{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,20]],"date-time":"2026-10-20T00:41:18Z","timestamp":1792456878783,"version":"4.5.0"},"reference-count":28,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,7,18]],"date-time":"2026-07-18T00:00:00Z","timestamp":1784332800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0"},{"start":{"date-parts":[[2026,10,20]],"date-time":"2026-10-20T00:00:00Z","timestamp":1792454400000},"content-version":"vor","delay-in-days":94,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0"}],"funder":[{"name":"the Provincial Health Commission of Hebei Province","award":["20241615"],"award-info":[{"award-number":["20241615"]}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Sci Rep"],"DOI":"10.1038\/s41598-026-60626-3","type":"journal-article","created":{"date-parts":[[2026,7,18]],"date-time":"2026-07-18T14:35:10Z","timestamp":1784385310000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Elevated FT4 is associated with prevalent stroke in euthyroid adults: a cross\u2011sectional study"],"prefix":"10.1038","volume":"16","author":[{"given":"Wenmei","family":"Sun","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mengsi","family":"Zhou","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Weiling","family":"Zhou","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-3147-1406","authenticated-orcid":false,"given":"Yanting","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,7,18]]},"reference":[{"key":"60626_CR1","doi-asserted-by":"publisher","first-page":"e7895","DOI":"10.1136\/bmj.e7895","volume":"345","author":"C Selmer","year":"2012","unstructured":"Selmer, C. et al. The spectrum of thyroid disease and risk of new onset atrial fibrillation: a large population cohort study. BMJ 345, e7895 (2012).","journal-title":"BMJ"},{"issue":"4","key":"60626_CR2","doi-asserted-by":"publisher","first-page":"491","DOI":"10.1530\/EJE-11-0299","volume":"165","author":"F Brandt","year":"2011","unstructured":"Brandt, F., Green, A., Heged\u00fcs, L. & Brix, T. H. A critical review and meta-analysis of the association between overt hyperthyroidism and mortality. Eur. J. Endocrinol. 165 (4), 491\u2013497 (2011).","journal-title":"Eur. J. Endocrinol."},{"issue":"7","key":"60626_CR3","doi-asserted-by":"publisher","first-page":"501","DOI":"10.1056\/NEJM200102153440707","volume":"344","author":"I Klein","year":"2001","unstructured":"Klein, I. & Ojamaa, K. Thyroid hormone and the cardiovascular system. N Engl. J. Med. 344 (7), 501\u2013509 (2001).","journal-title":"N Engl. J. Med."},{"issue":"7","key":"60626_CR4","doi-asserted-by":"publisher","first-page":"541","DOI":"10.1016\/j.amjmed.2005.09.028","volume":"119","author":"N Rodondi","year":"2006","unstructured":"Rodondi, N., Aujesky, D., Vittinghoff, E., Cornuz, J. & Bauer, D. C. Subclinical hypothyroidism and the risk of coronary heart disease: a meta-analysis. Am. J. Med. 119 (7), 541\u2013551 (2006).","journal-title":"Am. J. Med."},{"issue":"6","key":"60626_CR5","doi-asserted-by":"publisher","first-page":"546","DOI":"10.1016\/S0002-9343(98)00116-8","volume":"104","author":"DC Bauer","year":"1998","unstructured":"Bauer, D. C., Ettinger, B. & Browner, W. S. Thyroid functions and serum lipids in older women: a population-based study. Am. J. Med. 104 (6), 546\u2013551 (1998).","journal-title":"Am. J. Med."},{"issue":"1","key":"60626_CR6","doi-asserted-by":"publisher","first-page":"76","DOI":"10.1210\/er.2006-0043","volume":"29","author":"B Biondi","year":"2008","unstructured":"Biondi, B. & Cooper, D. S. The clinical significance of subclinical thyroid dysfunction. Endocr. Rev. 29 (1), 76\u2013131 (2008).","journal-title":"Endocr. Rev."},{"issue":"9","key":"60626_CR7","doi-asserted-by":"publisher","first-page":"5483","DOI":"10.1210\/jc.2005-0455","volume":"90","author":"L Wartofsky","year":"2005","unstructured":"Wartofsky, L. & Dickey, R. A. The evidence for a narrower thyrotropin reference range is compelling. J. Clin. Endocrinol. Metab. 90 (9), 5483\u20135488 (2005).","journal-title":"J. Clin. Endocrinol. Metab."},{"issue":"3","key":"60626_CR8","doi-asserted-by":"publisher","first-page":"841","DOI":"10.1210\/jc.2006-2208","volume":"92","author":"BO Asvold","year":"2007","unstructured":"Asvold, B. O., Bj\u00f8ro, T., Nilsen, T. I. & Vatten, L. J. Association between blood pressure and serum thyroid-stimulating hormone concentration within the reference range: a population-based study. J. Clin. Endocrinol. Metab. 92 (3), 841\u2013845 (2007).","journal-title":"J. Clin. Endocrinol. Metab."},{"issue":"12","key":"60626_CR9","doi-asserted-by":"publisher","first-page":"5023","DOI":"10.1210\/jc.2009-1180","volume":"94","author":"BO Asvold","year":"2009","unstructured":"Asvold, B. O., Bj\u00f8ro, T. & Vatten, L. J. Association of serum TSH with high body mass differs between smokers and never-smokers. J. Clin. Endocrinol. Metab. 94 (12), 5023\u20135027 (2009).","journal-title":"J. Clin. Endocrinol. Metab."},{"issue":"2","key":"60626_CR10","doi-asserted-by":"publisher","first-page":"181","DOI":"10.1530\/eje.1.02333","volume":"156","author":"BO Asvold","year":"2007","unstructured":"Asvold, B. O., Vatten, L. J., Nilsen, T. I. & Bj\u00f8ro, T. The association between TSH within the reference range and serum lipid concentrations in a population-based study. The HUNT Study. Eur. J. Endocrinol. 156 (2), 181\u2013186 (2007).","journal-title":"Eur. J. Endocrinol."},{"issue":"9913","key":"60626_CR11","doi-asserted-by":"publisher","first-page":"245","DOI":"10.1016\/S0140-6736(13)61953-4","volume":"383","author":"VL Feigin","year":"2014","unstructured":"Feigin, V. L. et al. Global and regional burden of stroke during 1990\u20132010: findings from the Global Burden of Disease Study 2010. Lancet 383 (9913), 245\u2013254 (2014).","journal-title":"Lancet"},{"issue":"5","key":"60626_CR12","doi-asserted-by":"publisher","first-page":"961","DOI":"10.1161\/STROKEAHA.109.577742","volume":"41","author":"JJ Sheu","year":"2010","unstructured":"Sheu, J. J., Kang, J. H., Lin, H. C. & Lin, H. C. Hyperthyroidism and risk of ischemic stroke in young adults: a 5-year follow-up study. Stroke 41 (5), 961\u2013966 (2010).","journal-title":"Stroke"},{"issue":"10","key":"60626_CR13","doi-asserted-by":"publisher","first-page":"2302","DOI":"10.1161\/01.STR.0000181772.78492.07","volume":"36","author":"A Squizzato","year":"2005","unstructured":"Squizzato, A., Gerdes, V. E., Brandjes, D. P., B\u00fcller, H. R. & Stam, J. Thyroid diseases and cerebrovascular disease. Stroke 36 (10), 2302\u20132310 (2005).","journal-title":"Stroke"},{"issue":"11","key":"60626_CR14","doi-asserted-by":"publisher","first-page":"4270","DOI":"10.1210\/jc.2016-2255","volume":"101","author":"L Chaker","year":"2016","unstructured":"Chaker, L. et al. Thyroid Function Within the Reference Range and the Risk of Stroke: An Individual Participant Data Analysis. J. Clin. Endocrinol. Metab. 101 (11), 4270\u20134282 (2016).","journal-title":"J. Clin. Endocrinol. Metab."},{"issue":"11","key":"60626_CR15","doi-asserted-by":"publisher","first-page":"791","DOI":"10.1007\/s10654-014-9946-8","volume":"29","author":"L Chaker","year":"2014","unstructured":"Chaker, L. et al. Subclinical thyroid dysfunction and the risk of stroke: a systematic review and meta-analysis. Eur. J. Epidemiol. 29 (11), 791\u2013800 (2014).","journal-title":"Eur. J. Epidemiol."},{"key":"60626_CR16","doi-asserted-by":"publisher","first-page":"29","DOI":"10.1016\/j.mce.2017.01.025","volume":"458","author":"AH van der Spek","year":"2017","unstructured":"van der Spek, A. H., Fliers, E. & Boelen, A. The classic pathways of thyroid hormone metabolism. Mol. Cell. Endocrinol. 458, 29\u201338 (2017).","journal-title":"Mol. Cell. Endocrinol."},{"issue":"4","key":"60626_CR17","doi-asserted-by":"publisher","first-page":"529","DOI":"10.1111\/j.1365-2265.2009.03534.x","volume":"71","author":"A Jostel","year":"2009","unstructured":"Jostel, A., Ryder, W. D. & Shalet, S. M. The use of thyroid function tests in the diagnosis of hypopituitarism: definition and evaluation of the TSH Index. Clin. Endocrinol. (Oxf). 71 (4), 529\u2013534 (2009).","journal-title":"Clin. Endocrinol. (Oxf)"},{"issue":"2","key":"60626_CR18","doi-asserted-by":"publisher","first-page":"303","DOI":"10.2337\/dc18-1410","volume":"42","author":"M Laclaustra","year":"2019","unstructured":"Laclaustra, M. et al. Impaired Sensitivity to Thyroid Hormones Is Associated With Diabetes and Metabolic Syndrome. Diabetes Care. 42 (2), 303\u2013310 (2019).","journal-title":"Diabetes Care"},{"key":"60626_CR19","doi-asserted-by":"publisher","first-page":"806256","DOI":"10.3389\/fendo.2022.806256","volume":"13","author":"ZM Liu","year":"2022","unstructured":"Liu, Z. M. et al. Increased Central and Peripheral Thyroid Resistance Indices During the First Half of Gestation Were Associated With Lowered Risk of Gestational Diabetes-Analyses Based on Huizhou Birth Cohort in South China. Front. Endocrinol. (Lausanne). 13, 806256 (2022).","journal-title":"Front. Endocrinol. (Lausanne)"},{"issue":"1","key":"60626_CR20","doi-asserted-by":"publisher","first-page":"8","DOI":"10.5603\/EP.a2020.0066","volume":"72","author":"L \u0160t\u011bp\u00e1nek","year":"2021","unstructured":"\u0160t\u011bp\u00e1nek, L. et al. Free triiodothyronine\/free thyroxine (FT3\/FT4) ratio is strongly associated with insulin resistance in euthyroid and hypothyroid adults: a cross-sectional study. Endokrynol Pol. 72 (1), 8\u201313 (2021).","journal-title":"Endokrynol Pol."},{"key":"60626_CR21","unstructured":"National Health and Nutrition Examination Survey (NHANES). Laboratory procedures manual. https:\/\/wwwn.cdc.gov\/nchs\/nhanes\/continuousnhanes\/manuals.aspx?BeginYear\u2009=\u20092011 (2011)."},{"issue":"5","key":"60626_CR22","first-page":"1608","volume":"82","author":"H Yagi","year":"1997","unstructured":"Yagi, H., Pohlenz, J., Hayashi, Y., Sakurai, A. & Refetoff, S. Resistance to thyroid hormone caused by two mutant thyroid hormone receptors beta, R243Q and R243W, with marked impairment of function that cannot be explained by altered in vitro 3,5,3\u2019-triiodothyroinine binding affinity. J. Clin. Endocrinol. Metab. 82 (5), 1608\u20131614 (1997).","journal-title":"J. Clin. Endocrinol. Metab."},{"issue":"12","key":"60626_CR23","doi-asserted-by":"publisher","first-page":"4575","DOI":"10.1210\/jc.2007-1499","volume":"92","author":"MI Surks","year":"2007","unstructured":"Surks, M. I. & Hollowell, J. G. Age-specific distribution of serum thyrotropin and antithyroid antibodies in the US population: implications for the prevalence of subclinical hypothyroidism. J. Clin. Endocrinol. Metab. 92 (12), 4575\u20134582 (2007).","journal-title":"J. Clin. Endocrinol. Metab."},{"issue":"3","key":"60626_CR24","doi-asserted-by":"publisher","first-page":"1088","DOI":"10.1210\/jc.2014-3586","volume":"100","author":"AR Cappola","year":"2015","unstructured":"Cappola, A. R. et al. Thyroid function in the euthyroid range and adverse outcomes in older adults. J. Clin. Endocrinol. Metab. 100 (3), 1088\u20131096 (2015).","journal-title":"J. Clin. Endocrinol. Metab."},{"issue":"3","key":"60626_CR25","doi-asserted-by":"publisher","first-page":"e1293","DOI":"10.1210\/clinem\/dgab744","volume":"107","author":"L Fani","year":"2022","unstructured":"Fani, L. et al. Thyroid Status and Brain Circulation: The Rotterdam Study. J. Clin. Endocrinol. Metab. 107 (3), e1293\u2013e1302 (2022).","journal-title":"J. Clin. Endocrinol. Metab."},{"issue":"5","key":"60626_CR26","doi-asserted-by":"publisher","first-page":"e0155499","DOI":"10.1371\/journal.pone.0155499","volume":"11","author":"J Six-Merker","year":"2016","unstructured":"Six-Merker, J. et al. Treatment of Thyroid Dysfunctions Decreases the Risk of Cerebrovascular Events in Men but Not in Women: Results of the MONICA\/KORA Cohort Study. PLoS One. 11 (5), e0155499 (2016).","journal-title":"PLoS One"},{"issue":"1","key":"60626_CR27","doi-asserted-by":"publisher","first-page":"e250346","DOI":"10.1530\/JOE-25-0346","volume":"268","author":"CC Faria","year":"2026","unstructured":"Faria, C. C., Correa da Costa, V. M., Ferreira, A. C. F., Fortunato, R. S. & Carvalho, D. P. Sex differences in thyroid function: from central regulation to hormone metabolism and disease susceptibility. J. Endocrinol. 268 (1), e250346 (2026).","journal-title":"J. Endocrinol."},{"key":"60626_CR28","doi-asserted-by":"publisher","first-page":"746924","DOI":"10.3389\/fendo.2021.746924","volume":"12","author":"MA de Parra-Montes","year":"2021","unstructured":"de Parra-Montes, M. A., Sotelo-Rivera, I., Guti\u00e9rrez-Mata, A., Charli, J. L. & Joseph-Bravo, P. Sex Dimorphic Responses of the Hypothalamus-Pituitary-Thyroid Axis to Energy Demands and Stress. Front. Endocrinol. (Lausanne). 12, 746924 (2021).","journal-title":"Front. Endocrinol. (Lausanne)"}],"container-title":["Scientific Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.nature.com\/articles\/s41598-026-60626-3","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41598-026-60626-3.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41598-026-60626-3.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,20]],"date-time":"2026-10-20T00:27:23Z","timestamp":1792456043000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.nature.com\/articles\/s41598-026-60626-3"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,18]]},"references-count":28,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,12]]}},"alternative-id":["60626"],"URL":"https:\/\/doi.org\/10.1038\/s41598-026-60626-3","relation":{},"ISSN":["2045-2322"],"issn-type":[{"value":"2045-2322","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,18]]},"assertion":[{"value":"18 November 2024","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"29 June 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"18 July 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"The authors declare no competing interests.","order":1,"name":"Ethics","label":"Competing interests","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"All human studies were performed in compliance with institutional and national ethical guidelines, including the Declaration of Helsinki (1964) and its later revisions. Ethical approval for NHANES-based analyses was granted by the corresponding ethics committees, with written informed consent obtained from all participants as documented on the NHANES website. Clinical validation was approved by the Ethics Committee of the Second Hospital of Hebei Medical University (No. 2023-R340).","order":2,"name":"Ethics","label":"Ethics approval","group":{"name":"EthicsHeading","label":"Declarations"}}],"article-number":"32995"}}