Thyroid function and ioduria in infants after cardiac surgery: Comparison of patients with primary and delayed sternal closure

Kováčiková, Ľubica; Kunovsky, P; Lakomy, Miroslav; Skrak, Peter; Hraška, Viktor; Kostalova, Ludmila; Tomecková, E

doi:10.1097/01.pcc.0000154960.59452.06

Cited by 13 publications

(9 citation statements)

References 21 publications

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“…Likewise, we did not find an association between DSC and hypothyroidism on multivariate analysis. Although a previous study reported such an association [ 17 ], that study did not control for underlying morbidity or renal function.…”

Section: Discussionmentioning

confidence: 99%

“…Neonates with congenital heart disease (CHD) represent an especially vulnerable group, because they have a higher frequency of congenital morphological defects of the thyroid gland [ 9 , 10 ], are routinely exposed to excess iodine, and are at risk of neurodevelopmental disabilities [ 11 , 12 ]. Sources of excess iodine exposure in infants with CHD include iodinated contrast media (ICM) administered during radiological procedures and topical iodine-containing antiseptics and iodine-impregnated dressings applied to chest wounds in the setting of delayed sternal closure (DSC) after cardiac surgery [ 13 – 17 ]. An injection of 3 to 5 mL/kg of Optiray 350 during cardiac catheterization, for example, contains 350 mg/mL of organically bound iodine and provides an iodine load far greater than the tolerable upper limit of 200 µg/day for infants 1 to 3 years of age [ 18 ].…”

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confidence: 99%

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Hypothyroidism in Infants With Congenital Heart Disease Exposed to Excess Iodine

Thaker

Galler

Marshall

et al. 2017

Journal of the Endocrine Society

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Thyroid hormone is critical for neonatal brain development, and even transient hypothyroidism can cause adverse neurocognitive outcomes. Infants exposed to excess iodine are at risk of developing hypothyroidism, especially those with congenital heart disease (CHD), because they are routinely exposed to excess iodine from intravenous iodinated contrast media and topical antiseptics. The aim of the present study was to identify the proportion of neonates with CHD exposed to iodine who developed hypothyroidism and to identify the associated risk factors. This was a retrospective study of neonates undergoing cardiac catheterization at Boston Children’s Hospital during a 3-year period, some of whom also underwent cardiac surgery. Hypothyroidism was defined as an elevated thyroid-stimulating hormone level (>20 mIU/L at 24 to 96 hours of age and >15 mIU/L at >96 hours of age by heel-stick sampling and >9.1 mIU/L at 1 to 20 weeks of age by serum testing). Multivariate logistic regression was performed to predict the odds of developing hypothyroidism. Hypothyroidism was diagnosed incidentally in 46 of 183 infants (25%) with CHD after iodine exposure. Controlling for baseline cardiac risk, postnatal age, and gestational age, we found a fourfold increase in odds of developing hypothyroidism in neonates with serum creatinine >0.9 mg/dL and a fourfold increase in those who underwent more than three procedures. Hypothyroidism in neonates with CHD exposed to excess iodine is associated with multiple procedures and impaired renal function. Routine serial monitoring of thyroid function in these neonates is warranted. Future studies should examine the association between hypothyroidism and neurocognitive function in this population.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Hypothyroidism in Infants With Congenital Heart Disease Exposed to Excess Iodine

Thaker

Galler

Marshall

et al. 2017

Journal of the Endocrine Society

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“…Of these, one developed severe primary hypothyroidism requiring treatment, the second resolved after transient treatment, and the third resolved spontaneously (23). Other studies have shown that the use of povidone-iodine irrigation in association with delayed sternal closure did not lead to any significant alteration in thyroid function (24–26). Further studies are needed to assess the need for monitoring thyroid function after cardiac angiography or prolonged exposure to iodine-containing antiseptics.…”

Section: Iodine-induced Hypothyroidismmentioning

confidence: 91%

Endocrinologic Diseases in Pediatric Cardiac Intensive Care

Soto-Rivera

Schwartz

Sawyer

et al. 2016

Pediatric Critical Care Medicine

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Objectives The objectives of this review are to discuss the pathophysiology, clinical impact and treatment of hyperglycemia and disturbances in thyroid and adrenal function prior to and following cardiac surgery in children. Data Source MEDLINE, PubMed Conclusions Disturbances in glucose metabolism and thyroid and adrenal function are common in critically ill children with cardiac disease and in particular in children undergoing cardiac surgery for complex congenital heart disease. An understanding of the pathophysiology, clinical impact and treatment of these disturbances is essential for the management of these at risk patients.

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“…The evidence for iodine absorption of most of these studies includes documented serum iodine concentration and thyroid function abnormalities. Kovacikova et al (2005) investigated thyroid function and ioduria in infants after cardiac surgery with primary sternal closure compared with delayed sternal closure (DSC) and the exposure to povidone iodine for sternal wound protection. The patients with DSC display more profound thyroid suppression in the immediate postoperative period.…”

Section: Discussionmentioning

confidence: 99%

Povidone iodine skin absorption: An ex-vivo study

et al. 2015

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Povidone iodine is a water-soluble complex used to disinfect the skin surface and it exerts prolonged germicidal action against a broad spectrum of germs. Indeed, it is often applied on burned skin, large wounds, deep tissues or mucosa. Notably some surgical hand-scrub solutions, which are considered safe antiseptics, contain large amounts of iodine that can be absorbed by skin. The aim of present study was to study the skin absorption of iodine after the application on the skin of povidone-iodine solution, used by health care workers during surgical procedure. We use Franz diffusion static cells with human skin. After 24h from the beginning of our measurement the iodine concentration in the receiving compartment was 11.59±6.3μg/cm(2). The medium flux calculated was 0.73±0.33μg/cm(2)/h with a lag time of 8.9±1.5h. These in vitro results confirmed that povidone iodine could pass through the skin in a relevant amount that can explain the clinical findings in burned or surgically treated patients. In professional use the repetitive contact with povidone iodine, also as soap, can cause iodine skin permeation that must be considered when the washing procedures are repeated more than 20 times a day

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Thyroid function and ioduria in infants after cardiac surgery: Comparison of patients with primary and delayed sternal closure

Cited by 13 publications

References 21 publications

Hypothyroidism in Infants With Congenital Heart Disease Exposed to Excess Iodine

Hypothyroidism in Infants With Congenital Heart Disease Exposed to Excess Iodine

Endocrinologic Diseases in Pediatric Cardiac Intensive Care

Povidone iodine skin absorption: An ex-vivo study

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