Prevalence of thyroid dysfunction and effect of contrast medium on thyroid metabolism in cardiac patients undergoing coronary angiography
Abstract
Background: Iodinated contrast media (CM) may influence thyroid function. Precautions are generally taken in patients with hyperthyroidism, even if subclinical, whereas the risks in patients with hypothyroidism or low triiodothyronine (T3) syndrome are not considered as appreciable. Purpose: To assess the presence and type of thyroid dysfunction in patients admitted for coronary angiography (CA), to assess the concentration of free-iodide in five non-ionic CM, and to evaluate changes in thyroid function after CA in patients with low T3 syndrome. Material and Methods: We measured free T3, free thyroxine (T4), and thyroid-stimulating hormone (TSH) in 1752 consecutive patients prior to CA and free-iodide in five non-ionic CM. Urinary free-iodide before and 24 h after CA, and thyroid hormone profile 48 h after CA were also made in 17 patients with low T3 syndrome. Patients were followed up for an average duration of 63.5 months. Results: The patients were divided into four groups: euthyroidism (60%), low T3 syndrome (28%), hypothyroidism (10%), and hyperthyroidism (2%). The free-iodide resulted far below the recommended limit of 50 μg/mL in all tested CM. In low T3 syndrome, 24-h free-iodide increased after CA from 99.9± 63 ug to 12276±9285 ug (P< 0.0001). A reduction in TSH (4.97±1.1 vs. 4.17±1.1 mUI/mL, P < 0.01) and free T3 (1.44±0.2 vs. 1.25±0.3 pg/mL, P < 0.01), with an increase in free T4 (11.3±2.9 vs. 12.5±3.4 pg/dL, P < 0.001), was found. Patients with functional thyroid disease in the follow-up had a significant lower rate survival compared to euthyroid patients (90.7 vs. 82.2%, P < 0.00001). Conclusion: Thyroid dysfunction is frequent in patients who perform a CA, and low T3 syndrome is the predominant feature. The administration of contrast medium may further compromise the thyroid function.
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In an Italian study, 1.9% of 1752 patients undergoing coronary angiography developed a suppressed TSH with normal free T4 and T3 levels.
“a study from Italy that found that 1.9% of 1752 patients undergoing coronary angiography developed a suppressed TSH with normal free T 4 and T 3 levels (568)”
From 2016 American Thyroid Association Guidelines for Diagnosis and Management of Hyperthyroidism and Other Causes of Thyrotoxicosis (2016) · cites this paper as [568]
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- Authors
- Marraccini, P., Bianchi, M., Bottoni, A., Mazzarisi, A., Coceani, M., Molinaro, S., Lorenzoni, V., Landi, P., & Iervasi, G.
- Affiliations
- Istituto di Fisiologia Clinica (IT)
- Azienda Ospedaliera Universitaria Pisana (IT)
- Fondazione Toscana Gabriele Monasterio (IT)
- Corresponding author
- Marraccini, Paolo
- Venue
- Acta Radiologica
- Publisher
- SAGE Publications
- Published
- 2013-02
- Volume
- 54
- Issue
- 1
- Pages
- 42-47
- ISSN
- 0284-1851 (ISSN-L)
- 1600-0455
- OpenAlex
- W2327352272
- Cited by
- 35
- References
- 17
- Citations by year
- 2026: 1 · 2025: 3 · 2024: 1 · 2022: 1 · 2021: 3 · 2020: 6 · 2019: 5 · 2018: 2 · 2017: 2 · 2016: 4 · 2015: 2 · 2014: 4 · 2012: 1
- FWCI
- 1.80
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Acta Radiologica (publishedVersion)
- PubMed (publishedVersion)
- CINECA IRIS Institutional Research Information System (Sant'Anna School of Advanced Studies) (submittedVersion)
- 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
- thyroid dysfunction, low T3 syndrome, iodinated contrast media, coronary angiography, thyroid function, thyroid-stimulating hormone, free thyroxine, free triiodothyronine, urinary iodide, hypothyroidism, hyperthyroidism, cardiac patients, nonionic contrast media, iodide toxicity, thyroid hormone replacement
- MeSH terms
- Aged, Chromatography, High Pressure Liquid, Contrast Media, Female, Humans, Iohexol, Iopamidol, Male, Middle Aged, Thyroid Diseases, Thyroid Function Tests, Thyroid Hormones, Triiodobenzoic Acids, Comorbidity, Prevalence, Chi-Square Distribution, Proportional Hazards Models, Coronary Angiography
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