA may partly reflect impaired peripheral conversion after haemorrhage, but low fT3 was also independently associated with aneurysm presence in females. Low fT3 may be a candidate endocrine marker associated with aneurysm presence. Whether thyroid optimisation influences aneurysm development remains to be tested in prospective studies.

PMID:
42846038
Bibliographic data and abstract were imported from PubMed on 08 Oct 2026.

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