Iodine is a vital micronutrient and its importance in thyroid function is well established. However, abnormalities in iodine intake may also have other effects. In particular, iodine is taken up avidly by the ovary and endometrium. Iodine deficiency is associated with reduced fertility. The use of high iodine concentration contrast media has recently been shown to improve conception rates in couples with unexplained infertility (UI). We hypothesize that this improvement could be related to the iodine excess and mechanisms independent of its action on thyroid. In this article, the metabolism of iodine and its potential role in fertility will be discussed, including the impact of both iodine deficiency and excess states and the importance of iodine in normal fetal development. This will include insights from animal studies on the effect of iodine in the uterine and ovarian structural environment, hormonal milieu and immunological factors affecting implantation. We speculate that iodine may well have a role as a potential therapy for UI.

Context Hysterosalpingography with oil-soluble contrast medium (OSCM) improves pregnancy rates. However, OSCM has high iodine content and long half-life, leading to potential iodine excess. Objective To determine the pattern of iodine excess after OSCM hysterosalpingography and the impact on thyroid function. Design A prospective cohort study. Participants 196 consecutive consenting eligible women without overt hypothyroidism or hyperthyroidism were recruited. All completed the study with compliance >95%. Interventions Participants underwent OSCM hysterosalpingography (Auckland, 2019-2021) with serial monitoring of thyroid stimulating hormone (TSH), free thyroxine (FT4) and urine iodine concentration (UIC) for 24 weeks. Main Outcome measure Development of subclinical hypothyroidism (SCH), defined as a non-pregnant TSH >4 mIU/L with normal FT4 (11–22 pmol/L), in those with normal baseline thyroid function. Results Iodine excess (UIC ≥300 μg/L) was almost universal (98%) with UIC peaking usually by four weeks. There was marked iodine excess, with 90% and 17% of participants having UIC ≥1000 μg/L and >10,000 μg/L, respectively. Iodine excess was prolonged with 67% having a UIC ≥1000 μg/L for at least three months. SCH developed in 38%; the majority (96%) were mild (TSH 4–10 mIU/L) and most developed SCH by week 4 (75%). Three participants met the current treatment guidelines (TSH >10 mIU/L). Thyroxine treatment of mild SCH tended to improve pregnancy success [p = 0.063]. Hyperthyroidism (TSH <0.3 mIU/L) occurred in 9 participants (5%). Conclusions OSCM hysterosalpingography resulted in marked and prolonged iodine excess. SCH occurred frequently with late-onset hyperthyroidism occasionally. Regular thyroid function tests are required for 6 months following this procedure.

Multiple lytic bone lesions in a child can be a manifestation of various diseases like Langerhans cell histiocytosis, metastatic neuroblastoma, leukemia, hyperparathyroidism, multifocal osteomyelitis and histoplasmosis. Disseminated histoplasmosis caused by Histoplasma capsulatum var. duboisii is well known to present with multiple osteolytic lesions in immunocompromised adults and is mostly restricted to the African subcontinent. Histoplasmosis seen in American and Asian countries is caused by Histoplasma capsulatum var. capsulatum, which presents with pulmonary and systemic manifestations and rarely bone involvement. We report a case of histoplasmosis, caused by H. capsulatum var. capsulatum with extensive lytic bone lesions in a 13 year old immunocompetent boy who presented with prolonged fever, weight loss and multiple boggy swellings. He responded to amphotericin and is currently on Itraconazole. This case is unique for extensive osteolytic lesions with H. capsulatum var. capsulatum infection in an immunocompetent child.

Objective. Hysterosalpingography (HSG) with oil-soluble contrast medium (OSCM) improves pregnancy rates in women with idiopathic infertility. However, OSCM has high iodine content and slow clearance resulting in potential iodine excess. If pregnancy occurs, this could impact fetal thyroid gland development and function. We aim to determine the effect of a preconceptional OSCM HSG on the thyroid function of the neonate. Design and Patients. This was a retrospective analysis of newborn TSH data for a cohort of neonates conceived within six months of an OSCM HSG in the Auckland region, New Zealand, from the years 2000 to 2019. Thyroid-stimulating hormone (TSH) levels of these newborns were obtained from newborn screening, which is routinely performed for all children at 48–72 hours of life. The primary outcome was the incidence of permanent or transient congenital hypothyroidism in this cohort. Results. Of 146 babies included, all had normal TSH levels with values ranging from 1 to 7 mIU/L on the whole blood analysis of a capillary heel sample using the Perkin–Elmer AutoDelfia assay. Conception during the first 3 cycles following an OSCM HSG was 76%; however, TSH levels in this group were not higher than those conceived in later cycles. Conclusion. Preconceptional OSCM HSG did not increase the risk of congenital hypothyroidism in the New Zealand scenario.