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Hypothyroidism and Stroke: The Connection

Understanding the connection between hypothyroidism and stroke can help thyroid patients have better health outcomes.
Hypothyroidism and Stroke: The Connection
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Hypothyroidism, a condition where your thyroid gland does not produce enough thyroid hormones, is a condition that affects tens of millions of Americans. The thyroid gland plays a crucial role in maintaining the body’s metabolism and regulating various bodily functions. When it fails to produce adequate amounts of thyroid hormone, it can lead to better-known symptoms like fatigue, weight gain, and depression. Hypothyroidism can also have serious implications for cardiovascular health, including an increased risk of stroke.

Recent research suggests that hypothyroidism can affect your cardiovascular risk, atherosclerosis progression, and stroke outcomes. This emerging link raises important questions about the potential influence of hypothyroidism on stroke risk and recovery, especially in younger people. In this article, we look at the connection between hypothyroidism and stroke, potential outcomes for hypothyroid patients, and targeted management strategies for optimal treatment. 

What is a stroke?

A stroke, often referred to as a “brain attack,” occurs when there is a sudden interruption in the blood supply to the brain, leading to a decrease in oxygen. 

When a stroke is caused by a blockage in the blood vessels supplying the brain – usually due to a blood clot – it’s referred to as an ischemic stroke. Ischemic strokes are the most common and account for about 87% of all strokes. Ischemic strokes can be further divided into thrombotic and embolic strokes. Thrombotic strokes are caused by a blood clot that develops in the brain’s arteries. They are often seen in older people. Embolic strokes are caused by a blood clot or plaque debris that develops elsewhere in the body and then travels to the brain.

When the stroke results from a rupture and subsequent bleeding of a blood vessel in the brain – often the result of high blood pressure that weakens the arteries –  it’s called a hemorrhagic stroke. Hemorrhagic strokes account for about 13% of all strokes. Intracerebral hemorrhage (ICH) and subarachnoid hemorrhage (SAH) are two types of hemorrhagic strokes. ICH occurs when there is bleeding into the brain tissue itself. This type of stroke is considered the most serious. It can lead to a rapid expansion of the bleeding, causing sudden deterioration of consciousness and neurological damage. SAH occurs when there is bleeding into the subarachnoid space, which is the area between the brain and the tissues that cover it. The rupture of an aneurysm or an arteriovenous malformation commonly causes this type of hemorrhagic stroke. SAH can lead to a sudden severe headache, nausea, and vomiting, and in serious cases, it can cause permanent brain damage, paralysis, or even death.

In addition to ischemic and hemorrhagic strokes, there is also what’s known as a transient ischemic attack (TIA) or ministroke, which is similar to an ischemic stroke but usually lasts only a few minutes and does not cause permanent damage. TIAs are often a warning sign of an increased risk of a full-blown stroke.

What causes a stroke?

One of the primary causes of stroke is atherosclerosis, a common condition that involves the buildup of plaque inside the arteries. This plaque is made up of fats, cholesterol, calcium, and other substances, causing the artery walls to thicken and become stiff. Atherosclerosis is a slow and progressive disease that can start early in life and may not show symptoms until complications arise. Atherosclerosis can lead to reduced blood flow, increased risk of blood clots, and various complications such as heart attacks and strokes. The common risk factors for atherosclerosis include high cholesterol, high blood pressure, smoking, diabetes, obesity, and a sedentary lifestyle.

In addition to atherosclerosis, several other factors can cause a stroke. These include:

  • High Blood Pressure: Also known as hypertension, high blood pressure can damage blood vessels, increasing the risk of stroke[1][5].
  • Heart/Cardiovascular Disease: Conditions such as heart failure, heart defects, heart infection, or irregular heart rhythm, such as atrial fibrillation, can contribute to the risk of stroke.
  • Smoking: Tobacco use, including smoking and exposure to secondhand smoke, can significantly increase the likelihood of a stroke.
  • Diabetes: People with diabetes are at a greater risk of stroke due to the damage it causes to blood vessels.
  • Obesity: Being overweight or obese is a risk factor for stroke.
  • High Cholesterol: High cholesterol levels can lead to the thickening or hardening of arteries, which increases the risk of stroke.
  • Obstructive Sleep Apnea: This condition is a potential risk factor for stroke.

What are the symptoms of a stroke?

The symptoms of a stroke can vary but are often characterized by the sudden onset of:

  • Numbness or weakness of the face, arm, or leg, particularly on one side of the body
  • Loss of movement on one side of the body
  • Paralysis on one side of the body
  • Confusion
  • Trouble speaking or understanding speech
  • Vision problems in one or both eyes, double vision
  • Difficulty walking, dizziness, or loss of balance or coordination
  • Severe headache

To aid in the recognition of stroke symptoms, the acronym “FAST” is commonly used:

  • Face drooping
  • Arm weakness
  • Speech difficulty
  • Time to call emergency services

It’s important to note that these symptoms are medical emergencies, and immediate medical attention is crucial. Whether it’s an ischemic or hemorrhagic stroke, timely recognition and treatment are essential for the best possible outcome.

How is a stroke diagnosed?

Diagnosing a stroke is a critical and time-sensitive process that involves a combination of methods to determine the type of stroke and its cause. When a person is suspected of having a stroke, a healthcare provider will typically conduct a physical and neurological examination to assess the symptoms and medical history. This is followed by imaging tests, such as a CT scan or an MRI of the brain, to confirm the diagnosis and determine the type of stroke. These tests are crucial for identifying the specific type of stroke, whether it is ischemic or hemorrhagic, and its location, which helps in planning the appropriate treatment.

In addition to imaging tests, blood tests are often performed to help determine the cause of the stroke symptoms. These may include a complete blood count (CBC), blood glucose levels, and coagulation studies. The results of these tests can provide valuable information about the underlying factors contributing to the stroke, such as high cholesterol, diabetes, or blood clotting disorders. Furthermore, other diagnostic tests, such as an electrocardiogram (ECG) and echocardiogram, may be conducted to assess the heart’s function and identify any potential sources of blood clots that could have traveled to the brain.

Once a stroke is suspected, it is crucial to seek immediate medical attention, as the sooner a stroke is diagnosed and treated, the better the chances of minimizing brain damage and improving the patient’s outcomes. The diagnostic process aims to confirm the presence of a stroke and determine the specific type and cause, which are essential for guiding the most effective treatment and rehabilitation strategies.

How is a stroke treated?

The treatment of a stroke depends on the type and underlying cause. For an ischemic stroke, the primary goal is to restore blood flow to the affected part of the brain. This can be achieved by administering clot-busting medications (thrombolytics) such as tissue plasminogen activator (tPA) or performing a mechanical thrombectomy to remove the blood clot. In the case of a hemorrhagic stroke, the focus is on controlling the bleeding and reducing pressure on the brain.

Following the acute phase of treatment, stroke care often involves a multidisciplinary approach, including rehabilitation services to help individuals regain any lost function and relearn any skills. This may involve physical, occupational, and speech therapy, as well as psychological support to address the emotional impact of a stroke.

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What is the connection between hypothyroidism and stroke?

Hypothyroidism is associated with a number of the critical risk factors for stroke. These include: 

Hypertension (High Blood Pressure)

Hypothyroidism can lead to an increase in blood pressure, another risk factor for stroke. The imbalance of thyroid hormones can result in a decrease in blood vessel elasticity and an increase in peripheral resistance, causing elevated blood pressure levels.

Hypercholesterolemia (High Cholesterol)

Hypothyroidism can lead to elevated levels of low-density lipoprotein (LDL) cholesterol, commonly called “bad cholesterol.” High LDL cholesterol levels contribute to plaque formation in the arteries, leading to atherosclerosis. Atherosclerosis narrows the blood vessels, making them more susceptible to blockages that can cause a stroke. 

Cardiac Dysfunction

Hypothyroidism can lead to changes in cardiac function, including diastolic dysfunction and reduced cardiac output.


Hypothyroidism affects blood clotting factors, making individuals more prone to forming blood clots. This, in turn, increases the risk of a clot traveling to the brain and causing a stroke. 

Several research studies have also shown connections between hypothyroidism and stroke. 

  • A study published in the journal Stroke discussed the association between overt hypothyroidism, atherosclerotic risk factors, and stroke. 
  • An article in MDPI’s journal highlighted the increased risk of stroke associated with hypothyroidism. 
  • A study in the NCBI database examined the alteration of thyroid hormone among patients with ischemic stroke, emphasizing the increased risk of stroke in subjects with subclinical hypothyroidism, particularly those younger than 65 years and people with higher TSH levels. 
  • Research also shows that postmenopausal women with subclinical hypothyroidism may be at increased risk of ischemic stroke. 
  • Additionally, a study published in Thyroid Research had an interesting finding, indicating that patients with low Free T3 levels had worse outcomes from stroke. The study was not conclusive, however, and more research is needed. 

There’s one piece of good news, however. Subclinical or borderline hypothyroidism, with high-normal TSH levels, is associated with a reduced risk of stroke due to atrial fibrillation

Is there a link between Hashimoto’s thyroiditis and stroke?

Several studies have indicated that there is a connection between Hashimoto’s disease and stroke. Hashimoto’s disease is a common autoimmune disease characterized by chronic thyroiditis caused by antithyroid antibodies that can lead to hypothyroidism. Several studies have revealed that stroke is more common in patients with Hashimoto’s disease than in the average population. A study published in The Journal of Clinical Endocrinology & Metabolism also identified variation in normal range thyroid function, and patients with Hashimoto’s thyroiditis are at a 7% higher risk of cardiovascular disease, which leads to an increased risk of stroke. 

What can hypothyroid patients do to reduce stroke risk? 

When you’re hypothyroid, you can make several lifestyle changes to help prevent stroke. These changes primarily focus on managing the risk factors associated with stroke, such as high blood pressure, high cholesterol, and obesity. Here are some recommended approaches:

Get Optimal Thyroid Treatment: If you have hypothyroidism, managing your thyroid hormone levels with appropriate medication and regular monitoring is essential. Work closely with your healthcare professional to monitor and manage your thyroid hormone levels. Regular blood tests will help ensure hormone levels stay within a healthy range, reducing the risk of complications like stroke.

Follow a Healthy Diet: Adopt a diet rich in fruits, vegetables, whole grains, and foods low in saturated fats, trans fats, cholesterol, and sodium. The Mediterranean diet, which emphasizes legumes, fruits, vegetables, nuts, poultry, and fish while avoiding red meat, dairy, and concentrated sweets and sugar, is particularly recommended. Additionally, avoid excessive salt intake, as it can increase blood pressure, a significant risk factor for stroke.

Get Regular Physical Activity: Regular exercise can help keep your blood vessels flexible and prevent plaque buildup in the arteries. This could be as simple as walking regularly or involve more intense activities like running, swimming, or weight training. Aim for at least 30 minutes of moderate aerobic activity at least five times weekly.

Manage Your Weight: Maintain a healthy weight to reduce the risk of high blood pressure, high cholesterol, and diabetes, all of which are risk factors for stroke.

Stop Smoking: If you smoke, quitting is one of the most effective ways to reduce your risk of stroke. Avoid secondhand smoke as well[1][3].

Limit Alcohol Consumption: For women, more than one alcoholic drink a day raises stroke risk. “One drink” is defined as a glass of wine (5 ounces), a can of beer (12 ounces), or a shot of liquor (1.5 ounces).

Stress Management: High levels of stress can contribute to behaviors such as overeating, lack of physical activity, unhealthy diet, and smoking, all of which can increase stroke risk. Chronic stress can also negatively impact thyroid function. Incorporate stress-management techniques into your daily routine, such as meditation, deep breathing exercises, yoga, or engaging in hobbies and activities that bring you joy and relaxation. 

Regular Medical Checkups: Regular checkups, including assessing your risk for stroke, can help detect and manage any health conditions that could increase your risk of stroke.

Adequate Sleep: Aim for 7 to 9 hours of sleep per night for adults. Lack of sleep can contribute to conditions like high blood pressure and obesity, which are risk factors for stroke.

A note from Paloma

Becoming a Paloma Health member for your hypothyroidism care can be a crucial step in protecting your overall health and reducing the risk of stroke. By taking a holistic approach that includes regular thyroid function monitoring, medical interventions, and lifestyle adjustments, you can effectively reduce the circulatory effects and stroke risk factors associated with hypothyroidism. 

Paloma offers you access to experienced thyroid experts and innovative virtual telemedicine features, empowering you to take control of your health. Paloma Health’s team of practitioners can assist in evaluating and managing your hypothyroidism, and the platform offers practical, affordable, at-home testing kits to monitor your thyroid levels easily.

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O’Keefe LM, Conway SE, Czap A, et al. Thyroid hormones and functional outcomes after ischemic stroke. Thyroid Research. 2015;8(1). doi:

Talhada, D. et al. Thyroid Hormones in the Brain and Their Impact in Recovery Mechanisms After Stroke. Front. Neurol., 18 October 2019. Sec. Stroke. Volume 10 - 2019 |

Murolo M, Di Vincenzo O, Cicatiello AG, Scalfi L, Dentice M. Cardiovascular and Neuronal Consequences of Thyroid Hormones Alterations in the Ischemic Stroke. Metabolites. 2023;13(1):22. doi:

Marouli E, Kus A, Del Greco M F, et al. Thyroid Function Affects the Risk of Stroke via Atrial Fibrillation: A Mendelian Randomization Study. The Journal of Clinical Endocrinology and Metabolism. 2020;105(8):dgaa239. doi:

Hamano E, Nakagawa M, Mori H, Satow T, Takahashi J. Intracranial arterial stenosis associated with Hashimoto’s disease: angiographic features and clinical outcomes. BMC Neurology. 2020;20(1). doi:

Marouli, E. et al. Thyroid Function and Risk of Stroke. The Journal of Clinical Endocrinology & Metabolism, Volume 105, Issue 8, August 2020, dgaa239

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Mary Shomon

Patient Advocate

Mary Shomon is an internationally-recognized writer, award-winning patient advocate, health coach, and activist, and the New York Times bestselling author of 15 books on health and wellness, including the Thyroid Diet Revolution and Living Well With Hypothyroidism. On social media, Mary empowers and informs a community of more than a quarter million patients who have thyroid and hormonal health challenges.

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