"Iodinated contrast media (ICM) are commonly administered pharmaceutical agents," the authors write as background information. ICM are frequently used in scans and imaging procedures such as cardiac catheterization and computed tomography (CT scans). "Although certain complications of ICM (e.g., contrast-induced nephropathy) have been extensively studied, there has been little examination of the effect of ICM on thyroid function."
Connie M. Rhee, MD, Brigham and Women's Hospital (BWH) Renal Division and colleagues from Massachusetts General Hospital examined data from patients treated between January 1990 and June 2010 who did not have preexisting hyperthyroidism or hypothyroidism. Patients were matched with euthyroid (normal thyroid function) controls, and exposure to iodinated contrast media was assessed using claims data.
A total of 178 patients with incident hyperthyroidism and 213 patients with incident hypothyroidism were matched to 655 and 779 euthyroid persons, respectively. The authors found that iodinated contrast media exposure was associated with incident hyperthyroidism, but no statistically significant association was found with incident hypothyroidism.
Secondary analysis indicated an association between iodinated contrast media exposure and incident overt (clinical; diagnosed based on characteristic clinical features) hypothyrodism and incident overt (clinical) hyperthyroidism.
"In summary, these data support association between ICM exposure and incident hyperthyroidism, incident overt hyperthyroidism and incident overt hypothyroidism," the authors conclude. "Given the pervasive use of ICM in contemporary practice and the known sequelae of thyroid functional derangements, further studies are needed to confirm and evaluate generalizability of these findings, to establish causality and to explore mechanisms."
Invited Commentary: Iodine-Induced Thyroid Dysfunction
In an accompanying invited commentary, Elizabeth N. Pearce, MD, MSc, of Boston University School of Medicine writes that Rhee et al "describe significant associations between contrast exposure and the development of hyperthyroidism. While no overall association exists between contrast exposure and all forms of hypothyroidism, an association was noted when cases were restricted to those with overt hypothyroidism."
"These data represent an important contribution to our knowledge about a clinically relevant and understudied area," Pearce writes. "Rhee et al have demonstrated that a relatively large proportion of individuals who developed iodine-induced thyroid dysfunction were not known to have underlying risk factors. Therefore, patients who may be particularly unable to tolerate thyroid dysfunction, such as those with underlying unstable cardiovascular disease, are also good candidates for monitoring of thyroid function after iodine exposure."
This research was supported by the National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health; Veracyte, Inc.; and Asuragen, Inc.
This press release was provided by the Archives of Internal Medicine.
Brigham and Women's Hospital (BWH) is a 793-bed nonprofit teaching affiliate of Harvard Medical School and a founding member of Partners HealthCare, an integrated health care delivery network. BWH is the home of the Carl J. and Ruth Shapiro Cardiovascular Center, the most advanced center of its kind. BWH is committed to excellence in patient care with expertise in virtually every specialty of medicine and surgery. The BWH medical preeminence dates back to 1832, and today that rich history in clinical care is coupled with its national leadership in quality improvement and patient safety initiatives and its dedication to educating and training the next generation of health care professionals. Through investigation and discovery conducted at its Biomedical Research Institute (BRI), www.brighamandwomens.org/research, BWH is an international leader in basic, clinical and translational research on human diseases, involving more than 900 physician-investigators and renowned biomedical scientists and faculty supported by more than $537 M in funding. BWH is also home to major landmark epidemiologic population studies, including the Nurses' and Physicians' Health Studies and the Women's Health Initiative.
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