Cretinism Associated With Maternal Sodium Iodide I 131 Therapy During Pregnancy

Green, H. G.; Gareis, Frank J.; Shepard, T. H.; Kelley, Vincent C.

doi:10.1001/archpedi.1971.02110030105016

Cited by 12 publications

(9 citation statements)

References 7 publications

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“…Some researchers have placed the onset of fetal thyroid function as early as 8 weeks' gestation [1], and others as late as 14 weeks' [3]. Some researchers have shown that concentration of radioactive iodine in the fetal thyroid gland is at least 10 times greater than that in the maternal thyroid [4], but others claim that the fetal thyroid gland can concentrate as much as 50 times more than can the mother's [5]. The fetal thyroid has a much greater relative affinity for radioactive material than does the maternal thy-roid.…”

Section: Discussionmentioning

confidence: 99%

Iodine-131 and the Pregnant Patient

Berlin

2001

American Journal of Roentgenology

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A 29-year-old woman was referred to the radiology department of a hospital for a whole-body radionuclide scan using iodine-131. The patient had undergone a total thyroidectomy for papillary carcinoma 4 years earlier and was being examined for metastases. Images obtained 48 hr after oral administration of 2 µ Ci (74 MBq) of iodine-131 disclosed no evidence of functioning thyroid tissue or metastatic disease.Three weeks later, the patient discovered that she was pregnant. The patient's obstetrician consulted with the radiologist, who suggested that the patient consider terminating the pregnancy because of potential damage to the fetal thyroid gland. The patient rejected this course of action, however, and elected to continue the pregnancy. At term, the patient delivered a baby afflicted with severe hypothyroidism. Six months later, the mother filed a medical malpractice lawsuit on behalf of her infant child and herself against the radiologist and the hospital, alleging that the defendants' failure to ascertain whether the patient had been pregnant at the time of iodine-131 administration constituted negligence. Medical-Legal IssuesDefense attorneys representing the hospital and the radiologist immediately reviewed the pertinent medical records. They found that the patient indeed had been unknowingly 15 weeks pregnant at the time of iodine-131 administration. The attorneys discovered that the routine practice in the department was for nuclear medicine technologists to ask each patient undergoing a radionuclide procedure specific questions, including one about the possibility of pregnancy, and to record the response on a form. On the questionnaire filled out for this patient, a nuclear medicine technologist had checked off "no" next to the question, "Is patient pregnant?" When questioned, the technologist told the attorneys that he specifically remembered asking the patient whether she was pregnant and that the patient had appeared reliable and had answered, "No." The form was later reviewed and countersigned by the radiologist.The defense attorneys then reviewed the radiology department policy that covered procedures for examinations using radionuclides. The policy stated, in part, that "[d]etermination should be made prior to administration of iodine-131 that female patients in the childbearing age are not pregnant." Furthermore, the policy also stated that signs containing the language, "If you are pregnant or think you are pregnant, please notify technologist or radiologist" should be posted in plain view throughout the nuclear medicine department.Before formal legal discovery proceedings began, the attorney for the plaintiff produced an affidavit signed by the patient stating that she had no recollection of ever having been asked by the technologist at the time of the iodine-131 administration whether she was pregnant. The patient also claimed that she may have been "vaguely aware" of signs posted in the department that advised patients to notify a technologist if they were pregnant but that she "did not pay att...

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Section: Discussionmentioning

confidence: 99%

Iodine-131 and the Pregnant Patient

Berlin

2001

American Journal of Roentgenology

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“…53 Modified with permission from the New Zealand National Radiation Laboratory natural background radiation during an entire pregnancy is approximately 0.5-1.6 mGy. 33,34 The radiation exposure from one chest X-ray is, therefore, approximately equivalent to the amount of radiation exposure one experiences from the natural surroundings in 10 days.…”

Section: Naturally Occurring 'Background' Radiationmentioning

confidence: 99%

“…The risk of fetal growth restriction and malignancy due to high dose exposure of irradiation starts from 4 weeks of gestation and lasts throughout pregnancy. The most sensitive stage of pregnancy, for subsequent fetal growth restriction, is at 3-10 weeks and the Average environmental background radiation (cumulative dose over 9 months): 0.5-1.6 33,34 The accepted background cumulative dose of ionising radiation during pregnancy is 5 rad (50 mGy), which is much more than the exposure dose of most of the radiological diagnostic examinations. Table 5 Estimated fetal exposure for nuclear medicine studies estimated threshold dose is 200-250 mGy.…”

Section: Nuclear Medicine Investigationsmentioning

confidence: 99%

Safety of diagnostic imaging in pregnancy. Part 1: X‐ray, nuclear medicine investigations, computed tomography and contrast media

Eskandar

Eckford

Watkinson

2010

The Obstetric & Gynaecologis

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Key content:• The safety of diagnostic imaging in pregnancy is a real concern.• In general, X-rays and computed tomography scans are unlikely to cause deterministic effects in an individual pregnancy. • Apart from the adverse effect of iodine on the fetal thyroid gland, common nuclear medicine investigation procedures are unlikely to involve teratogenic fetal doses. • Iodinated agents should be avoided in pregnancy.• It is recommended that paramagnetic contrast agents used with magnetic resonance imaging are only considered in pregnancy if absolutely necessary. Learning objectives:• To understand the principles, diagnostic value and safety of various diagnostic modalities using ionised radiation, at different stages of pregnancy. • To choose the most appropriate imaging tool for various medical conditions in pregnancy.• To be able to counsel pregnant women and provide them with accurate information about the safety of various diagnostic imaging modalities. Ethical issues:• Physicians should carefully weigh the risks and benefits of any radiographic procedure and include the mother in the decision-making process whenever possible. Keywords angiography / fetal growth restriction / intravenous pyelography / ionising radiation / miscarriage / ventilation-perfusion lung scanningPlease cite this article as: Eskandar OS, Eckford SD, Watkinson T. Safety of diagnostic imaging in pregnancy. Part 1: X-ray, nuclear medicine investigations, computed tomography and contrast media.

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“…The use of I131 is absolutely contraindicated during pregnancy principally because of the risk of damaging the fetal thyroid gland and thus leading to hypothyroidism or cretinism (1,2,3,4,5,6). Neonatal hyperthyrotropinemia is observed if the applieddose is below 10 mCi (7).…”

Section: Introductionmentioning

confidence: 99%

Congenital Hypothyroidism Due To Maternal Radioactive Iodine Exposure During Pregnancy

Kurtoğlu¹,

Akın²,

Daar³

et al. 2012

JCRPE

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Radioactive iodine (RAI) is used effectively in the treatment of hyperthyroidism and thyroid cancer, but it is contraindicated during pregnancy. RAI treatment during pregnancy can lead to fetal hypothyroidism, mental retardation and increased malignancy risk in the infant. Pregnancy tests must be performed before treatment in all women of reproductive age. However, at times, RAI is being used before ruling out pregnancy.We herein present a male newborn infant with congenital hypothyroidism whose mother was given a three-week course of methimazole therapy for her multiple hyperactive nodules and subsequently received 20 mCi RAI during the 12th week of her pregnancy. The patient was referred to our neonatology unit at age two weeks when his thyrotropin (TSH) level was reported to be high in the neonatal screening test. Physical examination was normal. Laboratory investigations revealed hypothyroidism (free triiodothyronine 1.55 pg/mL, free thyroxine 2.9 pg/mL, TSH 452 mU/L, thyroglobulin 20.1 ng/mL). The thyroid gland could not be visualized by ultrasonography. L-thyroxine treatment was initiated. Conflict of interest:None declared.

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Cretinism Associated With Maternal Sodium Iodide I 131 Therapy During Pregnancy

Cited by 12 publications

References 7 publications

Iodine-131 and the Pregnant Patient

Iodine-131 and the Pregnant Patient

Safety of diagnostic imaging in pregnancy. Part 1: X‐ray, nuclear medicine investigations, computed tomography and contrast media

Congenital Hypothyroidism Due To Maternal Radioactive Iodine Exposure During Pregnancy

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