open access

Vol 74, No 1 (2023)
Guidelines / Expert consensus
Submitted: 2023-02-15
Accepted: 2023-02-15
Published online: 2023-02-23
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Polski

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

Tomasz Bednarczuk1, Dariusz Kajdaniuk2, Bogdan Marek2, Marek Bolanowski3, Marek Dedecjus4, Aleksandra Gilis-Januszewska5, Alicja Hubalewska-Dydejczyk5, Barbara Jarząb6, Roman Junik7, Grzegorz Kamiński8, Beata Kos-Kudła2, Aldona Kowalska9, Andrzej Lewiński10, Beata Matyjaszek-Matuszek11, Marek Ruchała12, Lucyna Siemińska2, Krzysztof Sworczak13, Anhelli Syrenicz14, Wojciech Zgliczyński15
·
Pubmed: 36847719
·
Endokrynol Pol 2023;74(1):1-4.
Affiliations
  1. Department of Internal Medicine and Endocrinology, Medical University of Warsaw, Warsaw, Poland
  2. Chair of Pathophysiology and Endocrinology, Medical University of Silesia, Katowice, Poland
  3. Chair and Department of Endocrinology, Diabetes, and Isotope Therapy, Medical University of Wroclaw, Wroclaw, Poland
  4. Department of Oncological Endocrinology and Nuclear Medicine, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
  5. Chair and Department of Endocrinology, Jagiellonian University Medical College, Krakow, Poland
  6. Nuclear Medicine and Endocrine Oncology Department, M. Sklodowska-Curie National Research Institute of Oncology, Gliwice Branch, Gliwice, Poland
  7. Department of Endocrinology and Diabetology, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, Bydgoszcz, Poland
  8. Department of Endocrinology and Radioisotope Therapy, Military Institute of Medicine — National Research Institute, Warsaw, Poland
  9. Department of Endocrinology, Holycross Cancer Centre, Collegium Medicum, Jan Kochanowski University, Kielce, Poland
  10. Department of Endocrinology and Metabolic Diseases, Medical University of Lodz, Lodz, Poland
  11. Chair and Department of Endocrinology, Diabetology and Metabolic Diseases, Medical University of Lublin, Lublin, Poland
  12. Department of Endocrinology, Metabolism and Internal Medicine, Medical University in Poznan, Poznan, Poland
  13. Chair and Department of Endocrinology and Internal Diseases, Medical University of Gdansk, Gdansk, Poland
  14. Department of Endocrinology, Metabolic and Internal Diseases, Pomeranian Medical University, Szczecin, Poland
  15. Department of Endocrinology, Centre of Postgraduate Medical Education, Warsaw, Poland

open access

Vol 74, No 1 (2023)
Guidelines
Submitted: 2023-02-15
Accepted: 2023-02-15
Published online: 2023-02-23

Abstract

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.

Abstract

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.

Get Citation

Keywords

iodine; contrast media; iodinated contrast media; thyroid; hyperthyroidism; hypothyroidism; prevention

About this article
Title

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

Journal

Endokrynologia Polska

Issue

Vol 74, No 1 (2023)

Article type

Guidelines / Expert consensus

Pages

1-4

Published online

2023-02-23

Page views

5197

Article views/downloads

5366

DOI

10.5603/EP.a2023.0014

Pubmed

36847719

Bibliographic record

Endokrynol Pol 2023;74(1):1-4.

Keywords

iodine
contrast media
iodinated contrast media
thyroid
hyperthyroidism
hypothyroidism
prevention

Authors

Tomasz Bednarczuk
Dariusz Kajdaniuk
Bogdan Marek
Marek Bolanowski
Marek Dedecjus
Aleksandra Gilis-Januszewska
Alicja Hubalewska-Dydejczyk
Barbara Jarząb
Roman Junik
Grzegorz Kamiński
Beata Kos-Kudła
Aldona Kowalska
Andrzej Lewiński
Beata Matyjaszek-Matuszek
Marek Ruchała
Lucyna Siemińska
Krzysztof Sworczak
Anhelli Syrenicz
Wojciech Zgliczyński

References (14)
  1. Bednarczuk T, Brix TH, Schima W, et al. 2021 European Thyroid Association Guidelines for the Management of Iodine-Based Contrast Media-Induced Thyroid Dysfunction. Eur Thyroid J. 2021; 10(4): 269–284.
  2. Thomsen HS. European Society of Urogenital Radiology (ESUR) guidelines on the safe use of iodinated contrast media. Eur J Radiol. 2006; 60(3): 307–313.
  3. Rokicka D, Wróbel M, Stołtny D, et al. Use of metformin in patients who require intravascular administration of a contrast agent. Endokrynol Pol. 2022; 73(6): 913–916.
  4. Rutkowski P, Zapaśnik A, Dębska-Ślizień A, et al. Ostre uszkodzenie nerek po środkach kontrastowych — stanowisko Polskiego Towarzystwa Nefrologicznego. Forum Nefrologiczne. 2016; 9(2): 118–125.
  5. Płaczkiewicz-Jankowska E, Bednarczuk T. Postępowanie w zaburzeniach tarczycy wywołanych przez jodowe środki kontrastowe. Omówienie wytycznych European Thyroid Association 2021. Med Prakt. 2022; 1: 21–28.
  6. Rhee CM, Bhan I, Alexander EK, et al. Association between iodinated contrast media exposure and incident hyperthyroidism and hypothyroidism. Arch Intern Med. 2012; 172(2): 153–159.
  7. Kornelius E, Chiou JY, Yang YS, et al. Iodinated Contrast Media Increased the Risk of Thyroid Dysfunction: A 6-Year Retrospective Cohort Study. J Clin Endocrinol Metab. 2015; 100(9): 3372–3379.
  8. Pelewicz K, Wolny R, Bednarczuk T, et al. Prevention of Iodinated Contrast Media-Induced Hyperthyroidism in Patients with Euthyroid Goiter. Eur Thyroid J. 2021; 10(4): 306–313.
  9. Skórkowska-Telichowska K, Kosińska J, Szymczak R, et al. Comparison and assessment of thyroid morphology and function in inhabitants of Lower Silesia before and after administration of a single dose of iodine-containing contrast agent during cardiac intervention procedure. Endokrynol Pol. 2012; 63(4): 294–299.
  10. Lewiński A, Płaczkiewicz‑Jankowska E. Zasady profilaktycznego blokowania jodochwytności tarczycy w przypadku zdarzeń radiacyjnych z uwolnieniem jodu promieniotwórczego. Omówienie wytycznych Światowej Organizacji Zdrowia. Med Prakt. 2022; 4: 72–79.
  11. Hudzik B, Zubelewicz-Szkodzińska B. Radiocontrast-induced thyroid dysfunction: is it common and what should we do about it? Clin Endocrinol (Oxf). 2014; 80(3): 322–327.
  12. Bervini S, Trelle S, Kopp P, et al. Prevalence of Iodine-Induced Hyperthyroidism After Administration of Iodinated Contrast During Radiographic Procedures: A Systematic Review and Meta-Analysis of the Literature. Thyroid. 2021; 31(7): 1020–1029.
  13. Inoue K, Guo R, Lee ML, et al. Iodinated Contrast Administration and Risks of Thyroid Dysfunction: A Retrospective Cohort Analysis of the U.S. Veterans Health Administration System. Thyroid. 2023 [Epub ahead of print].
  14. Żach M, Kryjan K, Ambroziak U, et al. [Hyperthyroidism after iodine-containing contrast agent administration]. Kardiol Pol. 2013; 71(7): 752–756.

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