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Cited by 222Thyroid Disorders and TreatmentsThyroid Cancer Diagnosis and TreatmentThyroid and Parathyroid Surgery

Association Between Iodinated Contrast Media Exposure and Incident Hyperthyroidism and Hypothyroidism

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Rhee, Connie M.·2012·Archives of Internal Medicine
DOI 10.1001/archinternmed.2011.677
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Abstract

BACKGROUND: Sudden exposure to high iodide levels may cause thyroid dysfunction. Despite compelling biological plausibility and clinical implication, the association between iodinated contrast media exposure and incident hyperthyroidism and hypothyroidism has not been rigorously studied. METHODS: We performed a nested case-control study of patients treated between January 1, 1990, and June 30, 2010, who did not have preexisting hyperthyroidism or hypothyroidism. In parallel analyses, incident hyperthyroid or hypothyroid cases were defined by a change in thyrotropin level from normal (at baseline) to low or high (follow-up measurement). Euthyroid controls were selected using an incidence density sampling approach and were matched to cases on the basis of age, sex, race/ethnicity, estimated glomerular filtration rate, follow-up thyrotropin measurement date, and interval between baseline and the follow-up thyrotropin measurement date. Iodinated contrast media exposure was assessed using claims data for contrast-enhanced computed tomography or cardiac catheterization. RESULTS: In total, 178 and 213 incident hyperthyroid and hypothyroid cases, respectively, were matched to 655 and 779 euthyroid controls, respectively. Iodinated contrast media exposure was associated with incident hyperthyroidism (odds ratio [OR], 1.98; 95% CI, 1.08-3.60), but a statistically significant association with incident hypothyroidism was not observed (OR, 1.58; 95% CI, 0.95-2.62). In prespecified secondary analysis, iodinated contrast media exposure was associated with incident overt hyperthyroidism (follow-up thyrotropin level ≤ 0.1 mIU/L; OR, 2.50; 95% CI, 1.06-5.93) and with incident overt hypothyroidism (follow-up thyrotropin level >10 mIU/L; OR, 3.05; 95% CI, 1.07-8.72). CONCLUSION: Iodinated contrast media exposure is associated with subsequent development of incident hyperthyroidism and incident overt hypothyroidism.

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  • A recent US case-control study found that iodinated contrast exposure in patients without baseline thyroid abnormality resulted in hyperthyroidism (defined only as a suppressed TSH value) with an odds ratio of 1.98 (95% CI, p = 0.03), and that 23 patients would need to be exposed before encountering one case of iodine-induced thyrotoxicosis.

    “A recent case-control study in the United States found that iodinated contrast exposure in patients without baseline thyroid abnormality resulted in hyperthyroidism (defined only as a suppressed TSH value) with an odds ratio of 1.98 ([95% CI,, p = 0.03), and that 23 patients would need to be exposed before encountering one case of iodineinduced thyrotoxicosis (570).”

    From 2016 American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and Other Causes of Thyrotoxicosis (2016) · cites this paper as [570]

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Authors
Rhee, C. M.
Affiliations
Brigham and Women's Hospital (US)
Corresponding author
Rhee, Connie M.
ORCID
Rhee, Connie M.
Venue
Archives of Internal Medicine
Publisher
American Medical Association (AMA)
Published
2012-01-23
Volume
172
Issue
2
Pages
153
ISSN
0003-9926 (ISSN-L)
DOI
10.1001/archinternmed.2011.677
OpenAlex
W1999841655
Cited by
222
References
49
Citations by year
2026: 3 · 2025: 10 · 2024: 16 · 2023: 18 · 2022: 15 · 2021: 17 · 2020: 12 · 2019: 22 · 2018: 11 · 2017: 11 · 2016: 13 · 2015: 18 · 2014: 24 · 2013: 21 · 2012: 11
FWCI
18.99
Type
journal article
Language
en
Open access
Licence
cc-by
Locations
  • Archives of Internal Medicine (publishedVersion)
  • PubMed (publishedVersion)
  • eScholarship (California Digital Library) (submittedVersion, cc-by)
Funders
National Institute of Diabetes and Digestive and Kidney Diseases (T32DK007527, K23DK079056, DK079056, DK007527-26)
Topics
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Thyroid Disorders and Treatments
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Thyroid Cancer Diagnosis and Treatment
  • Health Sciences › Medicine › Surgery › Thyroid and Parathyroid Surgery
Keywords
iodinated contrast media, hyperthyroidism, hypothyroidism, thyroid dysfunction, iodine exposure, thyroid-stimulating hormone, overt hyperthyroidism, overt hypothyroidism, contrast-enhanced CT, cardiac catheterization
MeSH terms
Autoantibodies, Contrast Media, Female, Humans, Hyperthyroidism, Hypothyroidism, Iodide Peroxidase, Iodine, Male, Middle Aged, Thyroglobulin, Thyrotropin, Cohort Studies, Case-Control Studies

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