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Review
. 2015 Feb;100(2):376-83.
doi: 10.1210/jc.2014-3292. Epub 2014 Nov 6.

A review: Radiographic iodinated contrast media-induced thyroid dysfunction

Sun Y Lee  1 , Connie M Rhee, Angela M Leung, Lewis E Braverman, Gregory A Brent, Elizabeth N Pearce
Affiliations
Review

A review: Radiographic iodinated contrast media-induced thyroid dysfunction

Sun Y Lee et al. J Clin Endocrinol Metab. 2015 Feb.

Abstract

Context: Thyroid hormone production is dependent on adequate iodine intake. Excess iodine is generally well-tolerated, but thyroid dysfunction can occur in susceptible individuals after excess iodine exposure. Radiological iodinated contrast media represent an increasingly common source of excess iodine.

Objective: This review will discuss the thyroidal response after acute exposure to excess iodine; contrast iodine-induced thyroid dysfunction; risks of iodine-induced thyroid dysfunction in vulnerable populations, such as the fetus, neonate, and patients with impaired renal function; and recommendations for the assessment and treatment of contrast iodine-induced thyroid dysfunction.

Methods: Data for this review were identified by searching PubMed, Google Scholar, and references from relevant articles from 1948 to 2014.

Conclusions: With the increase in the use of computed tomography scans in the United States, there is increasing risk of contrast-induced thyroid dysfunction. Patients at risk of developing iodine-induced thyroid dysfunction should be closely monitored after receiving iodinated contrast media and should be treated as needed.

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Figures

Figure 1.
Figure 1.
The Wolff-Chaikoff Effect. Panel A shows a propsed mechanism of the acute Wolff-Chaikoff effect. During the the first day of iodine exposure, the sodium-iodide symporter transports the excess iodine into the thyroid, resulting in transient inhibition of thyroid peroxidase (TPO) and a decrease in thyroid hormone synthesis. Panel B shows the mechanism that turns off the acute Wolff-Chaikoff effect: a dramatic decrease in sodium-iodide symporter expression results in decreased iodine transport and the subsequent resumption of thyroid hormone synthesis. DIT denotes diiodotyrosine, I iodide, MIT monolodotyrosline, T3 triiodothyronine, and T4 thyroxine. Reprinted from P. Pramyothin et al: Clinical problem-solving. A hidden solution. N Engl J Med. 2011;365:2123–2127 (26), with permission. © Massachusetts Medical Society.
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References

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