Prevention of Iodinated Contrast Media-Induced Hyperthyroidism in Patients with Euthyroid Goiter

Pelewicz, Katarzyna; Wolny, Rafał; Bednarczuk, Tomasz; Miśkiewicz, Piotr

doi:10.1159/000515126

Cited by 9 publications

(9 citation statements)

References 29 publications

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“…A German randomized clinical trial conducted on a series of 51 subjects in 1996 found that medical prophylaxis with sodium perchlorate or methimazole had a protective effect in patients with thyroid autonomy ( 26 ). A prospective study published in 2004 found that thyroid scintigraphy using Tc-99m-pertechnetate can predict the onset of ICMIH in patients with low basal TSH levels: patients with a low thyroid volume and a low uptake on scintigraphy are at low risk of ICMIH, and probably do not require prophylactic therapy ( 27 , 28 ).…”

Section: Discussionmentioning

confidence: 99%

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Safety and efficacy of prophylactic treatment for hyperthyroidism induced by iodinated contrast media in a high-risk population

et al. 2023

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IntroductionThe use of iodinated contrast media (ICM) can lead to thyrotoxicosis, especially in patients with risk factors, such as Graves’ disease, multinodular goiter, older age, and iodine deficiency. Although hyperthyroidism may have clinically relevant effects, whether high-risk patients should receive prophylactic treatment before they are administered ICM is still debated.Aim of the studyWe aimed to demonstrate the safety and efficacy of prophylactic treatment with sodium perchlorate and/or methimazole to prevent ICM-induced hyperthyroidism (ICMIH) in a population of high-risk cardiac patients. We ran a cost analysis to ascertain the most cost-effective prophylactic treatment protocol. We also aimed to identify possible risk factors for the onset of ICMIH.Materials and methodsWe performed a longitudinal retrospective study on 61 patients admitted to a tertiary-level cardiology unit for diagnostic and/or therapeutic ICM-procedures. We included patients with available records of thyroid function tests performed before and after ICM were administered, who were at high risk of developing ICMIH. Patients were given one of two different prophylactic treatments (methimazole alone or both methimazole and sodium perchlorate) or no prophylactic treatment. The difference between their thyroid function at the baseline and 11-30 days after the ICM-related procedure was considered the principal endpoint.ResultsTwenty-three (38%) of the 61 patients were given a prophylactic treatment. Thyroid function deteriorated after the administration of ICM in 9/61 patients (15%). These cases were associated with higher plasma creatinine levels at admission, higher baseline TSH levels, lower baseline FT4 levels, and no use of prophylactic treatment. The type of prophylaxis provided did not influence any onset of ICMIH. A cost-benefit analysis showed that prophylactic treatment with methimazole alone was less costly per person than the combination protocol. On multivariate analysis, only the use of a prophylactic treatment was independently associated with a reduction in the risk of ICMIH. Patients not given any prophylactic treatment had a nearly five-fold higher relative risk of developing ICMIH.ConclusionProphylactic treatment can prevent the onset of ICMIH in high-risk populations administered ICM. Prophylaxis is safe and effective in this setting, especially in cardiopathic patients. Prophylaxis with methimazole alone seems to be the most cost-effective option.

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Section: Discussionmentioning

confidence: 99%

“…Different protocols have been proposed, involving various combinations of thyrostatic drugs and sodium perchlorate. Though some studies suggest that combined treatments are more effective, there is still no strong evidence to support the safety and efficacy of the different protocols ( 4 , 8 , 24 – 28 ).…”

Section: Introductionmentioning

confidence: 99%

Safety and efficacy of prophylactic treatment for hyperthyroidism induced by iodinated contrast media in a high-risk population

et al. 2023

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“…Due to the non-physiological iodine concentration in the contrast medium, ICM can induce both hyper-and hypothyroidism. In most cases, the ICM-induced thyroid dysfunction is mild, oligo-, or asymptomatic [1,[6][7][8][9]. Moreover, it is often self-limiting, lasts for 1-18 months, and subsides without treatment.…”

Section: Risk Factors For Icm-induced Hypothyroidismmentioning

confidence: 99%

“…At present, the prevalence and/or clinical significance of ICM-induced thyroid dysfunction worldwide remains largely unknown. It ranges between 0.05% and 15%, depending on iodine intake and concomitant thyroid dysfunction [1,7,8,11]. However, in a recently published meta-analysis [12] and in the largest population-based retrospective cohort study, it was described as low [13].…”

Section: Determinementioning

confidence: 99%

Basics of prevention and management of iodine-based contrast media-induced thyroid dysfunction — position paper by the Polish Society of Endocrinology

et al. 2023

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Medical practice involves a high number of radiological examinations using iodinated contrast media (ICM). Therefore, it is crucial for doctors of different specialties to be aware of possible adverse effects associated with ICM use. The most common and well characterized adverse effect is contrast-induced nephropathy, whereas thyroidal adverse reactions remain a diagnostic and therapeutic dilemma. ICM-induced thyroid dysfunction represents a highly heterogenous group of thyroid disorders. Due to supraphysiological iodine concentration, ICM can induce both hyper-and hypothyroidism. In most cases, the ICM-induced thyroid dysfunction is oligo-or asymptomatic, mild, and transient. In rare cases, however, the ICM-induced thyroid dysfunction may be severe and life threatening. Recently, the European Thyroid Association (ETA) Guidelines for the Management of Iodine-Based Contrast Media-Induced Thyroid Dysfunction were published. The authors advise an individualized approach to prevention and treatment of ICM-induced thyroid dysfunction, based on patient's age, clinical symptoms, pre-existing thyroid diseases, coexisting morbidities, and iodine intake. There is a geographic variation of ICM-induced thyroid dysfunction prevalence, which is linked to iodine intake. The prevalence of ICM-induced hyperthyroidism, which may pose a serious therapeutic challenge, is greater in countries with iodine deficiency. Poland is a region with a history of iodine deficiency, contributing to an increased prevalence of nodular thyroid disease, especially in the elderly. Therefore, the Polish Society of Endocrinology has proposed national, simplified principles of ICM-induced thyroid dysfunction prevention and treatment. (Endokrynol Pol 2023; 74 (1): 1-4)

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Section: Introductionmentioning

confidence: 99%

Safety and efficacy of prophylactic treatment for hyperthyroidism induced by iodinated contrast media in a high-risk population

Manso,

Piva,

Censi

et al. 2023

EJEA

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Introduction: The use of iodinated contrast media (ICM) can lead to thyrotoxicosis, especially in patients with risk factors, such as Graves' disease, multinodular goiter, older age, and iodine deficiency. Although hyperthyroidism may have clinically relevant effects, whether high-risk patients should receive prophylactic treatment before they are administered ICM is still debated.Aim of the study: We aimed to demonstrate the safety and efficacy of prophylactic treatment with sodium perchlorate and/or methimazole to prevent ICM-induced hyperthyroidism (ICMIH) in a population of high-risk cardiac patients. We ran a cost analysis to ascertain the most cost-effective prophylactic treatment protocol. We also aimed to identify possible risk factors for the onset of ICMIH. Materials and methods:We performed a longitudinal retrospective study on 61 patients admitted to a tertiary-level cardiology unit for diagnostic and/or therapeutic ICM-procedures. We included patients with available records of thyroid function tests performed before and after ICM were administered, who were at high risk of developing ICMIH. Patients were given one of two different prophylactic treatments (methimazole alone or both methimazole and sodium perchlorate) or no prophylactic treatment. The difference between their thyroid function at the baseline and 11-30 days after the ICM-related procedure was considered the principal endpoint.Results: Twenty-three (38%) of the 61 patients were given a prophylactic treatment. Thyroid function deteriorated after the administration of ICM in 9/ 61 patients (15%). These cases were associated with higher plasma creatinine levels at admission, higher baseline TSH levels, lower baseline FT4 levels, and no use of prophylactic treatment. The type of prophylaxis provided did not influence any onset of ICMIH. A cost-benefit analysis showed that prophylactic treatment Frontiers in Endocrinology frontiersin.org 01

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Prevention of Iodinated Contrast Media-Induced Hyperthyroidism in Patients with Euthyroid Goiter

Cited by 9 publications

References 29 publications

Safety and efficacy of prophylactic treatment for hyperthyroidism induced by iodinated contrast media in a high-risk population

Safety and efficacy of prophylactic treatment for hyperthyroidism induced by iodinated contrast media in a high-risk population

Basics of prevention and management of iodine-based contrast media-induced thyroid dysfunction — position paper by the Polish Society of Endocrinology

Safety and efficacy of prophylactic treatment for hyperthyroidism induced by iodinated contrast media in a high-risk population

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