English
Basics of prevention and management of iodine-based contrast media-induced thyroid dysfunction — position paper by the Polish Society of Endocrinology
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.
Keywords: iodinecontrast mediaiodinated contrast mediathyroidhyperthyroidismhypothyroidismprevention
References
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.
- 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].
- Żach M, Kryjan K, Ambroziak U, et al. [Hyperthyroidism after iodine-containing contrast agent administration]. Kardiol Pol. 2013; 71(7): 752–756.
![](https://journals.viamedica.pl/plugins/generic/popups/images/icons/close.png)