Assessment of serum ferritin and thyroid hormones level in acute ischemic stroke and their association with hemorrhagic conversion


  • Richa Giri Department of Medicine, KPS Institute, GSVM Medical College, Kapur, Uttar Pradesh, India
  • Faim Ahamed Department of Medicine, KPS Institute, GSVM Medical College, Kapur, Uttar Pradesh, India
  • Saurabh Agarwal Department of Medicine, KPS Institute, GSVM Medical College, Kapur, Uttar Pradesh, India
  • Lalit Kumar Department of Medicine, KPS Institute, GSVM Medical College, Kapur, Uttar Pradesh, India



Stroke, Ischemic stroke, Serum ferritin, Thyroid hormones, T3


Background: Acute ischemic stroke is a significant cause of mortality and the leading cause of long-term disability in the United States. Collective evidence suggests that low T3 levels and serum ferritin levels instantly following acute ischemic stroke are connected with greater stroke sternness, higher death rates, and poor functional outcomes. The aim of the study was to assess the serum ferritin and thyroid hormones level in acute ischemic stroke their association with hemorrhagic conversion.

Methods: In this observational study, 60 acute ischemic stroke patients aged ≥ 18 years of both gender who were reported with focal neurological deficit lasting greater than 24 hours were included. Clinical severity of stroke was assessed at admission and on the 7th day using Glasgow coma scale (G.C.S.), serum ferritin level, and thyroid hormones level were measured at admission and on the 7th day in all these subjects.

Results: Overall mean age of patients was 56.28±11.45 years with a range of 29-87 years; 61.7% were male patients. Ischemic stroke was found in 55 (91.7%) patients, while 5 (8.3%) patients showed hemorrhagic conversion. Serum Ferritin and T3 level shows a significant association with G.C.S. score (p<0.05). Hemorrhagic Conversion patients were significantly greater in-hospital stay than the acute ischemic stroke group (p<0.05).

Conclusions: In our study, it was observed that after acute ischemic stroke high ferritin level and low T3 is associated with worse neurological outcome and linked to the poorer results at hospital discharge.

Author Biography

Faim Ahamed, Department of Medicine, KPS Institute, GSVM Medical College, Kapur, Uttar Pradesh, India

Junior Resident Internal Medicine


Koul RK, Yaseen Y, Amreen S, Shah PA, Hakeem MM. Role of Serum Ferritin in Determining the Severity and Prognosis of Stroke: A Hospital Based Study. Int J Sci Stud. 2017;6(7):142-5.

Joshi R, Cardona M, Iyengar S, Sukumar A, Raju CR, Raju KR, et al. Chronic diseases now a leading cause of death in rural India--mortality data from the Andhra Pradesh Rural Health Initiative. Int J Epidemiol. 2006;35(6):1522-9.

Upadhyay RP. An overview of the burden of non-communicable diseases in India. Iran J Public Health. 2012;41(3):1-8.

Dziedzic T. Clinical significance of acute phase reaction in stroke patients. Front Biosci. 2008 Jan 1;13:2922-7.

Mandal SK, Majumder, Muntasir M, Hossain Md S, Sarker M. Serum Ferritin and Plasma Fibrinogen Level in Acute Ischemic Stroke. Bangladesh Journal of Medical Biochemistry. 2018;10:16.

World Health organization. Serum ferritin concentrations for the assessment of iron status and iron deficiency in populations, 2009. Available at: Accessed on 23 February 2021.

Smith JW, Evans AT, Costall B, Smythe JW. Thyroid hormones, brain function and cognition: a brief review. Neurosci Biobehav Rev. 2002;26(1):45-60.

Wagner KR, Sharp FR, Ardizzone TD, Lu A, Clark JF. Heme and iron metabolism: Role in cerebral hemorrhage. J Cereb Blood Flow Metab 2003;23:629-52.

Bunevicius A, Iervasi G, Bunevicius R. Neuroprotective actions of thyroid hormones and low-T3 syndrome as a biomarker in acute cerebrovascular disorders. Expert Rev Neurother. 2015;15(3):315-26.

Pande SD, Win MM, Khine AA, Zaw EM, Manoharraj N, Lolong L, et al. Haemorrhagic transformation following ischaemic stroke: A retrospective study. Sci Rep. 2020;10(1):5319.

Mandal SK, Majumder M, Hossain MS, Sarker M.Serum ferritin and plasma fibrinogen level in acute ischemic stroke. Bangladesh J Med Biochem 2017;10(1):16-20.

Mehrpour M. Is the serum ferritin level a considerable predictor for hemorrhagic transformation of ischemic stroke?Med J Islam Repub Iran.2016;30:363.

Pande A, Goel VK, Rastogi A, Gupta A. Thyroid dysfunction in patients of ischemic cerebrovascular accidents. Thyroid Res Pract 2017;14:32-7.

O'Keefe LM, Conway SE, Czap A, Malchoff CD, Benashski S, Fortunato G, et al. Thyroid hormones and functional outcomes after ischemic stroke. Thyroid Res. 2015;8:9.

Paciaroni M, Bandini F, Agnelli G, Tsivgoulis G, Yaghi S, Furie KL, et al. Hemorrhagic Transformation in Patients with Acute Ischemic Stroke and Atrial Fibrillation: Time to Initiation of Oral Anticoagulant Therapy and Outcomes. J Am Heart Assoc. 2018;7(22):010133.

Aviv RI, Esterre CD, Murphy BD, Hopyan JJ, Buck B, Mallia G, et al. Hemorrhagic transformation of ischemic stroke: prediction with CT perfusion. Radiology. 2009 Mar;250(3):867-77.

Dzialowski I, Pexman JH, Barber PA, Demchuk AM, Buchan AM, Hill MD; CASES Investigators. Asymptomatic hemorrhage after thrombolysis may not be benign: prognosis by hemorrhage type in the Canadian alteplase for stroke effectiveness study registry. Stroke. 2007;38(1):75-9.

Kerenyi L, Kardos L, Szász J, Szatmári S, Bereczki D, Hegedüs K, et al. Factors influencing hemorrhagic transformation in ischemic stroke: a clinicopathological comparison. Eur J Neurol 2006;13:1251-5.

Lindley RI, Wardlaw JM, Sandercock PA, Rimdusid P, Lewis SC, Signorini DF, et al. Frequency and risk factors for spontaneous hemorrhagic transformation of cerebral infarction. J Stroke Cerebrovasc Dis. 2004;13(6):235-46.

Millan M, Sobrino T, Castellanos M, Nombela F, Arenillas JF, Riva E, et al. Increased body iron stores are associated with poor outcome after thrombolytic treatment in acute stroke. Stroke. 2007;38(1):90-5.

Choi KH, Park MS, Kim JT, Nam TS, Choi SM, Kim BC, Kim MK, Cho KH. The serum ferritin level is an important predictor of hemorrhagic transformation in acute ischaemic stroke. Eur J Neurol. 2012;19(4):570-7.

Bayir A, Kara H, SerifeOzdinc, Seydanoglu A, Kostekci SK, Fatih Kara. Thyroid hormone levels during early periods of ischemic and hemorrhagic stroke could serve as an indicator of prognosis. Neural Regeneration Res. 2009;4(4):659-63.

Emre U, Ergun U, Unal A, Coskun O, Atasoy HT, Yildiz H, et al. The Role of Acute Phase Reactants in Acute Ischemic Stroke. J Neurol Sci. 2007;10:64-9.

Balachandiran M, Selvakumar C Sridhar MG. Platelet Aggregation, Fibrinogen and Lipid Profile in Cerebrovascular Accidents. Int J Pharma Bio Sci 2012;3(2):115-121.

Kaushik R, Manish Mittal, Abhijeet Gupta.Serum ferritin level-a predictor of hemorrhagic transformation in acute ischaemic stroke. International Journal of Contemporary Medical Research 2018;5(1):24-31.

Dávalos A, Castillo J, Marrugat J, Fernandez-Real JM, Armengou A, Cacabelos P, et al. Body iron stores and early neurologic deterioration in acute cerebral infarction. Neurology. 2000;54(8):1568-74.

Erdemoglu AK, Ozbakir S. Serum ferritin levels and early prognosis of stroke. Eur J Neurol. 2002;9:633-7.

Alevizaki M, Synetou M, Xynos K, Pappa T, Vemmos KN. Low triiodothyronine: A strong predictor of outcome in acute stroke patients. Eur J Clin Invest. 2007;37:651-7.

Saha M, Nahar K, Hosen MA, Khan MH, Kumar Saha S, et al. Prevalence and Risk Factors of Asymptomatic Gallstone Disease in North-East Part of Bangladesh. Euroasian J Hepatogastroenterol. 2015;5(1):1-3.

Huang GQ, Zeng YY, Cheng QQ, Cheng HR, Ruan YT, Yuan CX et al. Low triiodothyronine syndrome is associated with hemorrhagic transformation in patients with acute ischaemic stroke. Aging Albany NY. 2019;11(16):6385-97.

Wang Y, Zhou S, Bao J, Pan S, Zhang X. Low T 3 levels as a predictor marker predict the prognosis of patients with acute ischemic stroke. Int J Neurosci. 2017;127(7):559-66.






Original Research Articles