Radio-contrast agent-induced hyperthyroidism: case report and review of the literature

Abstract

SUMMARYA 66 year-old woman with a history of a euthyroid multinodular goiter underwent a head and neck computed tomography (CT) scan (total iodine load of 35 g) in order to evaluate the extent of retrosternal expansion. Less than 24 h after the iodine-based contrast media (ICM) administration, she presented with symptoms and laboratory findings typical of thyrotoxicosis. She was treated successfully with antithyroid medications. This is the shortest time reported in the literature and it is of clinical importance, as it may have an impact to the recommendations given by the attending physician. Given the fact that a large number of ICM examinations are performed in everyday practice, physicians should be aware of this possible thyroid-specific effect. Prophylactic drugs could be considered in high-risk populations, such as administration of perchlorate and a thionamide class drug to elderly patients with suppressed TSH and/or palpable goiter, started the day before and continued for two weeks after ICM administration. Arch Endocrinol Metab. 2016;60(3):287-9

Heart failure as a serious complication of iodinated contrast-induced hyperthyroidism: case-report

“…Interestingly 4.2 % of patients still shows hyperthyroidism after three months, indicating ICM induced hyperthyroidism persists for a longer period. Although hyperthyroidism after ICM is quite common, literature regarding severity of disease and the prevalence of serious adverse events is sparse and limited to case studies [ 1 – 4 ]. Screening strategies and the use of prophylactic measures have been investigated.…”

“…This is especially seen in the elderly, where multinodular goitre and accompanying thyroid autonomy are more frequently present. Although rare, ICM induced hyperthyroidism can have severe consequences [ 1 – 4 ]. ICM are widely used in diagnostic and therapeutic procedures such as cardiac catheterization and computed tomography (CT) [ 5 ].…”

Iodide-induced Hyperthyroidism Within Four Hours of Iodide Load: A Case Report and Review

“…Intravenous iodide-based contrast has on average 14 to 35 million mcg of organic iodide per 100 mL depending on the concentration, which is several times higher than the recommended daily intake [3]. Exposure to large amounts of iodide is managed by the inhibition of iodide organification, which in turn diminishes the synthesis of thyroxine (T4) and triiodothyronine (T3) and increases thyroid-stimulating hormone (TSH) levels, a process known as the Wolff-Chaikoff effect [4]. On the other hand, individuals with certain thyroid pathologies when exposed to large amounts of iodide develop iodide-induced hyperthyroidism (IIH) or the Jod-Basedow phenomenon.…”