Among patients receiving iodinated contrast media (ICM) for contrast-enhanced computed tomography or cardiac catheterization, ICM exposure was associated with an increased risk for incident hyperthyroidism, as well as incident overt hyperthyroidism and incident overt hypothyroidism, according to a report published by Connie Rhee, MD, from Brigham and Women's Hospital, Massachusetts General Hospital, Harvard Medical School in Boston, Massachusetts, and colleagues in the January 23 issue of the Archives of Internal Medicine.

The researchers performed a nested case–control study of adult patients who were euthyroid at baseline and who were exposed to ICM between January 1990 and June 2010. Patients were matched with unexposed euthyroid control patients according to demographic and laboratory parameters, follow-up thyrotropin measurement date, and the interval between the baseline and follow-up thyrotropin measurement dates.

Exposed patients and control patients were drawn from the Partners HealthCare Research Patient Data Registry, which contains sociodemographic, diagnostic, procedural claims, laboratory, medication, healthcare encounter, and vital status data on more than 4.5 million patients. The database provides the ability for longitudinal follow-up.

Inclusion criteria included normal thyrotropin levels at baseline, no history of laboratory abnormalities in thyroid function, no history of thyroid dysfunction, no use of thyroid medications, and no radioiodine thyroid ablation or surgical thyroidectomy. Follow-up thyrotropin measurements were performed from 2 weeks to 2 years after ICM exposure.

Matching 178 patients with incident hyperthyroidism with 655 control patients, and 213 patients with incident hypothyroidism with 779 control patients, the researchers found a statistically significant association between ICM exposure and incident hyperthyroidism (odds ratio [OR], 1.98; 95% confidence interval [CI], 1.08 - 3.60; P = .03), but not incident hypothyroidism (OR, 1.58; 95% CI, 0.95 - 2.62; P = .08). Hypothyroidism and hyperthyroidism were defined as thyrotropin levels above or below the reference range, respectively, and control patients had thyrotropin levels within the reference range. For incident hyperthyroidism, the number needed to harm was 23.

A prespecified secondary analysis revealed that ICM exposure was associated with both incident overt hyperthyroidism (OR, 2.50; 95% CI, 1.06 - 5.93; P = .04) and incident overt hypothyroidism (OR, 3.05; 95% CI, 1.07 - 8.72; P = .04). Incident overt hyperthyroidism was defined as a follow-up thyrotropin level less than or equal to 0.1 mIU/L, and incident overt hypothyroidism was defined as a follow-up level greater than 10 mIU/L.

Patients developing incident overt hyperthyroidism were more likely to be women (P = .03), and those developing incident overt hypothyroidism were less likely to have renal dysfunction (P = .003).

The authors note that "the observed association between ICM exposure and incident hyperthyroidism...is of considerable clinical importance given the effects of prolonged hyperthyroid status on cardiovascular disease and survival."

They add that the strengths of the study include rigorous inclusion and exclusion criteria, to restrict consideration to incident thyroid disease, as well as controlling for potential confounding through rigorous subject–control matching. Most of the limitations of the study (eg, lack of certain laboratory data or ICM volume or osmolarity) would apply equally to exposed patients and control patients, and would, according to the authors, preclude bias.

The investigators recommend that physicians and patients be aware of the potential thyroid-specific sequellae associated with the administration of ICM, as well as use appropriate discretion.

In an invited commentary, Elizabeth Pearce, MD, from the Section of Endocrinology, Diabetes, and Nutrition at Boston University School of Medicine in Massachusetts, said that the "data represent an important contribution to our knowledge about a clinically relevant and understudied area." She notes that the study was conducted in the Boston area, which has sufficient dietary iodine intake, so the results may not be generalizable to parts of the world with insufficient intake.

Dr. Pearce recommends particular care before administering ICM to patients who are at elevated risk for the development of thyroid dysfunction, including those with palpable goiter, nodular goiter, or serum antibodies to thyroperoxidase. In addition, patients who may not tolerate thyroid dysfunction, such as those with underlying unstable cardiovascular disease, should be monitored for thyroid function after iodine exposure.



Arch Intern Med. 2012;172:153-159, 159-161.

Приходится сожалеть , что аналогичная работа из ЭНЦ была выполнена неряшливо и не опубликована в журналах с высоким импакт -фактором
А ведь работа годков 7 как бвла сделана ( Егоров , Свириденко )

Контроль функции ЩЖ после рентгеноконтрастных исследований - это понятно, и мы его рекомендуем, особенно пациентам с имеющимися заболеваниями ЩЖ и тем, для кого развитие тиреотоксикоза было бы особенно неблагоприятно.
А вот в чем может заключаться "особенное внимание" на этапе подготовки к контрастному исследованию? Если только предварительное определение ТТГ/АТ-ТПО?

По мне так тиростатики там , где есть риск декомпенсации функциональной автономии иди т-токсикоза при короткой ремиссии ДТЗ .
впрочем, работ по доказательству справедливости этой идеи ( по здравому смыслу ) не помню.

Спасибо!

А через какое время необходимо провести контроль тироидных гормонов после исследований?, и касается ли это в\венной урографии? Потому что в статье говориться о КТ И коронарографии насколько я поняла.

Обычный срок после коронарографии (для пациентов без предсуществующей патологии щитовидной железы) - от 2 до 6 месяцев. В отношении урографии с иодсодержащим контрастом - думаю, действуют те же принципы.

в/ венной особенно , контроль - в наших исследованиях ( Егоров , Свириденко ) через три мес ( но описаны случаи острого тиротоксикоза сразу же после в/ венной нагрузки , я была в гостях в клинике у восточных немцев в Йене , когда как раз развился такой эпизод)