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Cherella CE, Breault DT, Thaker V, Levine BS, Smith JR. Early Identification of Primary Hypothyroidism in Neonates Exposed to Intralymphatic Iodinated Contrast: A Case Series. J Clin Endocrinol Metab 2018; 103:3585-3588. [PMID: 30085021 PMCID: PMC6179162 DOI: 10.1210/jc.2018-00960] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Accepted: 07/26/2018] [Indexed: 11/19/2022]
Abstract
CONTEXT In neonates, iatrogenic hypothyroidism can result from topical or IV iodine exposure. Data on intralymphatic iodine exposure, risk factors for disease severity, and timing of hypothyroidism are limited. CASE DESCRIPTIONS We report 4 cases of premature neonates with previously normal thyroid function tests (TFTs) who developed hypothyroidism after intralymphatic iodinated contrast. Patients 1 and 2, premature infants with complex medical histories, had chylous effusions and high-volume chest tube output requiring imaging with lymphangiograms on day of life (DOL) 97 and DOL 43, respectively. They developed severe, primary hypothyroidism with TSH of 335.7 mIU/mL (reference range, 1.7 to 9.1) on DOL 111 and TSH of 470.2 mIU/mL (reference range, 1.7 to 9.1) on DOL 68. Patient 3 had prenatally diagnosed fetal hydrops manifesting with chylous effusions and high-volume chest tube output. The infant underwent lymphangiography on DOL 90 and was noted to have an elevated TSH of 13.35 mIU/mL (reference range, 1.7 to 9.1) 4 days later with spot urine iodine of 1742 µg/L (normal, <200). Patient 4 had a lymphatic malformation and underwent sclerotherapy with doxycycline with intralymphatic iodine exposure on DOL 4 and was found to have a TSH of 16.7 µU/mL (reference range, 1.7 to 9.1) 3 days later with spot urine iodine of 228,712 µg/L (normal, <200). The TFT results for all patients improved after levothyroxine administration. CONCLUSION Intralymphatic iodine should be considered a major risk factor in the development of iatrogenic primary hypothyroidism, especially in premature neonates soon after exposure. Close monitoring of TFTs is imperative to avoid potential long-term adverse outcomes in this population.
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Affiliation(s)
| | - David T Breault
- Division of Endocrinology, Boston Children’s Hospital, Boston, Massachusetts
| | - Vidhu Thaker
- Division of Molecular Genetics, Columbia University Medical Center, New York, New York
| | - Bat-Sheva Levine
- Division of Endocrinology, Boston Children’s Hospital, Boston, Massachusetts
| | - Jessica R Smith
- Division of Endocrinology, Boston Children’s Hospital, Boston, Massachusetts
- Correspondence and Reprint Requests: Jessica R. Smith, MD, Division of Endocrinology, Boston Children’s Hospital, 300 Longwood Avenue, Boston, Massachusetts 02115. E-mail:
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52
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Hansen MP, Kahaly GJ. [Managing hypothyroidism in general practice]. MMW Fortschr Med 2018; 160:42-46. [PMID: 30302683 DOI: 10.1007/s15006-018-0983-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Affiliation(s)
- Martin P Hansen
- Universitätsmedizin der Johannes-Gutenberg-Universität, Mainz, Deutschland
| | - George J Kahaly
- Universitätsmedizin der Johannes-Gutenberg-Universität, Mainz, Deutschland.
- I. Medizinische Klinik und Poliklinik, Labor Prof. G. J. Kahaly, Gebäude 402 UG, Univ.-Medizin der Johannes-Gutenberg-Universität, Langenbeckstr. 1, D-55131, Mainz, Deutschland.
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Duntas LH. The catalytic role of iodine excess in loss of homeostasis in autoimmune thyroiditis. Curr Opin Endocrinol Diabetes Obes 2018; 25:347-352. [PMID: 30124478 DOI: 10.1097/med.0000000000000425] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
PURPOSE OF REVIEW To review the latest developments concerning the role of iodine in the pathophysiology of autoimmune thyroiditis. RECENT FINDINGS Recent studies have provided evidence that in areas with excess iodine intake, increased incidence of autoimmune thyroiditis marked by high titers of thyroid peroxidase and thyroglobulin antibodies has occurred. Investigations in the NOD.H2h4 mouse, a strain prone to AIT, showed that they are better adapted to the Wolff-Chaikoff effect. SUMMARY To provide an overview of the studies conducted during the last few years implicating iodine in the development and manifestation of autoimmune thyroiditis.
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Affiliation(s)
- Leonidas H Duntas
- Evgenidion Hospital, Unit of Endocrinology, Metabolism and Diabetes, Thyroid Section, University of Athens, Greece
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54
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Hollhumer R, Indiveri F. Jod-Basedow phenomenon: Reactivation of thyroid eye disease after contrast computed tomography. AFRICAN VISION AND EYE HEALTH 2018. [DOI: 10.4102/aveh.v77i1.436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
To report a case of Jod-Basedow phenomenon, where a patient with quiescent thyroid eye disease became active after a contrast computed tomography (CT). A patient with clinically inactive thyroid eye disease underwent a contrast CT, after which her clinical activity score increased for 1 to 6/10 with optic nerve dysfunction. She was managed medically with intravenous steroids, neomercazole and propranolol. Jod-Basedow phenomenon is a rare condition where thyroid eye disease reactivates after a large iodine bolus. It is important for clinicians to be aware of this when considering special investigations, such as contrast scans, where iodine is given in large doses.
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55
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Duan J, Kang J, Deng T, Yang X, Chen M. Exposure to DBP and High Iodine Aggravates Autoimmune Thyroid Disease Through Increasing the Levels of IL-17 and Thyroid-Binding Globulin in Wistar Rats. Toxicol Sci 2018; 163:196-205. [DOI: 10.1093/toxsci/kfy019] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Affiliation(s)
- Jiufei Duan
- Hubei Key Laboratory of Genetic Regulation and Integrative Biology, School of Life Sciences, Central China Normal University, Wuhan, Hubei 430079, China
| | - Jun Kang
- Hubei Key Laboratory of Genetic Regulation and Integrative Biology, School of Life Sciences, Central China Normal University, Wuhan, Hubei 430079, China
| | - Ting Deng
- Hubei Key Laboratory of Genetic Regulation and Integrative Biology, School of Life Sciences, Central China Normal University, Wuhan, Hubei 430079, China
| | - Xu Yang
- Hubei Key Laboratory of Genetic Regulation and Integrative Biology, School of Life Sciences, Central China Normal University, Wuhan, Hubei 430079, China
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56
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Udovcic M, Pena RH, Patham B, Tabatabai L, Kansara A. Hypothyroidism and the Heart. Methodist Debakey Cardiovasc J 2018; 13:55-59. [PMID: 28740582 DOI: 10.14797/mdcj-13-2-55] [Citation(s) in RCA: 124] [Impact Index Per Article: 20.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Hypothyroidism is a commonly encountered clinical condition with variable prevalence. It has profound effects on cardiac function that can impact cardiac contractility, vascular resistance, blood pressure, and heart rhythm. With this review, we aim to describe the effects of hypothyroidism and subclinical hypothyroidism on the heart. Additionally, we attempt to briefly describe how hypothyroid treatment affects cardiovascular parameters.
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57
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Brundridge W, Perkins J. Iodinated Contrast Administration Resulting in Cardiogenic Shock in Patient with Uncontrolled Graves Disease. J Emerg Med 2017; 53:e125-e128. [PMID: 29102101 DOI: 10.1016/j.jemermed.2017.08.096] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Revised: 08/25/2017] [Accepted: 08/30/2017] [Indexed: 11/20/2022]
Abstract
BACKGROUND Thyroid storm (also known as thyroid or thyrotoxic crisis) is part of the spectrum of thyrotoxicosis and represents the extreme end of that spectrum. The condition is quite rare, yet mortality rates are high and may approach 10-30%. CASE REPORT A 34-year-old-man who had a history of Graves disease presented in atrial fibrillation with rapid ventricular response and mild congestive heart failure. During the course of his Emergency Department (ED) stay he deteriorated into cardiogenic shock. Roughly 10 h transpired between his presentation and the development of cardiogenic shock. He had received an intravenous contrast load of iohexol shortly after initial presentation, and the associated iodine bolus, we suspect, contributed to his abrupt deterioration into cardiogenic shock. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Thyroid storm is infrequently seen in the ED, and there is potential for management errors that can lead to a detrimental patient outcome.
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Affiliation(s)
- Wes Brundridge
- Department of Ophthalmology, Brooke Army Medical Center, San Antonio, Texas
| | - Jack Perkins
- Virginia Tech Carilion Emergency Medicine Residency, Department of Emergency Medicine, Virginia Tech Carilion School of Medicine, Roanoke, Virginia
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58
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Thaker VV, Galler MF, Marshall AC, Almodovar MC, Hsu HW, Addis CJ, Feldman HA, Brown RS, Levine BS. Hypothyroidism in Infants With Congenital Heart Disease Exposed to Excess Iodine. J Endocr Soc 2017; 1:1067-1078. [PMID: 29264559 PMCID: PMC5686596 DOI: 10.1210/js.2017-00174] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Accepted: 07/06/2017] [Indexed: 12/05/2022] Open
Abstract
Thyroid hormone is critical for neonatal brain development, and even transient hypothyroidism can cause adverse neurocognitive outcomes. Infants exposed to excess iodine are at risk of developing hypothyroidism, especially those with congenital heart disease (CHD), because they are routinely exposed to excess iodine from intravenous iodinated contrast media and topical antiseptics. The aim of the present study was to identify the proportion of neonates with CHD exposed to iodine who developed hypothyroidism and to identify the associated risk factors. This was a retrospective study of neonates undergoing cardiac catheterization at Boston Children's Hospital during a 3-year period, some of whom also underwent cardiac surgery. Hypothyroidism was defined as an elevated thyroid-stimulating hormone level (>20 mIU/L at 24 to 96 hours of age and >15 mIU/L at >96 hours of age by heel-stick sampling and >9.1 mIU/L at 1 to 20 weeks of age by serum testing). Multivariate logistic regression was performed to predict the odds of developing hypothyroidism. Hypothyroidism was diagnosed incidentally in 46 of 183 infants (25%) with CHD after iodine exposure. Controlling for baseline cardiac risk, postnatal age, and gestational age, we found a fourfold increase in odds of developing hypothyroidism in neonates with serum creatinine >0.9 mg/dL and a fourfold increase in those who underwent more than three procedures. Hypothyroidism in neonates with CHD exposed to excess iodine is associated with multiple procedures and impaired renal function. Routine serial monitoring of thyroid function in these neonates is warranted. Future studies should examine the association between hypothyroidism and neurocognitive function in this population.
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Affiliation(s)
- Vidhu V Thaker
- Division of Endocrinology, Boston Children's Hospital, Boston, Massachusetts 02115
- Harvard Medical School, Boston, Massachusetts 02115
- Columbia University Medical Center, New York, New York 10032
| | - Marjorie F Galler
- Medstar Georgetown University Hospital, Washington, District of Columbia 20007
| | - Audrey C Marshall
- Harvard Medical School, Boston, Massachusetts 02115
- Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts 02115
| | | | - Ho-Wen Hsu
- New England Newborn Screening Program, Jamaica Plain, Massachusetts 02130
- University of Massachusetts Medical School, Worcester, Massachusetts 01655
| | | | - Henry A Feldman
- Division of Endocrinology, Boston Children's Hospital, Boston, Massachusetts 02115
- Harvard Medical School, Boston, Massachusetts 02115
| | - Rosalind S Brown
- Division of Endocrinology, Boston Children's Hospital, Boston, Massachusetts 02115
- Harvard Medical School, Boston, Massachusetts 02115
| | - Bat-Sheva Levine
- Division of Endocrinology, Boston Children's Hospital, Boston, Massachusetts 02115
- Harvard Medical School, Boston, Massachusetts 02115
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59
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Larrosa Campo D, Ramón Carbajo C, García Urruzola F, Calleja Puerta S. Orthostatic tremor as the only manifestation of thyrotoxicosis following cerebral angiography. Neurologia 2017; 34:137-138. [PMID: 28712843 DOI: 10.1016/j.nrl.2017.05.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2017] [Accepted: 05/11/2017] [Indexed: 10/19/2022] Open
Affiliation(s)
- D Larrosa Campo
- Servicio de Neurología, Hospital Universitario Central de Asturias, Oviedo, Asturias, España.
| | - C Ramón Carbajo
- Servicio de Neurología, Hospital Universitario Central de Asturias, Oviedo, Asturias, España
| | - F García Urruzola
- Servicio de Endocrinología y Nutrición, Hospital Universitario Central de Asturias, Oviedo, Asturias, España
| | - S Calleja Puerta
- Servicio de Neurología, Hospital Universitario Central de Asturias, Oviedo, Asturias, España
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Thyroid Disorders in Central Ghana: The Influence of 20 Years of Iodization. J Thyroid Res 2017; 2017:7843972. [PMID: 28744391 PMCID: PMC5514328 DOI: 10.1155/2017/7843972] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Revised: 05/16/2017] [Accepted: 05/28/2017] [Indexed: 11/17/2022] Open
Abstract
Background Ghana began mandatory iodization of salt in 1996. This study compares the prevalence of thyroid disorders before and after the introduction of iodization. Methods This is a retrospective study of thyroid cases from the middle belt of Ghana between 1982 and 2014. To demonstrate a link between iodization and hyperthyroidism and autoimmunity, we compared the prevalence of hyperthyroidism and autoimmune thyroid disorders before and after the iodization programme. Results A total of 10,484 (7548 females, 2936 males) cases were recorded. The rate of thyroid cases seen was 343/100,000. Nontoxic nodular goiters (25.7%) and toxic nodular goiters (22.5%) represented the second commonest thyroid disorders recorded. The prevalence of hyperthyroid disorders seen after 1996 was significantly higher than the prevalence seen before the iodization (40.0 versus 21.1%, p < 0.001). The prevalence of autoimmune disorders recorded after iodization was significantly higher than that before the iodization programme started (22.3% versus 9.6%, p < 0.001). Conclusions This study has revealed a significant increase in thyroid admissions in Central Ghana over the decades. A connection between iodine fortification and iodine-induced hyperthyroidism and between iodine fortification and autoimmune thyroiditis has been shown in this study.
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61
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Yang JW, How J. Lugol's solution-induced painless thyroiditis. Endocrinol Diabetes Metab Case Rep 2017; 2017:EDM170034. [PMID: 28620500 PMCID: PMC5467656 DOI: 10.1530/edm-17-0034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Accepted: 07/03/2017] [Indexed: 11/08/2022] Open
Abstract
Lugol’s solution is usually employed for a limited period for thyroidectomy preparation in patients with Graves’ disease and for the control of severe thyrotoxicosis and thyroid storm. We describe a rare case of Lugol’s solution-induced painless thyroiditis. In November 2014, a 59-year-old woman was prescribed Lugol’s solution four drops per day for the alleviation of menopausal symptoms. She was referred to our clinic in June 2015 for fatigue, hair loss, and a 20-lb weight loss without thyroid pain or discomfort. Physical examination revealed a normal thyroid gland. On 7 May 2015, laboratory tests revealed a suppressed thyroid-stimulating hormone (TSH) 0.01 U/L with elevated free T4 3.31 ng/dL (42.54 pmol/L). Repeat testing on 25 May 2015 showed spontaneous normalization of the free thyroid hormone levels with persistently low TSH 0.10 U/L. Following these results, a family physician prescribed methimazole 10 mg PO TID and very soon after, the TSH concentration rose to >100 U/L along with subnormal free T4 and T3 levels. Methimazole was promptly discontinued, namely within 18 days of its initiation. Over the course of the next few months, the patient spontaneously achieved clinical and biochemical euthyroidism. To our knowledge, this is a unique case of painless thyroiditis induced by Lugol’s solution, which has not been reported before. Lugol’s solution is a short-term medication given for the preparation of thyroidectomy in patients with Graves’ disease and for the control of severe thyrotoxicosis. Iodine excess can cause both hyperthyroidism and hypothyroidism. Rarely, Lugol’s solution can cause acute painless thyroiditis.
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Affiliation(s)
- Ji Wei Yang
- Division of Endocrinology and Metabolism, Department of Medicine, McGill University Health Centre, Montreal, QuebecCanada
| | - Jacques How
- Division of Endocrinology and Metabolism, Department of Medicine, McGill University Health Centre, Montreal, QuebecCanada
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62
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Miyake D, Bogaki A, Tokuda C, Igarashi T, Yasui A. A New Analytical Method for Measuring Total Iodine Content in Fish for the Standard Tables of Food Composition in Japan. J JPN SOC FOOD SCI 2017. [DOI: 10.3136/nskkk.64.312] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
| | | | | | | | - Akemi Yasui
- Food Research Institute, National Agriculture and Food Research Organization
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63
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Thyroidal response following iodine excess for cardiac catheterisation and intervention in early infancy. Int J Cardiol 2016; 223:1014-1018. [DOI: 10.1016/j.ijcard.2016.08.292] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Accepted: 08/18/2016] [Indexed: 11/23/2022]
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64
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Troendle JF. Statistical design considerations applicable to clinical trials of iodine supplementation in pregnant women who may be mildly iodine deficient. Am J Clin Nutr 2016; 104 Suppl 3:924S-7S. [PMID: 27534639 PMCID: PMC5004499 DOI: 10.3945/ajcn.115.110403] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
No large, randomized, placebo-controlled trial of iodine supplementation in pregnant women in a region of mild or moderate iodine deficiency has been completed in which a primary outcome measure was an assessment of the neurobehavioral development of the offspring at age ≥2 y. In this article, I discuss considerations for the design of such a trial in a region of mild iodine deficiency, with a focus on statistical methods and approaches. Exposure and design issues include the ethics of using a placebo, the potential for overexposure to iodine, and the possibility of community randomization. The main scientific goal of the trial is important in determining the follow-up period. If the goal is to determine whether iodine supplementation during pregnancy improves neurobehavioral development in the offspring, then follow-up should continue until a reasonably reliable assessment can be conducted, which might be at age ≥2 y. Once the timing of assessment is decided, the impact of potential loss to follow-up should be considered so that appropriate statistical methods can be incorporated into the design. The minimum sample size can be calculated by using a sample size formula that incorporates noncompliance and assumes that a certain proportion of study participants do not have any outcome observed. To have sufficient power to detect a reasonably modest difference in neurobehavioral development scores using an assessment tool with an SD of 15, a large number of participants (>500/group) is required. The minimum adequate number of participants may be even larger (>1300/group) depending on the magnitude of the difference in outcome between the supplementation and placebo groups, the estimated proportion of the iodine-supplementation group that fails to take the supplement, and the estimated proportion of pregnancies that do not produce outcome measurements.
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Affiliation(s)
- James F Troendle
- Office of Biostatistics Research, Division of Cardiovascular Sciences, National Heart, Lung, and Blood Institute, NIH, Bethesda, MD
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65
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Kornelius E, Chiou JY, Yang YS, Lo SC, Peng CH, Lai YR, Huang CN. Iodinated Contrast Media-Induced Thyroid Dysfunction in Euthyroid Nodular Goiter Patients. Thyroid 2016; 26:1030-8. [PMID: 27315873 DOI: 10.1089/thy.2016.0051] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND The risks of thyroid dysfunction after iodinated contrast media exposure in patients with euthyroid nodular goiter are largely unknown. METHODS This observational, retrospective cohort study included a random selection of one million people in Taiwan. All patients with iodinated contrast media exposure during this study period were selected. Patients with euthyroid nodular goiter were identified as cases, while patients without thyroid nodule were selected as controls. We followed these patients until the first event of thyroid dysfunction including hyperthyroidism or hypothyroidism after iodinated contrast media exposure. RESULTS A total of 334 cases and 2672 matched controls were selected in this study. The mean age of cases and controls were 58.6 and 58.4 years old, and mean follow-up durations were 2.1 and 2 years respectively. After adjustment, patients with euthyroid nodular goiter had a higher risk of thyroid dysfunction (hazard ratio 5.43, [confidence interval (CI) 3.01-9.80]) compared with controls after iodinated contrast media exposure. In the subgroup analysis, the risks of hyperthyroidism and hypothyroidism in cases compared with controls were 5.77 [CI 2.64-12.62] and 4.95 [CI 2.15-11.40] respectively. Half of the euthyroid nodular goiter cases developed thyroid dysfunction within one year after iodinated contrast media exposure. Interestingly, all thyroid-related comorbidities and drug prescriptions did not increase the risk of thyroid dysfunction. CONCLUSIONS Presence of euthyroid nodular goiter was associated with higher risk of thyroid dysfunction including hyperthyroidism and hypothyroidism after iodinated contrast media exposure.
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Affiliation(s)
- Edy Kornelius
- 1 Department of Internal Medicine, Division of Endocrinology and Metabolism, Chung Shan Medical University Hospital , Taichung, Taiwan
- 2 Institute of Medicine of Chung Shan Medical University , Taichung, Taiwan
| | - Jeng-Yuan Chiou
- 3 School of Health Policy and Management, Institute of Medicine of Chung Shan Medical University , Taichung, Taiwan
| | - Yi-Sun Yang
- 1 Department of Internal Medicine, Division of Endocrinology and Metabolism, Chung Shan Medical University Hospital , Taichung, Taiwan
- 2 Institute of Medicine of Chung Shan Medical University , Taichung, Taiwan
| | - Shih-Chang Lo
- 1 Department of Internal Medicine, Division of Endocrinology and Metabolism, Chung Shan Medical University Hospital , Taichung, Taiwan
| | - Chiung-Huei Peng
- 4 Division of Basic Medical Research, Hung Kuang University , Taichung, Taiwan
| | - Yung-Rung Lai
- 5 Pharmacy, Chung Shan Medical University Hospital , Taichung, Taiwan
| | - Chien-Ning Huang
- 1 Department of Internal Medicine, Division of Endocrinology and Metabolism, Chung Shan Medical University Hospital , Taichung, Taiwan
- 2 Institute of Medicine of Chung Shan Medical University , Taichung, Taiwan
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Iakovou I, Zapandiotis A, Mpalaris V, Goulis DG. Radio-contrast agent-induced hyperthyroidism: case report and review of the literature. ARCHIVES OF ENDOCRINOLOGY AND METABOLISM 2016; 60:287-289. [PMID: 26886087 PMCID: PMC10522297 DOI: 10.1590/2359-3997000000143] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/14/2015] [Accepted: 11/05/2015] [Indexed: 11/21/2022]
Abstract
A 66 year-old woman with a history of a euthyroid multinodular goiter underwent a head and neck computed tomography (CT) scan (total iodine load of 35 g) in order to evaluate the extent of retrosternal expansion. Less than 24 h after the iodine-based contrast media (ICM) administration, she presented with symptoms and laboratory findings typical of thyrotoxicosis. She was treated successfully with antithyroid medications. This is the shortest time reported in the literature and it is of clinical importance, as it may have an impact to the recommendations given by the attending physician. Given the fact that a large number of ICM examinations are performed in everyday practice, physicians should be aware of this possible thyroid-specific effect. Prophylactic drugs could be considered in high-risk populations, such as administration of perchlorate and a thionamide class drug to elderly patients with suppressed TSH and/or palpable goiter, started the day before and continued for two weeks after ICM administration.
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Affiliation(s)
- Ioannis Iakovou
- Third Department of Nuclear MedicineMedical SchoolAristotle University of ThessalonikiGreeceThird Department of Nuclear Medicine, Medical School, Aristotle University of Thessaloniki, Greece
| | - Apostolos Zapandiotis
- First Department of Obstetrics and GynecologyMedical SchoolAristotle University of ThessalonikiGreece Unit of Reproductive Endocrinology, First Department of Obstetrics and Gynecology, Medical School, Aristotle University of Thessaloniki, Greece
| | - Vassileios Mpalaris
- Third Department of Nuclear MedicineMedical SchoolAristotle University of ThessalonikiGreeceThird Department of Nuclear Medicine, Medical School, Aristotle University of Thessaloniki, Greece
| | - Dimitrios G. Goulis
- First Department of Obstetrics and GynecologyMedical SchoolAristotle University of ThessalonikiGreece Unit of Reproductive Endocrinology, First Department of Obstetrics and Gynecology, Medical School, Aristotle University of Thessaloniki, Greece
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Petrulea MS, Lencu C, Piciu D, Lisencu CI, Georgescu CE. Challenges of thyroid cancer management in amiodarone-treated patients: a case report. Med Pharm Rep 2016; 88:550-4. [PMID: 26733755 PMCID: PMC4689250 DOI: 10.15386/cjmed-502] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Accepted: 09/08/2015] [Indexed: 02/02/2023] Open
Abstract
Thyroid carcinoma (TC) is the most common endocrine malignancy. Although the overall prognosis for patients with TC is good, up to 20–30% of patients have recurrent or persistent disease after conventional therapy by surgical resection and radioactive iodine (RAI). Amiodarone is a highly efficient anti-arrhythmic drug with a very long half-life, so it may interfere with RAI many months after the drug withdrawal. This case report mirrors the challenges of thyroid cancer management in an amiodarone-treated patient.
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Affiliation(s)
- Mirela Sanda Petrulea
- Department of Endocrinology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Codruta Lencu
- Department of Endocrinology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Doina Piciu
- Nuclear Medicine Department, Ion Chiricuta Institute of Oncology, Cluj-Napoca, Romania
| | - Cosmin Ioan Lisencu
- Department of Surgery, Ion Chiricuta Institute of Oncology, Cluj-Napoca, Romania
| | - Carmen Emanuela Georgescu
- Department of Endocrinology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
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Hsieh MS, Chiu CS, Chen WC, Chiang JH, Lin SY, Lin MY, Chang SL, Sheu ML, Hu SY. Iodinated Contrast Medium Exposure During Computed Tomography Increase the Risk of Subsequent Development of Thyroid Disorders in Patients Without Known Thyroid Disease: A Nationwide Population-Based, Propensity Score-Matched, Longitudinal Follow-Up Study. Medicine (Baltimore) 2015; 94:e2279. [PMID: 26683955 PMCID: PMC5058927 DOI: 10.1097/md.0000000000002279] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
To investigate the association between iodinated contrast medium (ICM) exposure during computed tomography (CT) and the subsequent development of thyroid disorders in patients without known thyroid disease in Taiwan, an iodine-sufficient area. We conducted a population-based cohort study by using data from 1996 to 2012 in the Taiwan National Health Insurance Research Database. A total of 33,426 patients who underwent ICM-enhanced CT were included as the study cohort. To avoid selection bias, we used propensity score and matched for the index year (defined as the year of first ICM exposure) to retrieve 33,426 patients as the comparison cohort. No patients in the 2 cohorts had any known thyroid disease before the index year. Patients with a history of amiodarone treatment or coronary angiography and those with <1 year follow-up were excluded. Participants were followed until a new diagnosis of thyroid disorder or December 31, 2011. Hazard ratios (HRs) with 95% confidence interval (95% CI) were calculated using the Cox proportional hazards regression. An association was identified between ICM exposure and the subsequent development of thyroid disorders after adjustment for potential confounders (adjusted HR = 1.17; 95% CI: 1.07-1.29; P = 0.001). Male patients and patients' ages ≥40 years in the ICM-exposure cohort had a higher adjusted HR for developing thyroid disorders than did those in the non-ICM-exposure cohort. Hypothyroidism had the highest adjusted HR (HR = 1.37; 95% CI: 1.06-1.78; P < 0.05) among all thyroid disorders and had a higher risk of development or detection during >0.5-year post-ICM exposure compared with that during ≤0.5-year post-ICM exposure (HR = 1.26; 95% CI: 1.01-1.58; P < 0.05). Repeated ICM exposure increased the risk of thyroid disorders in patients who accepted >1 time of ICM per year on average compared with those who accepted ≤1 time per year on average (adjusted HR = 3.04; 95% CI: 2.47-3.73; P < 0.001). This study identified ICM exposure during CT as a risk factor for the subsequent development of thyroid disorders in patients without known thyroid disease, particularly in patients with repeated exposure.
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Affiliation(s)
- Ming-Shun Hsieh
- From the Department of Emergency Medicine, Taipei Veterans General Hospital, Taoyuan Branch, Taoyuan, Taiwan, R.O.C. (M-SH); Department of Emergency Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, R.O.C. (M-SH); School of Medicine, National Yang-Ming University, Taipei, Taiwan, R.O.C. (M-SH, C-SC, S-YL); Institute of Occupational Medicine and Industrial Hygiene, National Taiwan University College of Public Health, Taipei, Taiwan, R.O.C. (M-SH); Department of Dermatology (C-SC), Center for Geriatrics and Gerontology, Taichung Veterans General Hospital, Taichung, Taiwan, R.O.C. (S-YL), Department of Radiology (M-YL), Department of Education and Research (C-SC, M-LS), and Department of Emergency Medicine (S-YH), Taichung Veterans General Hospital, Taichung, Taiwan, R.O.C.; Rong Hsing Research Center for Translational Medicine (C-SC, M-LS) and Institute of Biomedical Sciences (C-SC, M-LS), National Chung Hsing University, Taichung, Taiwan, R.O.C.; Department of Medicinal Botanicals and Health Applications, Da-Yeh University, Changhua, Taiwan, R.O.C. (C-SC, S-LC); Department of Cosmetic Science, Providence University, Taichung, Taiwan, R.O.C. (C-SC); Graduate Institute of Integrated Medicine, College of Chinese Medicine, Research Center for Chinese Medicine and Acupuncture (W-CC, J-HC), College of Medicine (J-HC), and Management Office for Health Data (J-HC), China Medical University, Taichung, Taiwan, R.O.C.; Sex Hormone Research Center, Departments of Obstetrics and Gynecology, Urology, and Medical Research (W-CC) and Department of Medical Research, Obstetrics and Gynecology, Dermatology, and Urology (W-CC), China Medical University Hospital, Taichung, Taiwan, R.O.C.; School of Medicine (S-YH) and Institute of Medicine (S-YH), Chung Shan Medical University, Taichung, Taiwan, R.O.C.; Department of Nursing, College of Health, National Taichung University of Science and Technology, Taichung, Taiwan, R.O.C. (S-YH)
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Vargas-Uricoechea H, Sierra-Torres CH. Thyroid hormones and the heart. Horm Mol Biol Clin Investig 2015; 18:15-26. [PMID: 25389997 DOI: 10.1515/hmbci-2013-0059] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2013] [Accepted: 11/20/2013] [Indexed: 01/08/2023]
Abstract
Thyroid hormones have a significant impact on heart function, mediated by genomic and non-genomic effects. Consequently, thyroid hormones deficit as well as excess are expected to result in profound changes in cardiac function regulation and cardiovascular hemodynamics. Thyroid hormones upregulate the expression of the sarcoplasmic reticulum calcium-activated ATPase and downregulate the expression of phospholamban. Overall, hyperthyroidism is characterized by an increase in resting heart rate, blood volume, stroke volume, myocardial contractility, and ejection fraction. The development of "high-output heart failure" in hyperthyroidism may be due to "tachycardia-mediated cardiomyopathy." In contrast, in the hypothyroid state, thyroid hormone deficiency results in lower heart rate and weakening of myocardial contraction and relaxation, with prolonged systolic and early diastolic times. Cardiac preload is decreased owing to impaired diastolic function, cardiac afterload is increased, and chronotropic and inotropic functions are reduced. Subclinical thyroid dysfunction is relatively common in patients >65 years of age. In general, subclinical hypothyroidism increases the risk of cardiovascular heart disease (CHD) mortality and CHD events, but not of total mortality. The risk of CHD mortality and atrial fibrillation (but not other outcomes) in subclinical hyperthyroidism is higher among patients with very low levels of thyrotropin. Finally, medications such as amiodarone may induce hypothyroidism (mediated by the Wolff-Chaikoff effect) as well as hyperthyroidism (mediated by the Jod-Basedow effect). In both instances, the underlying cause is the high concentration of iodine in this medication. The purpose of this review is to assess the effects of thyroid hormones on the heart, and their clinical repercussions.
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71
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Lee SY, Rhee CM, Leung AM, Braverman LE, Brent GA, Pearce EN. A review: Radiographic iodinated contrast media-induced thyroid dysfunction. J Clin Endocrinol Metab 2015; 100:376-83. [PMID: 25375985 PMCID: PMC4318903 DOI: 10.1210/jc.2014-3292] [Citation(s) in RCA: 117] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2014] [Accepted: 10/30/2014] [Indexed: 12/17/2022]
Abstract
CONTEXT Thyroid hormone production is dependent on adequate iodine intake. Excess iodine is generally well-tolerated, but thyroid dysfunction can occur in susceptible individuals after excess iodine exposure. Radiological iodinated contrast media represent an increasingly common source of excess iodine. OBJECTIVE This review will discuss the thyroidal response after acute exposure to excess iodine; contrast iodine-induced thyroid dysfunction; risks of iodine-induced thyroid dysfunction in vulnerable populations, such as the fetus, neonate, and patients with impaired renal function; and recommendations for the assessment and treatment of contrast iodine-induced thyroid dysfunction. METHODS Data for this review were identified by searching PubMed, Google Scholar, and references from relevant articles from 1948 to 2014. CONCLUSIONS With the increase in the use of computed tomography scans in the United States, there is increasing risk of contrast-induced thyroid dysfunction. Patients at risk of developing iodine-induced thyroid dysfunction should be closely monitored after receiving iodinated contrast media and should be treated as needed.
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Affiliation(s)
| | | | - Angela M. Leung
- Section of Endocrinology, Diabetes, and Nutrition (S.Y.L., L.E.B., E.N.P.), Boston University School of Medicine, Boston, Massachusetts 02118; Division of Nephrology and Hypertension (C.M.R.), Department of Medicine, University of California Irvine, Orange, California 92868; and Division of Endocrinology (A.M.L., G.A.B.), Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California 90095
| | - Lewis E. Braverman
- Section of Endocrinology, Diabetes, and Nutrition (S.Y.L., L.E.B., E.N.P.), Boston University School of Medicine, Boston, Massachusetts 02118; Division of Nephrology and Hypertension (C.M.R.), Department of Medicine, University of California Irvine, Orange, California 92868; and Division of Endocrinology (A.M.L., G.A.B.), Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California 90095
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Hudzik B, Zubelewicz-Szkodzinska B. Amiodarone-related thyroid dysfunction. Intern Emerg Med 2014; 9:829-39. [PMID: 25348560 DOI: 10.1007/s11739-014-1140-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2014] [Accepted: 10/10/2014] [Indexed: 11/28/2022]
Abstract
Nowadays, amiodarone is the most commonly used antidysrhythmic drug in clinical practice. It is highly effective in the management of recurrent ventricular dysrhythmias, paroxysmal supraventricular dysrhythmias, including atrial fibrillation and flutter, and in the maintenance of sinus rhythm after electrical cardioversion of atrial fibrillation. Moreover, it has the added benefit of being well tolerated in patients with both normal and impaired left ventricular systolic function. Despite amiodarone's potent antidysrhythmic actions, its use is hampered by numerous adverse effects on various organs, including the thyroid. Adverse effects are becoming more prevalent given the increasing incidence of dysrhythmias and wider amiodarone use. Thus, physicians and patients should both be aware of the potential thyroid-specific sequelae. However, amiodarone is likely to remain a significant problem for endocrinologists as concerns exist over the use of the new alternative antiarrhythmic agent, dronedarone, especially in patients with heart failure and left ventricular dysfunction because of the risk of hepatic injury and increased mortality. The final diagnostic and therapeutic approaches must be discussed among the patient, the general practitioner, the cardiologist, and the endocrinologist.
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Affiliation(s)
- Bartosz Hudzik
- Third Department of Cardiology, Silesian Centre for Heart Disease, Medical University of Silesia, Curie-Sklodowska 9, 41-800, Zabrze, Poland,
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Effects of thyroid hormones on the heart. CLINICA E INVESTIGACION EN ARTERIOSCLEROSIS 2014; 26:296-309. [PMID: 25438971 DOI: 10.1016/j.arteri.2014.07.003] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/14/2014] [Revised: 07/25/2014] [Accepted: 07/25/2014] [Indexed: 01/07/2023]
Abstract
Thyroid hormones have a significant impact on heart function, mediated by genomic and non-genomic effects. Consequently, thyroid hormone deficiencies, as well as excesses, are expected to result in profound changes in cardiac function regulation and cardiovascular hemodynamics. Thyroid hormones upregulate the expression of the sarcoplasmic reticulum calcium-activated ATPase and downregulate the expression of phospholamban. Overall, hyperthyroidism is characterized by an increase in resting heart rate, blood volume, stroke volume, myocardial contractility, and ejection fraction. The development of "high-output heart failure" in hyperthyroidism may be due to "tachycardia-mediated cardiomyopathy". On the other hand, in a hypothyroid state, thyroid hormone deficiency results in lower heart rate and weakening of myocardial contraction and relaxation, with prolonged systolic and early diastolic times. Cardiac preload is decreased due to impaired diastolic function. Cardiac afterload is increased, and chronotropic and inotropic functions are reduced. Subclinical thyroid dysfunction is relatively common in patients over 65 years of age. In general, subclinical hypothyroidism increases the risk of coronary heart disease (CHD) mortality and CHD events, but not of total mortality. The risk of CHD mortality and atrial fibrillation (but not other outcomes) in subclinical hyperthyroidism is higher among patients with very low levels of thyrotropin. Finally, medications such as amiodarone may induce hypothyroidism (mediated by the Wolff-Chaikoff), as well as hyperthyroidism (mediated by the Jod-Basedow effect). In both instances, the underlying cause is the high concentration of iodine in this medication.
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74
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Thaker VV, Leung AM, Braverman LE, Brown RS, Levine B. Iodine-induced hypothyroidism in full-term infants with congenital heart disease: more common than currently appreciated? J Clin Endocrinol Metab 2014; 99:3521-6. [PMID: 25004248 PMCID: PMC4184078 DOI: 10.1210/jc.2014-1956] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2014] [Accepted: 06/25/2014] [Indexed: 11/19/2022]
Abstract
CONTEXT Iodine is a micronutrient essential for thyroid hormone synthesis. Thyroid hormone is critical for normal neurocognitive development in young infants, and even transient hypothyroidism can cause adverse neurodevelopmental outcomes. Both iodine deficiency and excess can cause hypothyroidism. Although iodine-induced hypothyroidism is well recognized in premature infants, full-term neonates have received less attention. Infants with congenital heart disease (CHD) are commonly exposed to excess iodine from administration of iodinated contrast agents during cardiac catheterization as well as topical application of iodine-containing antiseptics and dressings; hence, this is a vulnerable population. OBJECTIVE We report three cases of iodine-induced hypothyroidism in full-term neonates with CHD after cardiac angiography and topical application of iodine-containing antiseptics and dressings in the operative setting. RESULTS Three neonates with CHD and normal thyroid function at birth developed hypothyroidism after exposure to excess iodine. Two of these infants had transient hypothyroidism, and one had severe hypothyroidism requiring ongoing thyroid replacement therapy. All infants were asymptomatic, with hypothyroidism detected incidentally in the inpatient setting due to repeat newborn screening mandated by the long duration of hospitalization in these infants. CONCLUSIONS Iodine-induced hypothyroidism may be under-recognized in infants with CHD exposed to excess iodine. Systematic monitoring of thyroid function should be considered to avoid potential long-term adverse neurodevelopmental effects of even transient thyroid dysfunction in this susceptible population.
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Affiliation(s)
- V V Thaker
- Division of Endocrinology (V.V.T., R.S.B., B.L.), Boston Children's Hospital, Boston, Massachusetts 02115; Division of Endocrinology (A.M.L.), University of California-Los Angeles, David Geffen School of Medicine, Los Angeles, California 90095; and Section of Endocrinology, Diabetes, and Nutrition (L.E.B.), Boston University School of Medicine, Boston, Massachusetts 02118
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Abstract
Iodine insufficiency is now a prominent issue in the UK and other European countries due to low intakes of dairy products and seafood (especially where iodine fortification is not in place). In the present study, we tested a commercially available encapsulated edible seaweed (Napiers Hebridean Seagreens® Ascophyllum nodosum species) for its acceptability to consumers and iodine bioavailability and investigated the impact of a 2-week daily seaweed supplementation on iodine concentrations and thyroid function. Healthy non-pregnant women of childbearing age, self-reporting low dairy product and seafood consumption, with no history of thyroid or gastrointestinal disease were recruited. Seaweed iodine (712 μg, in 1 g seaweed) was modestly bioavailable at 33 (interquartile range (IQR) 28-46) % of the ingested iodine dose compared with 59 (IQR 46-74) % of iodine from the KI supplement (n 22). After supplement ingestion (2 weeks, 0·5 g seaweed daily, n 42), urinary iodine excretion increased from 78 (IQR 39-114) to 140 (IQR 103-195) μg/l (P< 0·001). The concentrations of thyroid-stimulating hormone increased from 1·5 (IQR 1·2-2·2) to 2·1 (IQR 1·3-2·9) mIU/l (P< 0·001), with two participants having concentrations exceeding the normal range after supplement ingestion (but normal free thyroxine concentrations). There was no change in the concentrations of other thyroid hormones after supplement ingestion. The seaweed was palatable and acceptable to consumers as a whole food or as a food ingredient and effective as a source of iodine in an iodine-insufficient population. In conclusion, seaweed inclusion in staple foods would serve as an alternative to fortification of salt or other foods with KI.
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76
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Pesce L, Kopp P. Iodide transport: implications for health and disease. INTERNATIONAL JOURNAL OF PEDIATRIC ENDOCRINOLOGY 2014; 2014:8. [PMID: 25009573 PMCID: PMC4089555 DOI: 10.1186/1687-9856-2014-8] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/18/2014] [Accepted: 05/22/2014] [Indexed: 12/15/2022]
Abstract
Disorders of the thyroid gland are among the most common conditions diagnosed and managed by pediatric endocrinologists. Thyroid hormone synthesis depends on normal iodide transport and knowledge of its regulation is fundamental to understand the etiology and management of congenital and acquired thyroid conditions such as hypothyroidism and hyperthyroidism. The ability of the thyroid to concentrate iodine is also widely used as a tool for the diagnosis of thyroid diseases and in the management and follow up of the most common type of endocrine cancers: papillary and follicular thyroid cancer. More recently, the regulation of iodide transport has also been the center of attention to improve the management of poorly differentiated thyroid cancer. Iodine deficiency disorders (goiter, impaired mental development) due to insufficient nutritional intake remain a universal public health problem. Thyroid function can also be influenced by medications that contain iodide or interfere with iodide metabolism such as iodinated contrast agents, povidone, lithium and amiodarone. In addition, some environmental pollutants such as perchlorate, thiocyanate and nitrates may affect iodide transport. Furthermore, nuclear accidents increase the risk of developing thyroid cancer and the therapy used to prevent exposure to these isotopes relies on the ability of the thyroid to concentrate iodine. The array of disorders involving iodide transport affect individuals during the whole life span and, if undiagnosed or improperly managed, they can have a profound impact on growth, metabolism, cognitive development and quality of life.
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Affiliation(s)
- Liuska Pesce
- Stead Family Department of Pediatrics, Division of Pediatric Endocrinology and Diabetes, University of Iowa Carver School of Medicine, Iowa City, Iowa 52242, USA
| | - Peter Kopp
- Department of Internal Medicine, Division of Endocrinology, Metabolism and Molecular Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois 60611, USA
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Andreucci M, Solomon R, Tasanarong A. Side effects of radiographic contrast media: pathogenesis, risk factors, and prevention. BIOMED RESEARCH INTERNATIONAL 2014; 2014:741018. [PMID: 24895606 PMCID: PMC4034507 DOI: 10.1155/2014/741018] [Citation(s) in RCA: 113] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/07/2014] [Accepted: 03/03/2014] [Indexed: 12/18/2022]
Abstract
Radiocontrast media (RCM) are medical drugs used to improve the visibility of internal organs and structures in X-ray based imaging techniques. They may have side effects ranging from itching to a life-threatening emergency, known as contrast-induced nephropathy (CIN). We define CIN as acute renal failure occurring within 24-72 hrs of exposure to RCM that cannot be attributed to other causes. It usually occurs in patients with preexisting renal impairment and diabetes. The mechanisms underlying CIN include reduction in medullary blood flow leading to hypoxia and direct tubule cell damage and the formation of reactive oxygen species. Identification of patients at high risk for CIN is important. We have reviewed the risk factors and procedures for prevention, providing a long list of references enabling readers a deep evaluation of them both. The first rule to follow in patients at risk of CIN undergoing radiographic procedure is monitoring renal function by measuring serum creatinine and calculating the eGFR before and once daily for 5 days after the procedure. It is advised to discontinue potentially nephrotoxic medications, to choose radiocontrast media at lowest dosage, and to encourage oral or intravenous hydration. In high-risk patients N-acetylcysteine may also be given.
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Affiliation(s)
- Michele Andreucci
- Nephrology Unit, Department of “Health Sciences”, Campus “Salvatore Venuta”, “Magna Graecia” University, Loc. Germaneto, 88100 Catanzaro, Italy
| | - Richard Solomon
- University of Vermont College of Medicine, Fletcher Allen Health Care, Burlington, VT, USA
| | - Adis Tasanarong
- Nephrology Unit, Department of Medicine, Faculty of Medicine, Thammasat University, Rangsit Campus, Khlong Luang, Pathum Thani 12121, Thailand
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Rosen JE, Gardiner P, Saper RB, Pearce EN, Hammer K, Gupta-Lawrence RL, Lee SL. Kelp use in patients with thyroid cancer. Endocrine 2014; 46:123-30. [PMID: 24573490 DOI: 10.1007/s12020-013-0048-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2013] [Accepted: 08/26/2013] [Indexed: 11/26/2022]
Abstract
To report on the incidence and use of kelp among patients with thyroid cancer. Data were collected using a web-based online anonymous survey under Institutional Review Board approval from Boston University. This report is based on 27 responses from subjects with thyroid cancer who use kelp. Demographic factors and complementary and alternative use were included. Respondents were primarily over age 40, white, female and have at least a high school education. The top five modalities were multivitamins, special diets, herbal supplements, prayer for health reasons and herbal tea. Only one patient reported perceiving a particular modality had a negative effect on treatment. Complementary and alternative medicine (CAM) was more often perceived as being used to aid their thyroid cancer treatment than to help with symptoms. On average, respondents who use kelp also use at least 11 additional CAM modalities. Only 1/2 of respondents who use kelp reported telling their physicians about their CAM use, and nearly 1/3 of respondents reported their CAM use was neither known, prescribed nor asked about by their physicians. In comparison to both national surveys of the general US population and patients with thyroid cancer, kelp users with thyroid cancer use at least twice the number of additional CAM therapies and report their use far less often. Physicians who treat patients with thyroid cancer should be aware of these data to further assist in their assessment and care.
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Affiliation(s)
- Jennifer E Rosen
- Department of Surgery, Boston University, 820 Harrison Avenue Suite 5007, Boston, MA, 02118, USA,
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Hudzik B, Zubelewicz-Szkodzińska B. Radiocontrast-induced thyroid dysfunction: is it common and what should we do about it? Clin Endocrinol (Oxf) 2014; 80:322-7. [PMID: 24283715 DOI: 10.1111/cen.12376] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2013] [Revised: 11/16/2013] [Accepted: 11/22/2013] [Indexed: 01/28/2023]
Abstract
There has been a substantial increase in the use of radiocontrast-enhanced imaging studies in the past two decades (particularly computed tomography and coronary angiography). Sudden exposure to high levels of iodide may result in thyroid dysfunction (hyperthyroidism and hypothyroidism alike). Although the adverse-event rate is not very high, the condition is notable considering the large number of contrast-enhanced radiographic studies performed. Clinicians often have to decide on the most suitable diagnostic modality and the safest contrast medium when it comes to certain patients. In this study, we stress that the thyroid function of the patients should also be taken into consideration while making such decisions. We discuss in detail the prevalence and types (hypothyroidism and hyperthyroidism) of radiocontrast-induced thyroid dysfunction. We list the subsets of the population that are at a higher risk of radiocontrast-induced thyroid dysfunction and summarize the necessary prophylaxis and possible treatment. The presented principles apply to intravenous, intra-arterial and enteral (endoscopic retrograde cholangiopancreatography) routes of iodinated contrast medium administration.
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Affiliation(s)
- Bartosz Hudzik
- Third Department of Cardiology, Silesian Centre for Heart Disease, Medical University of Silesia, Zabrze, Poland
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Bouhouch RR, Bouhouch S, Cherkaoui M, Aboussad A, Stinca S, Haldimann M, Andersson M, Zimmermann MB. Direct iodine supplementation of infants versus supplementation of their breastfeeding mothers: a double-blind, randomised, placebo-controlled trial. Lancet Diabetes Endocrinol 2014; 2:197-209. [PMID: 24622750 DOI: 10.1016/s2213-8587(13)70155-4] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND Iodine deficiency in infants can damage the developing brain and increase mortality. Present recommendations state that oral iodised oil should be given to breastfeeding mothers to correct iodine deficiency in infancy when iodised salt is not available, and that direct supplementation should be given to infants who are not being breastfed or receiving iodine-fortified complimentary foods. However, there is little evidence for these recommendations. We aimed to assess the safety and efficacy of direct versus indirect supplementation of the infant. METHODS We did this double blind, randomised, placebo-controlled trial in Morocco. Healthy breastfeeding mothers and their term newborn babies (aged ≤8 weeks) were block randomised by clinic day to receive either: one dose of 400 mg iodine to the mother and placebo to the infant (indirect infant supplementation), or one dose of about 100 mg iodine to the infant and placebo to the mother (direct infant supplementation). Randomisation was masked to participants and investigators. Coprimary outcomes were: maternal and infant urinary iodine concentrations, breastmilk iodine concentration, maternal and infant thyroid-stimulating hormone (TSH) concentrations, maternal and infant thyroxine (T4) concentrations, and infant growth. These outcomes were measured at baseline, and when infants were aged about 3 months, 6 months, and 9 months, and the two groups were compared using mixed effects models. This study is registered with ClinicalTrials.gov, number NCT01126125. FINDINGS We recruited 241 mother-infant pairs between Feb 25, and Aug 10, 2010, and completed data collection by Aug 6, 2011. At baseline, median urinary iodine concentration was 35 μg/L (IQR 29-40) in mothers and 73 μg/L (29-237) in infants, suggesting iodine deficiency. During the study, maternal urinary iodine concentration (p=0.011), breastmilk iodine concentration (p<0.0001), and infant urinary iodine concentration (p=0.042) were higher in the indirect infant supplementation group than in the direct supplementation group. Maternal TSH (p=0.276) and T4 (p=0.074) concentrations did not differ between the groups over the course of the study, nor did infant TSH (p=0.597) and T4 (p=0.184) concentrations, but the number of infants with thyroid hypofunction was lower (p=0.023) in the indirect supplementation group than the direct supplementation group. The infant groups did not differ in anthropomorphic measures, except that length-for-age Z score was slightly greater in the direct infant supplementation group (p=0.032). At 3 months and 6 months of age, median infant urinary iodine concentration in the indirect infant supplementation group was sufficient (>100 μg/L), whereas infant urinary iodine concentration was sufficient only at 6 months in the direct supplementation group. There were no serious adverse events in either group. INTERPRETATION In regions of moderate-to-severe iodine deficiency without effective salt iodisation, lactating women who receive one dose of 400 mg iodine as oral iodised oil soon after delivery can provide adequate iodine to their infants through breastmilk for at least 6 months, enabling the infants to achieve euthyroidism. Direct supplementation is less effective in improving infant iodine status. FUNDING ETH Zurich, Switzerland; the Medicor Foundation, Vaduz, Lichtenstein.
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Affiliation(s)
| | - Sabir Bouhouch
- Laboratory of Human Ecology, Faculty of Sciences Semlalia, University Cadi Ayyad Marrakesh, Morocco
| | - Mohamed Cherkaoui
- Laboratory of Human Ecology, Faculty of Sciences Semlalia, University Cadi Ayyad Marrakesh, Morocco
| | - Abdelmounaim Aboussad
- Mohammed VI University Hospital, Marrakesh, Morocco; Medical Faculty, University Cadi Ayyad, Marrakesh, Morocco
| | - Sara Stinca
- Laboratory of Human Nutrition, ETH Zurich, Zurich, Switzerland
| | - Max Haldimann
- Consumer Protection Directorate, Federal Office of Public Health, Bern, Switzerland
| | - Maria Andersson
- Laboratory of Human Nutrition, ETH Zurich, Zurich, Switzerland; The International Council for the Control of Iodine Deficiency Disorders Global Network, Zurich, Switzerland
| | - Michael B Zimmermann
- Laboratory of Human Nutrition, ETH Zurich, Zurich, Switzerland; The International Council for the Control of Iodine Deficiency Disorders Global Network, Zurich, Switzerland.
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A Case Report of Post-Operative Jöd-Basedow Phenomennon Following Oral and IV Iodine Contrast Administration. Case Rep Endocrinol 2014; 2014:980283. [PMID: 24716009 PMCID: PMC3970037 DOI: 10.1155/2014/980283] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2013] [Accepted: 01/06/2014] [Indexed: 11/17/2022] Open
Abstract
This is a case of thyrotoxicosis, due to the Jöd-Basedow phenomenon following administration of oral and IV iodinated contrast in a patient with history of gastrointestinal stromal tumor (GIST) and small bowel obstruction. The patient developed atrial fibrillation and had an extended stay in the intensive care unit. Given the aging population with possible subclinical hyperthyroidism, multinodular goiter, and the rise in contrast administration for routine diagnostic studies, this case serves to raise awareness of the risks of “routine” tests administered to our aging patient population.
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Chen AY, Bernet VJ, Carty SE, Davies TF, Ganly I, Inabnet WB, Shaha AR. American Thyroid Association statement on optimal surgical management of goiter. Thyroid 2014; 24:181-9. [PMID: 24295043 DOI: 10.1089/thy.2013.0291] [Citation(s) in RCA: 103] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Goiter, or benign enlargement of the thyroid gland, can be asymptomatic or can cause compression of surrounding structures such as the esophagus and/or trachea. The options for medical treatment of euthyroid goiter are short-lived and are limited to thyroxine hormone suppression and radioactive iodine ablation. The objective of this statement article is to discuss optimal surgical management of goiter. METHODS A task force was convened by the Surgical Affairs Committee of the American Thyroid Association and was tasked with writing of this article. RESULTS/CONCLUSIONS Surgical management is recommended for goiters with compressive symptoms. Symptoms of dyspnea, orthopnea, and dysphagia are more commonly associated with thyromegaly, in particular, substernal goiters. Several studies have demonstrated improved breathing and swallowing outcomes after thyroidectomy. With careful preoperative testing and thoughtful consideration of the type of anesthesia, including the type of intubation, preparation for surgery can be optimized. In addition, planning the extent of surgery and postoperative care are necessary to achieve optimal results. Close collaboration of an experienced surgical and anesthesia team is essential for induction and reversal of anesthesia. In addition, this team must be cognizant of complications from massive goiter surgery such as bleeding, airway distress, recurrent laryngeal nerve injury, and transient hypoparathyroidism. With careful preparation and teamwork, successful thyroid surgery can be achieved.
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Affiliation(s)
- Amy Y Chen
- 1 Division of Endocrine Surgery, Department of Otolaryngology-Head and Neck Surgery, Emory University School of Medicine , Atlanta, Georgia
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Aceves C, Anguiano B, Delgado G. The extrathyronine actions of iodine as antioxidant, apoptotic, and differentiation factor in various tissues. Thyroid 2013; 23:938-46. [PMID: 23607319 PMCID: PMC3752513 DOI: 10.1089/thy.2012.0579] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Seaweed is an important dietary component and a rich source of iodine in several chemical forms in Asian communities. Their high consumption of this element (25 times higher than in Western countries) has been associated with the low incidence of benign and cancerous breast and prostate disease in Japanese people. SUMMARY We review evidence showing that, in addition to being a component of the thyroid hormone, iodine can be an antioxidant as well as an antiproliferative and differentiation agent that helps to maintain the integrity of several organs with the ability to take up iodine. In animal and human studies, molecular iodine (I2) supplementation exerts a suppressive effect on the development and size of both benign and cancerous neoplasias. Investigations by several groups have demonstrated that these effects can be mediated by a variety of mechanisms and pathways, including direct actions, in which the oxidized iodine dissipates the mitochondrial membrane potential, thereby triggering mitochondrion-mediated apoptosis, and indirect effects through iodolipid formation and the activation of peroxisome proliferator-activated receptors type gamma, which, in turn, trigger apoptotic or differentiation pathways. CONCLUSIONS We propose that the International Council for the Control of Iodine Deficient Disorders recommend that iodine intake be increased to at least 3 mg/day of I2 in specific pathologies to obtain the potential extrathyroidal benefits described in the present review.
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Affiliation(s)
- Carmen Aceves
- Institute of Neurobiology, National Autonomous University of Mexico (UNAM), Juriquilla, Mexico.
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Edinboro CH, Pearce EN, Pino S, Braverman LE. Iodine concentration in commercial cat foods from three regions of the USA, 2008-2009. J Feline Med Surg 2013; 15:717-24. [PMID: 23439761 PMCID: PMC11191715 DOI: 10.1177/1098612x13477855] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/10/2024]
Abstract
Fluctuations in iodine concentration in food have been suggested as one risk factor for the development of feline hyperthyroidism, an epidemic disease first described in 1979. Three international studies have examined iodine concentrations of commercial cat foods. The iodine concentration of 112 commercial cat foods from across the USA was measured, and the daily iodine intake by hypothetical 4.5 kg adult cats or 1.4 kg kittens calculated in this descriptive epidemiologic study to examine differences in feline iodine intake due to (i) geographical source of foods, (ii) packaging type, (iii) brand-to-brand variation, (iv) form of iodine supplementation, (v) types and numbers of seafood ingredients and (vi) kitten and 'therapeutic' diets. Dramatic variation among canned foods (resulting in ingestion of approximately 49-9639 μg iodine/day) suggests that the disparity in iodine concentrations may lead to development of nodular hyperplasia and, later, clinical hyperthyroidism, if cats consume diets that are at first iodine-deficient and later contain excessive iodine. Manufacturers are encouraged to ensure adequate iodine supplementation across all products and areas of the USA.
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Zhang L, Teng W, Liu Y, Li J, Mao J, Fan C, Wang H, Zhang H, Shan Z. Effect of maternal excessive iodine intake on neurodevelopment and cognitive function in rat offspring. BMC Neurosci 2012; 13:121. [PMID: 23043431 PMCID: PMC3479063 DOI: 10.1186/1471-2202-13-121] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2012] [Accepted: 10/04/2012] [Indexed: 12/20/2022] Open
Abstract
Background Iodine deficiency and iodine excess are both associated with adverse health consequences. Iodine deficiency during pregnancy leads to insufficient maternal thyroid hormone, subsequently causing irreversible adverse effects on the neurological and cognitive functions of the offspring. The results of our previous epidemiological study suggested that mild iodine excess might increase the prevalence of subclinical hypothyroidism. In the present study, female Wistar rats maintained on low-iodine grain were randomly assigned to three groups based on iodated water concentration: low iodine (LI, 1.2 μg/d), normal iodine (NI, 5–6 μg/d), and 3-fold high iodine (3HI, 15–16 μg/d). The present study investigated whether higher-than-normal iodine intake (3HI) by rats from before pregnancy until breastfeeding affects the postnatal (PN) neurodevelopment (PN7 and PN45) of their offspring during particularly sensitive periods in brain development. Results After 12 weeks of treatment (before pregnancy), iodine concentrations in urine and thyroid tissue and circulating thyroxine of adult females correlated with iodine intake. Brain-derived neurotrophic factor (BDNF) expression in the hippocampi of pups on PN7 and PN45 was decreased in 3HI group compared to the NI controls (P < 0.05, all) On PN7 and PN45, the BDNF levels of the 3HI pups were 83.5% and 88.8%, respectively, that of the NI pups. In addition, the 3HI group had a higher neuroendocrine-specific protein A (NSP-A) level than the NI controls on PN7 (P < 0.05). NSP-A levels of the 3HI pups were 117.0% that of the NI pups. No significant difference was observed in the expressions of c-Fos or c-Jun in the hippocampal CA1 region of the 3HI group compared to the controls (P > 0.05). Results from the Morris water maze test revealed that pups of the 3HI group had mild learning and spatial memory deficits. Conclusions The neurodevelopmental and cognitive deficits of the 3HI pups were mild and temporary, likely related to the changes in hippocampal protein expressions of BDNF and NSP-A.
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Affiliation(s)
- Le Zhang
- Department of Endocrinology and Metabolism, First Affiliated Hospital of China Medical University, Shenyang 110001, People's Republic of China
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