Impact of Iodinated Contrast Media in Patients Received Percutaneous Coronary Intervention: Focus on Thyroid Disease

Abstract

BackgroundWith the rapid advance in percutaneous coronary intervention (PCI) technology, patients absorb large volume of iodinated contrast media (ICM). Recent studies suggested that ICM may lead to hyperthyroidism, but the association between ICM volume and thyroid is still unclear. We sought to evaluate the long-term influence of ICM on thyroid dysfunction and disease in patients received PCI.MethodsThis single-center retrospective study included consecutive coronary artery disease (CAD) patients. A covariance (ANCOVA) model was performed to evaluate the change of serum TSH, FT3 and FT4 before and one-year after the PCI procedure. Restricted cubic splines and logistic regression were performed to evaluate the association between ICM volume and thyroid disease.Results2062 patients met inclusion criteria (1381 patients in the low-volume group and 681 patients in the high-volume group). The high-volume group was 0.238 ± 0.092 pmol/L higher than the low-volume group (P = 0.010) in the serum FT4. Restricted cubic splines show that there were linear dose-response relationships for ICM volume and composite endpoint and hyperthyroidism. In all models, there were significant differences in composite endpoint between the two groups. (OR 1.75, 95% CI (1.05, 2.92), P = 0.032, OR 1.73, 95% CI (1.01-2.96), P= 0.032 and OR 1.83, 95% CI (1.09-3.06), P= 0.022, respectively). The positive results were also showed for hyperthyroidism in all models (OR 2.35, 95% CI (1.14-4.84), P = 0.021, OR 10.36, 95% CI (1.20-89.00), P = 0.033 and OR 2.35, 95% CI (1.13-4.87), P = 0.022, respectively).ConclusionThe present analysis gives an overview that ICM volume is associated with an increased risk of thyroid dysfunction and thyroid disease.

The Impact of Iodinated Contrast Media Used in Epidural Steroid Injections on Thyroid Function Tests

“…Similar to the ndings of Chen Y et al, we discovered a slight difference in T3 and TSH levels but a signi cant change in T4 levels compared to pre-treatment. However, when compared, the amount of contrast material used differs [10]. We postulated that this may be due to non-dose-dependent personal and other variables, including living in an iodine-de ciency region and having an underlying autoimmune disease or thyroid issues (euthyroid goiter, euthyroid sick syndrome, etc.…”

“…The impact of ICM on nephrotoxicity has been widely explored; however, several studies have addressed ICM's effects on the normal thyroid gland in clinical practice, and most of those studies were related to the use of CT scans [9,10]. To the best of our knowledge, there have been no reports examining the association between ICM exposure via ESI procedures applied with uoroscopy guidance and subsequent thyroid functionality.…”

Iodine-Induced Hypothyroidism After Chemoembolization With Ethiodized Oil: A Case of Failure to Escape From Wolff-Chaikoff Effect (WCE)

“…In radiologic studies, ICM use is a common source of excessive iodine, considering the recommended daily allowance and higher doses may be required in invasive interventional procedures [5]. Some studies describe TD after the use of an ICM [9][10][11][12] but the prevalence and clinical significance of it is not yet well characterized [13]. Usually, patients return to a euthyroid state some weeks after ICM exposure, attending to the usual ICM half-life and rapid elimination from the body [5,13].…”