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Insulin-like growth factor-1 (IGF-1) is associated with the functional prognosis in cerebral infarction patients. However, no studies have been performed on patients who underwent intravenous thrombolytic therapy with recombinant tissue-type plasminogen activator (rt-PA). Fifty-five patients with hyperacute ischemic stroke within six hours of onset who were admitted to our hospital and underwent intravenous thrombolytic therapy and gave consent were included in this study. Serum IGF-1 levels were measured within 24 hours of stroke onset, and their association with the following data was assessed: age, sex, body mass index (BMI), medical history, blood D-dimer level, BNP level, blood glucose level, renal function, stroke subtype, infarct size, National Institutes of Health Stroke Scale (NIHSS) at stroke onset, and modified Rankin Scale (mRS) at three months. The good outcome group (mRS 0-1) had significantly higher serum IGF-1 levels than the poor outcome group (mRS ≥ 2, median 83 ng/mL vs. 62 ng/mL, p 0.032). Furthermore, the good outcome group was significantly younger than the poor outcome group (p < 0.001) which had higher BMI (p = 0.021), had lower D-dimer (p = 0.032) and BNP (p = 0.026) levels. There was no difference in NIHSS at onset, and the IGF-1 correlation was eliminated by age-adjustment. Serum IGF-1 levels may correlate with prognosis at three months after stroke in patients with hyperacute ischemic stroke treated with intravenous thrombolytic therapy, but the effect of age is also strong. Further studies that focus on specific age groups, include large number of patients, and evaluate mechanical thrombectomy at multiple institutions are needed.