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Pan J, Wang J, Zhao Y, Han B, Shu G, Ma M, Wang X, Wei X, Hou W, Sun SK. Real-time detection of gastrointestinal leaks via bismuth chelate-enhanced X-ray gastroenterography. Biomaterials 2024; 311:122646. [PMID: 38852553 DOI: 10.1016/j.biomaterials.2024.122646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Revised: 05/19/2024] [Accepted: 05/29/2024] [Indexed: 06/11/2024]
Abstract
Anastomotic leaks are among the most dreaded complications following gastrointestinal (GI) surgery, and contrast-enhanced X-ray gastroenterography is considered the preferred initial diagnostic method for GI leaks. However, from fundamental research to clinical practice, the only oral iodinated contrast agents currently available for GI leaks detection are facing several challenges, including low sensitivity, iodine allergy, and contraindications in patients with thyroid diseases. Herein, we propose a cinematic contrast-enhanced X-ray gastroenterography for the real-time detection of GI leaks with an iodine-free bismuth chelate (Bi-DTPA) for the first time. The Bi-DTPA, synthesized through a straightforward one-pot method, offers distinct advantages such as no need for purification, a nearly 100 % yield, large-scale production capability, and good biocompatibility. The remarkable X-ray attenuation properties of Bi-DTPA enable real-time dynamic visualization of whole GI tract under both X-ray gastroenterography and computed tomography (CT) imaging. More importantly, the leaky site and severity can be both clearly displayed during Bi-DTPA-enhanced gastroenterography in a rat model with esophageal leakage. The proposed movie-like Bi-DTPA-enhanced X-ray imaging approach presents a promising alternative to traditional GI radiography based on iodinated molecules. It demonstrates significant potential in addressing concerns related to iodine-associated adverse effects and offers an alternative method for visually detecting gastrointestinal leaks.
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Affiliation(s)
- Jinbin Pan
- Department of Radiology, Tianjin Key Laboratory of Functional Imaging, Tianjin Medical University General Hospital, Tianjin, 300052, China
| | - Jiaojiao Wang
- Department of Radiology, The Second Hospital of Tianjin Medical University, Tianjin, 300211, China
| | - Yujie Zhao
- Department of Radiology, Tianjin Key Laboratory of Functional Imaging, Tianjin Medical University General Hospital, Tianjin, 300052, China
| | - Bing Han
- Department of Radiology, Tianjin Key Laboratory of Functional Imaging, Tianjin Medical University General Hospital, Tianjin, 300052, China
| | - Gang Shu
- Department of Radiology, The Second Hospital of Tianjin Medical University, Tianjin, 300211, China
| | - Min Ma
- Department of Radiology, Tianjin Key Laboratory of Functional Imaging, Tianjin Medical University General Hospital, Tianjin, 300052, China
| | - Xu Wang
- Tianjin Key Laboratory of Technologies Enabling Development on Clinical Therapeutics and Diagnostics, School of Pharmacy, Tianjin Medical University, Tianjin, 300070, China
| | - Xi Wei
- Department of Diagnostic and Therapeutic Ultrasonography, Tianjin Key Laboratory of Digestive Cancer, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin, 300060, China
| | - Wenjing Hou
- Department of Diagnostic and Therapeutic Ultrasonography, Tianjin Key Laboratory of Digestive Cancer, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin, 300060, China.
| | - Shao-Kai Sun
- School of Medical Imaging, Tianjin Key Laboratory of Functional Imaging, Tianjin Medical University, Tianjin, 300203, China.
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Nakrour N, Neibling JE, Pathak A, Carbo A. Gastrointestinal pharmacoradiology, an updated review of medications and gastrointestinal contrasts in abdominal imaging. Abdom Radiol (NY) 2024:10.1007/s00261-024-04504-4. [PMID: 39225719 DOI: 10.1007/s00261-024-04504-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2024] [Revised: 07/15/2024] [Accepted: 07/16/2024] [Indexed: 09/04/2024]
Abstract
The purpose of this article is to review commonly used medications in abdominal radiology including their indications, mechanisms of action, dosages, contraindications, precautions, and adverse reactions. We will clarify common inquiries and address frequently asked questions by patients and clinicians related to their use. In addition, we will explore the indications, advantages and disadvantages, dosages, and contraindications of enteric contrast agents used for CT and fluoroscopic examinations.
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Affiliation(s)
- Nour Nakrour
- Department of Radiology, John D. Dingell VA Medical Center, Detroit, MI, USA.
| | - J E Neibling
- Department of Radiology, Wayne State University School of Medicine & Detroit Medical Center, Detroit, MI, USA
| | - Avani Pathak
- Michigan State University College of Osteopathic Medicine, East Lansing, MI, USA
| | - Alberto Carbo
- Department of Radiology, Ochsner- LSU Health, Shreveport, LA, USA
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3
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Zeng W, Tang J, Xu X, Zhang Y, Zeng L, Zhang Y, Liang Z, Xia C, Zhao L, Li Z. Safety of non-ionic contrast media in CT examinations for out-patients: retrospective multicenter analysis of 473,482 patients. Eur Radiol 2024; 34:5570-5577. [PMID: 38457038 DOI: 10.1007/s00330-024-10654-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 01/12/2024] [Accepted: 01/19/2024] [Indexed: 03/09/2024]
Abstract
OBJECTIVES This study aimed to explore the incidence of and potential risk factors for adverse drug reactions (ADRs) after non-ionic iodinated contrast media (NICM) administration for CT exams in out-patient settings in China. MATERIALS AND METHODS A total of 473,482 out-patients who underwent intravenous NICM between January 1st, 2017, and Dec 31st, 2021, were retrospectively enrolled from three institutions. The occurrence of ADRs and clinical information were recorded. Chi-square test, Poisson regression, and logistic regression analyses were used to evaluate potential ADR risk factors and correlation with demographics, season, and NICM type. RESULTS Among the 473,482 patients (mean age 55.22 ± 14.85; 253,499 male) who received intravenous NICM, the overall ADR incidence was 0.110% (522 of 473,482), with 0.099% acute-related drug reactions (469 of 473,482) and 0.0004% serious ADRs (two of 473,482). Iopromide was associated with a higher risk of acute ADRs. Late ADRs were more frequently observed with iodixanol 320. Multi-level logistic regression of patients with acute ADRs and a control group (matched 1:1 for age, gender, NICM, prescriber department, and institution) showed that summer (adjusted OR = 1.579; p = 0.035) and autumn (adjusted OR = 1.925; p < 0.001) were risk factors of acute ADRs. However, underlying disease and scanned body area were not related to a higher ADR incidence. CONCLUSION The use of NICM for out-patients is in general safe with a low ADR incidence. The type of contrast medium (iopromide) and the seasons (summer and autumn) were associated with a higher risk of acute ADRs. Late ADRs were more often observed with iodixanol. CLINICAL RELEVANCE STATEMENT In comparison to in-patients, out-patients may be exposed to higher risk due to a lack of extensive risk screening, less nursing care, and higher throughput pressure. Safety data about NICM from a large population may complement guidelines and avoid ambiguity. KEY POINTS • The incidence and risk factors for adverse events after using non-ionic iodinated contrast media are complex in out-patients. • Non-ionic iodinated contrast media are safe for out-patients and the overall incidence of adverse drug reactions was 0.110%. • There is a higher risk of acute adverse drug reactions in summer and autumn.
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Affiliation(s)
- Wen Zeng
- Department of Radiology, West China Hospital, Sichuan University, No. 37, Guoxue Lane, Wuhou District, Chengdu, 610041, Sichuan, China
| | - Jing Tang
- Department of Radiology, West China Hospital, Sichuan University, No. 37, Guoxue Lane, Wuhou District, Chengdu, 610041, Sichuan, China
| | - Xu Xu
- Department of Radiology, West China Hospital, Sichuan University, No. 37, Guoxue Lane, Wuhou District, Chengdu, 610041, Sichuan, China
| | - Yu Zhang
- Department of Radiology, West China Hospital, Sichuan University, No. 37, Guoxue Lane, Wuhou District, Chengdu, 610041, Sichuan, China
| | - Lingming Zeng
- Department of Radiology, West China Hospital, Sichuan University, No. 37, Guoxue Lane, Wuhou District, Chengdu, 610041, Sichuan, China
| | - Yiteng Zhang
- Department of Radiology, West China Hospital, Sichuan University, No. 37, Guoxue Lane, Wuhou District, Chengdu, 610041, Sichuan, China
| | - Zejun Liang
- Department of Radiology, West China Hospital, Sichuan University, No. 37, Guoxue Lane, Wuhou District, Chengdu, 610041, Sichuan, China
| | - Chunchao Xia
- Department of Radiology, West China Hospital, Sichuan University, No. 37, Guoxue Lane, Wuhou District, Chengdu, 610041, Sichuan, China
| | - Lihong Zhao
- Department of Radiology, West China Hospital, Sichuan University, No. 37, Guoxue Lane, Wuhou District, Chengdu, 610041, Sichuan, China.
| | - Zhenlin Li
- Department of Radiology, West China Hospital, Sichuan University, No. 37, Guoxue Lane, Wuhou District, Chengdu, 610041, Sichuan, China.
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Keestra SM, Van Welie N, Dreyer K, Van Eekelen R, Roseboom TJ, Oosterlaan J, Mol BW, Finken MJJ, Mijatovic V, Königs M. Neurodevelopmental outcomes of school-age children conceived after hysterosalpingography with oil-based or water-based iodinated contrast: long-term follow-up of a nationwide randomized controlled trial. Hum Reprod 2024:deae183. [PMID: 39198011 DOI: 10.1093/humrep/deae183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2023] [Revised: 06/18/2024] [Indexed: 09/01/2024] Open
Abstract
STUDY QUESTION Does preconceptional exposure to oil-based iodinated contrast media during hysterosalpingography (HSG) impact children's neurodevelopment compared with exposure to water-based alternatives? SUMMARY ANSWER Our study found no large-sized effects for neurodevelopment in children with preconceptional exposure to oil-based iodinated contrast media during HSG compared with water-based alternatives. WHAT IS KNOWN ALREADY HSG is widely used as a diagnostic tool in the female fertility work-up. Tubal flushing with oil-based iodinated contrast has been shown to enhance fertility outcomes in couples with unexplained infertility, increasing the chances of pregnancy and live birth compared with water-based alternatives. However, oil-based contrast contains higher doses of iodine and has a longer half-life, and concerns exist that iodinated contrast media can affect women's iodine status and cause temporary (sub)clinical hypothyroidism in mothers and/or foetuses. Considering that thyroid hormones are vital to embryonal and foetal brain development, oil-based contrast media use could increase the risk of impaired neurodevelopment in children conceived shortly after HSG. Here we examine neurodevelopmental outcomes in school-aged children conceived after HSG. STUDY DESIGN, SIZE, DURATION This is a long-term follow-up of the H2Oil trial in which oil-based or water-based contrast was used during HSG (Netherlands; 2012-2014; NTR3270). Of 369 children born <6 months after HSG in the study, we contacted the mothers of 140 children who gave consent to be contacted for follow-up. The follow-up study took place from January to July 2022 (NCT05168228). PARTICIPANTS/MATERIALS, SETTINGS, METHODS The study included 69 children aged 6-9 years who were conceived after HSG with oil-based (n = 42) or water-based contrast (n = 27). The assessments targeted intelligence (Wechsler Intelligence Scale for Children), neurocognitive outcomes (computerized neurocognitive tests), behavioural functioning (parent and teacher questionnaires), and academic performance. Linear regression models, adjusted for age, sex, and parental educational attainment were employed to compare groups. MAIN RESULTS AND THE ROLE OF CHANCE School-aged children born to mothers after oil-based contrast HSG did not significantly differ from children born to mothers after water-based contrast HSG, in regards to intelligence, neurocognitive functioning, behavioural functioning, or academic performance, with the exception of better performance for visuomotor integration functions in children exposed to oil-based contrast preconception. After exploratory correction for multiple comparisons, none of the group differences was statistically significant. LIMITATIONS, REASONS FOR CAUTION The small sample size of this follow-up study limited statistical power. This study provides evidence for the absence of large-sized differences between preconceptional exposure to the two contrast media types but does not rule out more subtle effects on neurodevelopment compared to naturally conceived children without preconceptional exposure to HSG. WIDER IMPLICATIONS OF THE FINDINGS This study contributes to our knowledge about the long-term effects of different types of iodinated contrast media used in fertility work-up, indicating that choosing oil-based over water-based iodinated contrast media is unlikely to have major effect on the long-term neurodevelopmental outcomes of children conceived shortly after HSG. However, further research should focus on the overall safety of iodine exposure during HSG, comparing children conceived after HSG to those conceived naturally as both types of contrast contain high amounts of iodine. STUDY FUNDING/COMPETING INTEREST(S) The original H2Oil randomized controlled trial was an investigator-initiated study that was funded by the two academic hospitals now merged into the Amsterdam University Medical Centre. The current follow-up study (Neuro-H2Oil) is funded through a research grant awarded to the authors by the Amsterdam Reproduction & Development (AR&D) research institute. S.K. is funded by a AMC MD/PhD Scholarship from the Amsterdam UMC. S.K. reports holding voluntary roles in the civil society organizations Universities Allied for Essential Medicines and People's Health Movement. V.M. reports receiving travel and speaker fees as well as research grants from Guerbet, Merck and Ferring. K.D. reports receiving travel and speaker fees as well as research grants from Guerbet. BWM is supported by a NHMRC Investigator grant (GNT1176437) and reports consultancy, travel support and research funding from Merck, consultancy for Organon and Norgine, and holding stock from ObsEva. The other authors report no conflict of interest. TRIAL REGISTRATION NUMBER NCT05168228.
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Affiliation(s)
- Sarai M Keestra
- Department of Paediatric Endocrinology, Emma Children's Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, Emma Children's Hospital, Amsterdam, The Netherlands
- Department of Epidemiology & Data Science, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Reproduction & Development Research Institute, Amsterdam UMC, Amsterdam, The Netherlands
| | - Nienke Van Welie
- Amsterdam Reproduction & Development Research Institute, Amsterdam UMC, Amsterdam, The Netherlands
- Department of Reproductive Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Kim Dreyer
- Amsterdam Reproduction & Development Research Institute, Amsterdam UMC, Amsterdam, The Netherlands
- Department of Reproductive Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Rik Van Eekelen
- Department of Epidemiology & Data Science, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Tessa J Roseboom
- Department of Epidemiology & Data Science, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Reproduction & Development Research Institute, Amsterdam UMC, Amsterdam, The Netherlands
- Department of Obstetrics & Gynaecology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Jaap Oosterlaan
- Amsterdam Reproduction & Development Research Institute, Amsterdam UMC, Amsterdam, The Netherlands
- Emma Neuroscience Group & Follow-Me Program, Emma Children's Hospital, Department of Pediatrics, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Ben W Mol
- Department of Obstetrics & Gynaecology, School of Clinical Sciences, Monash University, Melbourne, Australia
| | - Martijn J J Finken
- Department of Paediatric Endocrinology, Emma Children's Hospital, Amsterdam UMC, Vrije Universiteit Amsterdam, Emma Children's Hospital, Amsterdam, The Netherlands
- Amsterdam Reproduction & Development Research Institute, Amsterdam UMC, Amsterdam, The Netherlands
| | - Velja Mijatovic
- Amsterdam Reproduction & Development Research Institute, Amsterdam UMC, Amsterdam, The Netherlands
- Department of Reproductive Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Marsh Königs
- Amsterdam Reproduction & Development Research Institute, Amsterdam UMC, Amsterdam, The Netherlands
- Emma Neuroscience Group & Follow-Me Program, Emma Children's Hospital, Department of Pediatrics, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
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5
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Inoue K, Bashir MT, Warner AL, Ebrahimi R, Neverova NV, Currier JW, Sohn SY, Rhee CM, Lee ML, Leung AM. Cardiac Electrical And Structural Changes after Iodinated Contrast Media Administration: A Longitudinal Cohort Analysis. Thyroid 2024. [PMID: 39163054 DOI: 10.1089/thy.2024.0131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/21/2024]
Abstract
Background: Iodinated contrast is commonly used for radiological procedures, with one dose delivering several hundred-fold the daily requirements needed for normal thyroid hormone production. Risks of excess iodine include incident thyroid dysfunction, which is associated with adverse cardiac outcomes, yet there are no prospective studies investigating the changes in cardiac physiology following iodine contrast administration. This study was conducted to investigate the longitudinal relationships between the amount of iodinated contrast administration and changes in cardiac electrophysiology and structure. Methods: A longitudinal cohort study was conducted with prospectively enrolled participants who received iodine contrast for elective computed tomography or coronary angiography. Serum thyroid function tests, electrocardiograms (EKG), and transthoracic echocardiograms were obtained serially until 36 months. Trends of electrical and structural cardiac changes following iodine contrast administration were assessed using mixed effect models. Results: The cohort was composed of 129 patients (median age, 70 [interquartile range: 63, 75] years; 98% male). Larger amounts of iodine exposure were associated with increases in QRS and QTc durations and decreased ejection fraction (EF), and these associations were still observed for follow-up EF after additionally adjusting for baseline values (the high-iodine contrast group vs. the low-iodine contrast group, -4.23% [confidence interval, -7.66% to -0.79%]). Dose-response analyses also showed lower EF with larger amounts of iodine received; these trends were not significant for the EKG parameters studied. Conclusions: Over a period of up to 36 months, a larger amount of administered iodine contrast was associated with lower EF among participants. Further investigation is needed to elucidate the long-term trends of electrical and structural cardiac function after iodine contrast administration.
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Affiliation(s)
- Kosuke Inoue
- Department of Social Epidemiology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
- Hakubi Center, Kyoto University, Kyoto, Japan
| | - Muhammad T Bashir
- Research Service, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California, USA
| | - Alberta L Warner
- Division of Cardiology, Department of Medicine, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California, USA
- Division of Cardiology, Department of Medicine, University of California Los Angeles David Geffen School of Medicine, Los Angeles, California, USA
| | - Ramin Ebrahimi
- Division of Cardiology, Department of Medicine, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California, USA
- Division of Cardiology, Department of Medicine, University of California Los Angeles David Geffen School of Medicine, Los Angeles, California, USA
| | - Natalia V Neverova
- Division of Cardiology, Department of Medicine, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California, USA
- Division of Cardiology, Department of Medicine, University of California Los Angeles David Geffen School of Medicine, Los Angeles, California, USA
| | - Jesse W Currier
- Division of Cardiology, Department of Medicine, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California, USA
- Division of Cardiology, Department of Medicine, University of California Los Angeles David Geffen School of Medicine, Los Angeles, California, USA
| | - Seo Young Sohn
- Division of Endocrinology, Department of Internal Medicine, Myongji Hospital, Hanyang University College of Medicine, Goyang, South Korea
| | - Connie M Rhee
- Division of Nephrology, Department of Medicine, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California, USA
- Division of Nephrology, Department of Medicine, University of California Los Angeles David Geffen School of Medicine, Los Angeles, California, USA
| | - Martin L Lee
- Veterans Affairs Health Services Research & Development Center for the Study of Health Care Innovation, Implementation, and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
- Department of Biostatistics, University of California Los Angeles Fielding School of Public Health, Los Angeles, California, USA
| | - Angela M Leung
- Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California, USA
- Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, University of California Los Angeles David Geffen School of Medicine, Los Angeles, California, USA
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6
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Sohn SY, Inoue K, Rhee CM, Leung AM. Risks of Iodine Excess. Endocr Rev 2024:bnae019. [PMID: 38870258 DOI: 10.1210/endrev/bnae019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Revised: 06/04/2024] [Accepted: 06/12/2024] [Indexed: 06/15/2024]
Abstract
Iodine is a micronutrient that is required for thyroid hormone synthesis. The iodide cycle in thyroid hormone synthesis consists of a series of transport, oxidation, organification, and binding/coupling steps in thyroid follicular cells. Common sources of iodine include the consumption of an iodine-rich diet or iodine fortified foods, the administration of amiodarone, iodine-containing supplements, or iodinated contrast media, and other miscellaneous sources. Methods to assess population iodine status include the measurement of urinary iodine concentrations, blood thyroglobulin levels, prevalence of elevated neonatal TSH levels, and thyroid volume. Although excessive iodine intake or exposure is generally well tolerated, an acute iodine load may result in thyroid dysfunction (hypothyroidism or hyperthyroidism) in certain susceptible individuals due to the failure to escape from the Wolff-Chaikoff effect and to the Jod-Basedow phenomenon, respectively. In this review, we discuss the associations between excessive iodine intake or exposure, with particular focus on iodinated contrast media as a common source of excess iodine in healthcare settings, and risks of incident thyroid dysfunction. We also summarize the risks of iodine excess in vulnerable populations and review current guidelines regarding the screening and monitoring of iodinated contrast-induced thyroid dysfunction. Finally, we discuss the long-term potential nonthyroidal health risks associated with iodine excess and suggest the need for more data to define safe upper limits for iodine intake, particularly in high-risk populations.
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Affiliation(s)
- Seo Young Sohn
- Division of Endocrinology, Department of Internal Medicine, Myongji Hospital, Hanyang University College of Medicine, Goyang, South Korea
| | - Kosuke Inoue
- Department of Social Epidemiology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
- Hakubi Center, Kyoto University, Kyoto, Japan
| | - Connie M Rhee
- Division of Nephrology, Department of Medicine, Department of Medicine, University of California Los Angeles David Geffen School of Medicine, Los Angeles, California, USA
- Division of Nephrology, Department of Medicine, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California, USA
| | - Angela M Leung
- Division of Endocrinology, Diabetes, and Metabolism; Department of Medicine, University of California Los Angeles David Geffen School of Medicine, Los Angeles, California, USA
- Division of Endocrinology, Diabetes, and Metabolism; Department of Medicine, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California, USA
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7
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Rašiová M, Schlager O, Heiss C, Brodmann M, Olinic DM, Boc V, Buso G, Belch J, Mazzolai L, Madaric J. Adverse reactions after intravascular iodinated contrast media administration and their management. VASA 2024; 53:193-203. [PMID: 38651340 DOI: 10.1024/0301-1526/a001122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2024]
Abstract
Endovascular interventions and diagnostic examinations using iodinated contrast media (ICM) are standard of care in current vascular medicine. Although ICM use is generally considered safe, it may be associated with adverse reactions, vary from minor disturbances to rare, but severe life-threatening complications. This position paper of European Society of Vascular Medicine integrates current knowledge and summarizes the key information related to the use of intravascular ICM, serving as recommendation on prevention and management of acute, late, and very late adverse reactions. It should help the health professionals in all fields of vascular medicine to make decisions in daily practice for safe use of contrast media.
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Affiliation(s)
- Mária Rašiová
- Department of Angiology, Faculty of Medicine, University of Pavol Jozef Šafárik, East Slovak Institute of Cardiovascular Diseases, Kosice, Slovakia
| | - Oliver Schlager
- Division of Angiology, Department of Medicine II, Medical University of Vienna, Austria
| | - Christian Heiss
- Department of Clinical and Experimental Medicine, Faculty of Health and Medical Sciences, University of Surrey, Guildford, Vascular Department, Surrey and Sussex Healthcare NHS Trust, East Surrey Hospital, Redhill, United Kingdom
| | | | - Dan Mircea Olinic
- Department of Interventional Cardiology, Medical Clinic No. 1, Emergency County Hospital, Cluj-Napoca, Romania
| | - Vinko Boc
- Department of Vascular Diseases, University Medical Centre Ljubljana, Slovenia
| | - Giacomo Buso
- Department of Clinical and Experimental Sciences, Division of Internal Medicine, ASST Spedali Civili Brescia, University of Brescia, Italy
| | - Jill Belch
- Division of Molecular and Clinical Medicine, Institute of Cardiovascular Research, Ninewells Hospital and Medical School, Dundee, United Kingdom
| | - Lucia Mazzolai
- Angiology Division, Heart and Vessel Department, Lausanne University Hospital, University of Lausanne, Switzerland
| | - Juraj Madaric
- Department of Angiology, Comenius University and National Institute of Cardiovascular Diseases, Bratislava, Slovakia
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8
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Lang FM, Sajorda BJR, Pagan-Mendez M, Lowe H, Ali SR. Takotsubo cardiomyopathy as the primary manifestation of decompensated Graves' disease. J Cardiol Cases 2024; 29:178-181. [PMID: 38646084 PMCID: PMC11031651 DOI: 10.1016/j.jccase.2023.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 11/30/2023] [Accepted: 12/21/2023] [Indexed: 04/23/2024] Open
Abstract
Takotsubo cardiomyopathy (TCM) is characterized by transient left ventricular dysfunction with apical ballooning, usually observed in postmenopausal women after a stressful event. We discuss a rare presentation of TCM induced by thyrotoxicosis secondary to Graves' disease. This case raises interesting questions about the pathogenesis, diagnosis, and management of TCM. Learning objectives 1. To recognize hyperthyroidism as a possible etiology of takutsubo cardiomyopathy.2. To identify the effect of radioiodine contrast on diagnosis of some types of takutsubo cardiomyopathy.
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Affiliation(s)
- Frederick M. Lang
- Division of Cardiology, Department of Medicine, New York Presbyterian-Columbia University Irving Medical Center, New York, NY, USA
| | - Brian Joseph Revilla Sajorda
- Division of Cardiology, Department of Medicine, New York Presbyterian-Columbia University Irving Medical Center, New York, NY, USA
| | - Maria Pagan-Mendez
- Division of Endocrinology, Department of Medicine, New York Presbyterian-Columbia University Irving Medical Center, New York, NY, USA
| | - Hyesoo Lowe
- Division of Endocrinology, Department of Medicine, New York Presbyterian-Columbia University Irving Medical Center, New York, NY, USA
| | - Shah R. Ali
- Division of Cardiology, Department of Medicine, New York Presbyterian-Columbia University Irving Medical Center, New York, NY, USA
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9
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Gao R, Lyu X, Yang Y, Fu J, Zhao C, Guan H, Ma X. Evaluating the progression to abnormal thyrotropin in euthyroid preconception women: a population-based study. Thyroid Res 2024; 17:5. [PMID: 38462616 PMCID: PMC10926655 DOI: 10.1186/s13044-024-00192-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Accepted: 01/22/2024] [Indexed: 03/12/2024] Open
Abstract
BACKGROUND Abnormal preconception thyrotropin levels were associated with fecundability and adverse fetomaternal outcomes, however, little is known regarding the natural change of serum thyrotropin in euthyroid preconception women. Thus, we performed a population-based study to evaluate the progression to abnormal thyrotropin in euthyroid preconception women. METHODS This retrospective cohort study used data from the National Free Prepregnancy Checkups Project (NFPCP) collected between 2010 and 2020. Female Han Chinese participants aged 20-49 years who had two repeated NFPCP participations with a time interval of 1.5-3.0 years, confirmed non-pregnant status within this duration, and normal thyrotropin levels during their first participation were included for the analysis of thyrotropin abnormalities during the second NFPCP examination. Data were analyzed between June 1 and October 1, 2023. RESULTS This study included 186,095 euthyroid women of reproductive age (mean ± SD, 26.72 ± 4.70 years) whose preconception thyrotropin levels were between 0.37 and 4.87 mIU/L. The median follow-up time was 2.13 (IQR, 1.85-2.54) years. A total of 8,497 (4.57%) women developed abnormal thyrotropin, including 4,118 (2.21%) subnormal thyrotropin and 4,379 (2.35%) supranormal thyrotropin. Compared with the reference group (thyrotropin 1.01-2.00 mIU/L), the lower baseline thyrotropin group had greater risk of developing subnormal thyrotropin, and the higher baseline thyrotropin group had greater risk of developing supranormal thyrotropin. Moreover, the restricted cubic spline analysis revealed a U-shaped dose-response association of baseline thyrotropin levels or thyrotropin multiples of the median (MOM) levels against risk of subnormal thyrotropin in the follow-up, and a J-shaped dose-response association against risk of supranormal thyrotropin levels in the follow-up. We further found that baseline thyrotropin outside of 1.43-1.93 mIU/L or baseline thyrotropin MOM outside 0.59-1.36 would hava a higher risk of developing of abnormal thyrotropin. CONCLUSIONS Both low and high baseline thyrotropin were associated with a significantly increased risk of developing abnormal thyrotropin outcomes. The optimal preconception baseline thyrotropin levels may be between 1.43 mIU/L and 1.93 mIU/L or baseline thyrotropin MoM between 0.59 and 1.36 to minimize progression toward abnormal thyrotropin after 1.5-3.0 years. These findings may help with counseling of preconception thyroid function monitoring.
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Affiliation(s)
- Rili Gao
- Department of Endocrinology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
| | - Xinyi Lyu
- National Research Institute for Family Planning, Beijing, China
- National Human Genetic Resources Center, Beijing, China
- Graduate School of Peking Union Medical College, Beijing, China
| | - Ying Yang
- National Research Institute for Family Planning, Beijing, China
- National Human Genetic Resources Center, Beijing, China
- Graduate School of Peking Union Medical College, Beijing, China
| | - Jinrong Fu
- Department of Endocrinology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China
| | - Chuanyu Zhao
- National Research Institute for Family Planning, Beijing, China
- National Human Genetic Resources Center, Beijing, China
- Graduate School of Peking Union Medical College, Beijing, China
| | - Haixia Guan
- Department of Endocrinology, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Southern Medical University, Guangzhou, China.
| | - Xu Ma
- National Research Institute for Family Planning, Beijing, China.
- National Human Genetic Resources Center, Beijing, China.
- Graduate School of Peking Union Medical College, Beijing, China.
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Tani H, Hirashio S, Tsuda A, Tachiyama Y, Hara S, Masaki T. Renal dysfunction caused by severe hypothyroidism diagnosed by renal biopsy: a case report. CEN Case Rep 2024:10.1007/s13730-024-00853-7. [PMID: 38416371 DOI: 10.1007/s13730-024-00853-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 01/17/2024] [Indexed: 02/29/2024] Open
Abstract
There is a close relationship between thyroid dysfunction and renal dysfunction. However, thyroid dysfunction can unfortunately result in inaccurate measurements of serum creatinine and cystatin C levels. The chronic decrease in cardiac output due to hypothyroidism can reduce renal plasma flow (RPF) resulting in renal dysfunction. We report the case of a 36-year-old male in whom renal dysfunction detected during a company health check-up was found to be caused by severe hypothyroidism. His serum creatinine levels showed poor results, but serum cystatin C levels were within the normal range. The physician thus prioritized serum cystatin C for assessing the patient's renal function, and concluded that his renal function was normal. He subsequently visited our hospital, aged 36 years, for a comprehensive examination. His serum creatinine level was 1.88 mg/dL and his serum cystatin C level was 0.75 mg/dL, indicating an unusual discrepancy between the two measurements. The patient also presented with fatigue, suggesting hypothyroidism, and we therefore evaluated his thyroid function. His free thyroxine level was below the sensitivity of the assay, while his thyroid-stimulating hormone level was > 100 μIU/mL. A renal biopsy was performed to further explore the underlying cause of his renal dysfunction, which suggested that reduced RPF could be the leading cause of his renal ischemia, with no indications of chronic glomerulonephritis or other abnormalities. His hypothyroidism and renal function improved after thyroid hormone replacement therapy. Given the limited reports of renal biopsy tissue examination during the acute phase of hypothyroidism, the current case provides important information regarding the diagnosis of renal dysfunction in patients with hypothyroidism.
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Affiliation(s)
- Hiroki Tani
- Department of Nephrology, National Hospital Organization Hiroshima-Nishi Medical Center, 4‑1‑1 Kuba, Ootake, Hiroshima, 739‑0696, Japan
| | - Shuma Hirashio
- Department of Nephrology, National Hospital Organization Hiroshima-Nishi Medical Center, 4‑1‑1 Kuba, Ootake, Hiroshima, 739‑0696, Japan
- Department of Nephrology, Hiroshima University Hospital, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Akihiro Tsuda
- Department of Metabolism, Endocrinology and Molecular Medicine, Osaka Metropolitan University Graduate School of Medicine, Osaka 1-4-3, Asahi-machi, Abeno-ku, Osaka, 545-8585, Japan
| | - Yoshiro Tachiyama
- Department of Diagnostic Pathology, National Hospital Organization Hiroshima-Nishi Medical Center, 4‑1‑1 Kuba, Ootake, Hiroshima, 739‑0696, Japan
| | - Shigeo Hara
- Department of Diagnostic Pathology, Kobe City Medical Center General Hospital, 2-1-1 Minatojimaminamimachi, Chuo-ku, Kobe, Hyogo, 650-0047, Japan
| | - Takao Masaki
- Department of Nephrology, Hiroshima University Hospital, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan.
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11
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Saeed S, Niehoff JH, Boriesosdick J, Michael A, Woeltjen MM, Surov A, Moenninghoff C, Borggrefe J, Kroeger JR. Minimizing Contrast Media Dose in CT Pulmonary Angiography with Clinical Photon Counting Using High Pitch Technique. Acad Radiol 2024; 31:686-692. [PMID: 37393176 DOI: 10.1016/j.acra.2023.05.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 05/15/2023] [Accepted: 05/16/2023] [Indexed: 07/03/2023]
Abstract
RATIONALE AND OBJECTIVES To evaluate the potential to reduce the amount of iodinated contrast media (CM) for computer tomographic pulmonary angiography (CTPA) with a novel photon-counting-detector CT (PCCT). MATERIALS AND METHODS Overall, 105 patients referred for CTPA were retrospectively included in this study. CTPA was performed using bolus tracking and high-pitch dual-source scanning (FLASH mode) on a novel PCCT (Naeotom Alpha, Siemens Healthineers). CM (Accupaque 300, GE Healthcare) dose was lowered stepwise following the introduction of the new CT scanner. Thus, patients could be divided into 3 groups as follows: group 1, n = 29, 35 ml of CM; group 2, n = 62, 45 ml of CM and group 3, n = 14, 60 ml of CM. Four readers independently assessed the image quality (Likert-scale 1-5) and adequate assessment of the segmental pulmonary arteries. Additionally, the pulmonary arterial contrast opacification was measured. RESULTS The subjective image quality was rated highest in group 1 with 4.6 compared to 4.5 (group 2) and 4.1 (group 3) with a significant difference between groups 1 and 3 (p < 0.001) and between groups 2 and 3 (p = 0.003). In all groups, almost all segmental pulmonary arteries could be assessed adequately without significant differences (18.5 vs. 18.7 vs. 18.4). Mean attenuation in the pulmonary trunk did not differ significantly between groups 321 ± 92 HU versus 345 ± 93 HU versus 347 ± 88 HU (p = 0.69). CONCLUSION Significant CM dose reduction is possible without a reduction in image quality. PCCT enables diagnostic CTPA with 35 ml of CM.
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Affiliation(s)
- Saher Saeed
- Department of Radiology, Neuroradiology and Nuclear Medicine, Johannes Wesling University Hospital, Ruhr University Bochum, Bochum, Germany.
| | - Julius H Niehoff
- Department of Radiology, Neuroradiology and Nuclear Medicine, Johannes Wesling University Hospital, Ruhr University Bochum, Bochum, Germany
| | - Jan Boriesosdick
- Department of Radiology, Neuroradiology and Nuclear Medicine, Johannes Wesling University Hospital, Ruhr University Bochum, Bochum, Germany
| | - Arwed Michael
- Department of Radiology, Neuroradiology and Nuclear Medicine, Johannes Wesling University Hospital, Ruhr University Bochum, Bochum, Germany
| | - Matthias M Woeltjen
- Department of Radiology, Neuroradiology and Nuclear Medicine, Johannes Wesling University Hospital, Ruhr University Bochum, Bochum, Germany
| | - Alexey Surov
- Department of Radiology, Neuroradiology and Nuclear Medicine, Johannes Wesling University Hospital, Ruhr University Bochum, Bochum, Germany
| | - Christoph Moenninghoff
- Department of Radiology, Neuroradiology and Nuclear Medicine, Johannes Wesling University Hospital, Ruhr University Bochum, Bochum, Germany
| | - Jan Borggrefe
- Department of Radiology, Neuroradiology and Nuclear Medicine, Johannes Wesling University Hospital, Ruhr University Bochum, Bochum, Germany
| | - Jan Robert Kroeger
- Department of Radiology, Neuroradiology and Nuclear Medicine, Johannes Wesling University Hospital, Ruhr University Bochum, Bochum, Germany
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12
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Fontana F, Piacentino F, Gnesutta A, Macchi E, Coppola A, Saccomanno A, Gatta T, Recaldini C, Minenna M, Tamborini C, Dossi F, Ascenti V, Barbera S, Cicero G, Carcano G, Ascenti G, Castiglioni B, Venturini M. Transcatheter Aortic Valve Implantation (TAVI) Planning with Dual-Layer Spectral CT Using Virtual Monoenergetic Image (VMI) Reconstructions and 20 mL of Contrast Media. J Clin Med 2024; 13:524. [PMID: 38256659 PMCID: PMC10816911 DOI: 10.3390/jcm13020524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 01/13/2024] [Accepted: 01/15/2024] [Indexed: 01/24/2024] Open
Abstract
Transcatheter aortic valve implantation (TAVI) is a less invasive alternative to surgical implantation and its implementation is progressively increasing worldwide. We routinely perform pre-procedural aortic angiography CT to assess aortic dimensions and vascular anatomy. This study aims to evaluate the image quality of CTA for TAVI planning using dual-layer spectral CT, with virtual monoenergetic image reconstructions at 40 keV. Thirty-one patients underwent a CTA protocol with the injection of 20 mL of contrast media. Image quality was assessed by measuring the mean density in Hounsfield Units (HU), the signal-to-noise ratio, and the contrast-to-noise ratio in VMI reconstructions. Additionally, a blinded subjective analysis was conducted by two observers. The results showed significant enhancement at all sampled vascular levels with a gradual decrease in HU from proximal to distal regions. Favourable subjective ratings were given for all parameters, with greater variability in the evaluation of iliac axes. A significant negative correlation (p < 0.05) was observed between BMI and CA at all vascular levels, indicating reduced contrast enhancement with increasing BMI. Spectral CT, along with reducing iodine load, allows for obtaining high-quality images without a significant increase in noise. The reduction in iodine load can have positive implications in clinical practice, improving patient safety and resource efficiency.
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Affiliation(s)
- Federico Fontana
- Diagnostic and Interventional Radiology Unit, Circolo Hospital, ASST Sette Laghi, 21100 Varese, Italy; (F.F.); (A.G.); (E.M.); (A.S.); (T.G.); (C.R.); (M.V.)
- Postgraduate School of Radiology Technician, Insubria University, 21100 Varese, Italy;
| | - Filippo Piacentino
- Diagnostic and Interventional Radiology Unit, Circolo Hospital, ASST Sette Laghi, 21100 Varese, Italy; (F.F.); (A.G.); (E.M.); (A.S.); (T.G.); (C.R.); (M.V.)
| | - Aroa Gnesutta
- Diagnostic and Interventional Radiology Unit, Circolo Hospital, ASST Sette Laghi, 21100 Varese, Italy; (F.F.); (A.G.); (E.M.); (A.S.); (T.G.); (C.R.); (M.V.)
| | - Edoardo Macchi
- Diagnostic and Interventional Radiology Unit, Circolo Hospital, ASST Sette Laghi, 21100 Varese, Italy; (F.F.); (A.G.); (E.M.); (A.S.); (T.G.); (C.R.); (M.V.)
| | - Andrea Coppola
- Diagnostic and Interventional Radiology Unit, Circolo Hospital, ASST Sette Laghi, 21100 Varese, Italy; (F.F.); (A.G.); (E.M.); (A.S.); (T.G.); (C.R.); (M.V.)
| | - Angiola Saccomanno
- Diagnostic and Interventional Radiology Unit, Circolo Hospital, ASST Sette Laghi, 21100 Varese, Italy; (F.F.); (A.G.); (E.M.); (A.S.); (T.G.); (C.R.); (M.V.)
| | - Tonia Gatta
- Diagnostic and Interventional Radiology Unit, Circolo Hospital, ASST Sette Laghi, 21100 Varese, Italy; (F.F.); (A.G.); (E.M.); (A.S.); (T.G.); (C.R.); (M.V.)
| | - Chiara Recaldini
- Diagnostic and Interventional Radiology Unit, Circolo Hospital, ASST Sette Laghi, 21100 Varese, Italy; (F.F.); (A.G.); (E.M.); (A.S.); (T.G.); (C.R.); (M.V.)
| | - Manuela Minenna
- Postgraduate School of Radiology Technician, Insubria University, 21100 Varese, Italy;
| | - Claudio Tamborini
- Department of Cardiovascular Diseases, ASST Settelaghi, 21100 Varese, Italy; (C.T.); (F.D.); (B.C.)
| | - Filippo Dossi
- Department of Cardiovascular Diseases, ASST Settelaghi, 21100 Varese, Italy; (C.T.); (F.D.); (B.C.)
| | - Velio Ascenti
- Postgraduate School of Radiodiagnostics, Policlinico Universitario, University of Milan, 20133 Milano, Italy;
| | - Simone Barbera
- Diagnostic and Interventional Radiology Unit, Biomorf Department, University Hospital Messina, 98124 Messina, Italy; (S.B.); (G.C.); (G.A.)
| | - Giuseppe Cicero
- Diagnostic and Interventional Radiology Unit, Biomorf Department, University Hospital Messina, 98124 Messina, Italy; (S.B.); (G.C.); (G.A.)
| | - Giulio Carcano
- Department of Medicine and Technological Innovation, Insubria University, 21100 Varese, Italy;
| | - Giorgio Ascenti
- Diagnostic and Interventional Radiology Unit, Biomorf Department, University Hospital Messina, 98124 Messina, Italy; (S.B.); (G.C.); (G.A.)
| | - Battistina Castiglioni
- Department of Cardiovascular Diseases, ASST Settelaghi, 21100 Varese, Italy; (C.T.); (F.D.); (B.C.)
| | - Massimo Venturini
- Diagnostic and Interventional Radiology Unit, Circolo Hospital, ASST Sette Laghi, 21100 Varese, Italy; (F.F.); (A.G.); (E.M.); (A.S.); (T.G.); (C.R.); (M.V.)
- Department of Medicine and Technological Innovation, Insubria University, 21100 Varese, Italy;
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13
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Yu W, Wang Y, Ma L, Gou S, Fu P. Analysis of Thyroid Function in ANCA-Associated Vasculitis Patients with Renal Injury. J Pers Med 2024; 14:99. [PMID: 38248799 PMCID: PMC10817250 DOI: 10.3390/jpm14010099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 01/08/2024] [Accepted: 01/12/2024] [Indexed: 01/23/2024] Open
Abstract
BACKGROUND Previous studies indicated common thyroid dysfunction in various kidney diseases. This study aimed to investigate the thyroid function in patients with antineutrophil cytoplasmic antibody-associated vasculitis (AAV) with renal injury. METHODS Briefly, 174 patients diagnosed as having AAV with renal injury and without previous thyroid disease history were included in the retrospective and prospective study. The clinical parameters were collected and compared between different groups. RESULTS Of the patients included, 24 exhibited normal thyroid function, while 150 had thyroid dysfunction, including 55 (36.67%) with hypothyroidism. Those AAV patients with thyroid dysfunction showed different clinical parameters from those with normal thyroid function. The patients were followed up for a median of 68.6 (64.3; 72.8) months. Those with thyroid dysfunction were more prone to progressing to dialysis dependence compared to the group with normal thyroid function. Logistic regression analysis showed advanced age and decreased albumin as independent risk factors for thyroid dysfunction in patients with AAV. Survival analysis and multivariate Cox regression analysis showed that thyroid dysfunction was a risk factor for AAV patients with renal injury to progress to the endpoint of dialysis dependence. CONCLUSION Thyroid dysfunction, predominantly hypothyroidism, was commonly complicated in AAV patients with renal injury. AAV patients with thyroid dysfunction were presented with different clinical parameters and more prone to progressing to dialysis dependence compared to those with normal thyroid function.
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Affiliation(s)
- Wenhui Yu
- Department of Nephrology, Kidney Research Institute, West China Hospital of Sichuan University, Chengdu 610041, China; (W.Y.); (L.M.); (P.F.)
| | - Yuelan Wang
- Renal Division, Department of Medicine, Chengdu Second People’s Hospital, Chengdu 610041, China;
| | - Liang Ma
- Department of Nephrology, Kidney Research Institute, West China Hospital of Sichuan University, Chengdu 610041, China; (W.Y.); (L.M.); (P.F.)
| | - Shenju Gou
- Department of Nephrology, Kidney Research Institute, West China Hospital of Sichuan University, Chengdu 610041, China; (W.Y.); (L.M.); (P.F.)
- Department of Nephrology, West China Tianfu Hospital of Sichuan University, Chengdu 610200, China
| | - Ping Fu
- Department of Nephrology, Kidney Research Institute, West China Hospital of Sichuan University, Chengdu 610041, China; (W.Y.); (L.M.); (P.F.)
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14
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Bardo DME, Samis JH, Josefson JL, Malakooti MR, Tannous P, Fox JL, Elhadary J, Eichstaedt A, Gray K, Nytko A, Rigsby CK. One children's hospital planning and development process to adhere to the FDA recommendation that babies and young children undergo thyroid function testing after receiving an injection of iodine-containing contrast media for medical imaging. Pediatr Radiol 2024; 54:27-33. [PMID: 38030850 DOI: 10.1007/s00247-023-05806-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Revised: 10/30/2023] [Accepted: 10/31/2023] [Indexed: 12/01/2023]
Abstract
The United States (US) Food and Drug Administration (FDA) has issued multiple statements and guidelines since 2015 on the topic of thyroid function testing in babies and children through 3 years old after receiving iodinated contrast media for medical imaging exams. In April 2023, the FDA adjusted this recommendation to target babies and young children younger than 4 years of age who have a history of prematurity, very low birth weight, or underlying conditions which affect thyroid gland function, largely in response to solid arguments from expert statements from the American College of Radiology (ACR) which is endorsed by the Society for Pediatric Radiology (SPR), Pediatric Endocrinology Society (PES), and the Society for Cardiovascular Angiography & Intervention (SCAI). Herein we describe our approach and development of a clinical care guideline along with the steps necessary for implementation of the plan including alterations in ordering exams requiring iodinated contrast media, automatic triggering of lab orders, reporting, and follow-up, to address the 2022 FDA guidance statement to monitor thyroid function in children after receiving iodinated contrast media. The newly implemented clinical care guideline at Ann and Robert H. Lurie Children's Hospital of Chicago remains applicable following the 2023 updated recommendation from the FDA. We will track patients less than 3 months of age who undergo thyroid function testing following computed tomography (CT), interventional radiology, and cardiac catheterization exams for which an iodinated contrast media is administered as a clinical care quality initiative.
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Affiliation(s)
- Dianna M E Bardo
- Department of Medical Imaging, Ann & Robert H. Lurie Children's Hospital of Chicago, 225 East Chicago Ave., Box 9, Chicago, IL, 60611-2605, USA.
| | - Jill H Samis
- Department of Pediatric Endocrinology, Ann & Robert H. Lurie Children's Hospital of Chicago, 225 East Chicago Ave., Chicago, IL, 60611-2605, USA
| | - Jami L Josefson
- Department of Pediatric Endocrinology, Ann & Robert H. Lurie Children's Hospital of Chicago, 225 East Chicago Ave., Chicago, IL, 60611-2605, USA
| | - Marcelo R Malakooti
- Hospital Operations, Ann & Robert H. Lurie Children's Hospital of Chicago, 225 East Chicago Ave., Chicago, IL, 60611-2605, USA
| | - Paul Tannous
- Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, 225 East Chicago Ave., Chicago, IL, 60611-2605, USA
| | - Jeremy L Fox
- Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, 225 East Chicago Ave., Chicago, IL, 60611-2605, USA
| | - Jennifer Elhadary
- Patient Care & Nursing Administration, Ann & Robert H. Lurie Children's Hospital of Chicago, 225 East Chicago Ave., Chicago, IL, 60611-2605, USA
| | - Amanda Eichstaedt
- Department of Nursing, Ann & Robert H. Lurie Children's Hospital of Chicago, 225 East Chicago Ave., Chicago, IL, 60611-2605, USA
| | - Kenneth Gray
- Medical Center Services, Ann & Robert H. Lurie Children's Hospital of Chicago, 225 East Chicago Ave., Chicago, IL, 60611-2605, USA
| | - Agata Nytko
- Center for Quality and Safety, Ann & Robert H. Lurie Children's Hospital of Chicago, 225 East Chicago Ave., Chicago, IL, 60611-2605, USA
| | - Cynthia K Rigsby
- Department of Medical Imaging, Ann & Robert H. Lurie Children's Hospital of Chicago, 225 East Chicago Ave., Box 9, Chicago, IL, 60611-2605, USA
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15
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Owens TC, Anton N, Attia MF. CT and X-ray contrast agents: Current clinical challenges and the future of contrast. Acta Biomater 2023; 171:19-36. [PMID: 37739244 DOI: 10.1016/j.actbio.2023.09.027] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Revised: 09/05/2023] [Accepted: 09/17/2023] [Indexed: 09/24/2023]
Abstract
Computed tomography (CT) is a powerful and widely used imaging technique in modern medicine. However, it often requires the use of contrast agents to visualize structures with similar radiographic density. Unfortunately, current clinical contrast agents (CAs) for CT have remained largely unchanged for decades and come with several significant drawbacks, including serious nephrotoxicity and short circulation half-lives. The next generation of CT radiocontrast agents should strive to be long-circulating, non-toxic, and non-immunogenic. Nanoparticle contrast agents have shown promise in recent years and are likely to comprise the majority of next-generation CT contrast agents. This review highlights the fundamental mechanism and background of X-ray and contrast agents. It also focuses on the challenges associated with current clinical contrast agents and provides a brief overview of potential future agents that are based on various materials such as lipids, polymers, dendrimers, metallic, and non-metallic inorganic nanoparticles (NPs). STATEMENT OF SIGNIFICANCE: We realized a need for clarification on a number of concerns related to the use of iodinated contrast material as debates regarding the safety of these agents with patients with kidney disease, shellfish allergies, and thyroid dysfunction remain ongoing in medical practice. This review was partially inspired by debates witnessed in medical practice regarding outdated misconceptions of contrast material that warrant clarification in translational and clinical arenas. Given that conversation around currently available agents is at somewhat of a high water mark, and nanoparticle research has now reached an unprecedented number of readers, we find that this review is timely and unique in the context of recent discussions in the field.
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Affiliation(s)
- Tyler C Owens
- Center for Nanotechnology in Drug Delivery and Division of Pharmacoengineering and Molecular Pharmaceutics, Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, NC 27599, USA.
| | - Nicolas Anton
- Université de Strasbourg, INSERM, Regenerative Nanomedicine UMR 1260, Centre de Recherche en Biomédecine de Strasbourg (CRBS), F-67000 Strasbourg, France
| | - Mohamed F Attia
- Center for Nanotechnology in Drug Delivery and Division of Pharmacoengineering and Molecular Pharmaceutics, Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, NC 27599, USA.
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16
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Huang L, Luo Y, Chen ZL, Yang ZY, Wu Y. Thyroid dysfunction associated with iodine-contrast media: A real-world pharmacovigilance study based on the FDA adverse event reporting system. Heliyon 2023; 9:e21694. [PMID: 37954365 PMCID: PMC10638017 DOI: 10.1016/j.heliyon.2023.e21694] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 09/09/2023] [Accepted: 10/25/2023] [Indexed: 11/14/2023] Open
Abstract
Objective To comprehensively analyze characteristics of thyroid dysfunction associated with iodine contrast media (ICM) based on data from the FDA adverse event reporting system (FAERS). Methods Disproportionate analysis was employed to identify signals of thyroid dysfunction caused by ICM, and descriptive analysis was performed to examine the clinical characteristics of reported cases involving ICM-related thyroid dysfunctions. Results A total of 83 adverse event reports were identified, documenting thyroid dysfunctions associated with ICM agents. Treatment with ICM was significantly associated with higher reporting of hypothyroidism ([ROR] = 2.21, 95 % CI: 1.59-3.08; IC025 = 0.58) and hyperthyroidism (ROR = 3.49, 95 % CI: 2.37-5.13; IC025 = 1.14). Among the six ICM agents investigated, iodixanol demonstrated the highest signal strength in both hypothyroidism (ROR = 9.47) and hyperthyroidism (ROR = 5.44). Hypothyroidism and hyperthyroidism almost occurred in the first 30 days after ICM administration (76.9 % and 70 % of patients, respectively). Furthermore, the proportion of severe outcomes in hyperthyroidism was significantly higher than that in hypothyroidism (12/26 vs. 2/35, P = 0.009). Conclusion The present study highlights the varying risks of thyroid dysfunction associated with different ICM agents, with iodixanol exhibiting the highest signal intensity. Hypothyroidism and hyperthyroidism associated with ICM generally manifest within the first month following administration. Consequently, monitoring of thyroid function during this period is strongly recommended for ICM agents presenting higher risk profiles.
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Affiliation(s)
- Lu Huang
- Department of Pharmacy, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
- Personalized Drug Therapy Key Laboratory of Sichuan Province, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
- Department of Pharmacy, People's Hospital of Fushun County, Fushun, China
| | - Yan Luo
- Department of Pharmacy, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
- Personalized Drug Therapy Key Laboratory of Sichuan Province, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
- Department of Pharmacy, Chengdu Seventh People's Hospital, Chengdu, China
| | - Zhen-Lin Chen
- Department of Pharmacy, People's Hospital of Fushun County, Fushun, China
| | - Zhi-Yun Yang
- Department of Pharmacy, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Institute for Rational and Safe Medication Practices, Central South University, Changsha, China
| | - Yue Wu
- Department of Pharmacy, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
- Personalized Drug Therapy Key Laboratory of Sichuan Province, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
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Rhee CM, You AS, Narasaki Y, Brent GA, Sim JJ, Kovesdy CP, Kalantar-Zadeh K, Nguyen DV. Development and Validation of a Prediction Model for Incident Hypothyroidism in a National Chronic Kidney Disease Cohort. J Clin Endocrinol Metab 2023; 108:e1374-e1383. [PMID: 37186674 PMCID: PMC11009786 DOI: 10.1210/clinem/dgad261] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 04/15/2023] [Accepted: 05/09/2023] [Indexed: 05/17/2023]
Abstract
CONTEXT Hypothyroidism is a common yet under-recognized condition in patients with chronic kidney disease (CKD), which may lead to end-organ complications if left untreated. OBJECTIVE We developed a prediction tool to identify CKD patients at risk for incident hypothyroidism. METHODS Among 15 642 patients with stages 4 to 5 CKD without evidence of pre-existing thyroid disease, we developed and validated a risk prediction tool for the development of incident hypothyroidism (defined as thyrotropin [TSH] > 5.0 mIU/L) using the Optum Labs Data Warehouse, which contains de-identified administrative claims, including medical and pharmacy claims and enrollment records for commercial and Medicare Advantage enrollees as well as electronic health record data. Patients were divided into a two-thirds development set and a one-third validation set. Prediction models were developed using Cox models to estimate probability of incident hypothyroidism. RESULTS There were 1650 (11%) cases of incident hypothyroidism during a median follow-up of 3.4 years. Characteristics associated with hypothyroidism included older age, White race, higher body mass index, low serum albumin, higher baseline TSH, hypertension, congestive heart failure, exposure to iodinated contrast via angiogram or computed tomography scan, and amiodarone use. Model discrimination was good with similar C-statistics in the development and validation datasets: 0.77 (95% CI 0.75-0.78) and 0.76 (95% CI 0.74-0.78), respectively. Model goodness-of-fit tests showed adequate fit in the overall cohort (P = .47) as well as in a subcohort of patients with stage 5 CKD (P = .33). CONCLUSION In a national cohort of CKD patients, we developed a clinical prediction tool identifying those at risk for incident hypothyroidism to inform prioritized screening, monitoring, and treatment in this population.
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Affiliation(s)
- Connie M Rhee
- Division of Nephrology, Hypertension, and Kidney Transplantation, University of California Irvine, Orange, CA 92868, USA
- Southern California Institute for Research and Education, Tibor Rubin Veterans Affairs Medical Center, Long Beach, CA 90822, USA
| | - Amy S You
- Division of Nephrology, Hypertension, and Kidney Transplantation, University of California Irvine, Orange, CA 92868, USA
- Southern California Institute for Research and Education, Tibor Rubin Veterans Affairs Medical Center, Long Beach, CA 90822, USA
| | - Yoko Narasaki
- Division of Nephrology, Hypertension, and Kidney Transplantation, University of California Irvine, Orange, CA 92868, USA
- Southern California Institute for Research and Education, Tibor Rubin Veterans Affairs Medical Center, Long Beach, CA 90822, USA
| | - Gregory A Brent
- Division of Endocrinology, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, CA 90095, USA
- Department of Medicine, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA 90073, USA
| | - John J Sim
- Division of Nephrology, Kaiser Permanente Southern California, Los Angeles, CA 90027, USA
| | - Csaba P Kovesdy
- Division of Nephrology, University of Tennessee Health Science Center, Memphis, TN 38104, USA
- Section of Nephrology, Memphis Veterans Affairs Medical Center, Memphis, TN 38104, USA
| | - Kamyar Kalantar-Zadeh
- Division of Nephrology, Hypertension, and Kidney Transplantation, University of California Irvine, Orange, CA 92868, USA
- Southern California Institute for Research and Education, Tibor Rubin Veterans Affairs Medical Center, Long Beach, CA 90822, USA
- Division of Nephrology and Hypertension, Harbor-UCLA Medical Center, Torrance, CA 90502, USA
| | - Danh V Nguyen
- Division of General Internal Medicine and Primary Care, University of California Irvine, Orange, CA 92868, USA
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Inoue K, Guo R, Lee ML, Neverova NV, Ebrahimi R, Currier JW, Bashir MT, Leung AM. Iodine-Induced Hypothyroidism and Long-Term Risks of Incident Heart Failure. J Am Heart Assoc 2023; 12:e030511. [PMID: 37815042 PMCID: PMC10757548 DOI: 10.1161/jaha.123.030511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 09/07/2023] [Indexed: 10/11/2023]
Abstract
Background Although most individuals can adapt to a large iodine load and remain euthyroid, hypothyroidism can develop after iodine exposure. Hypothyroidism is associated with adverse cardiovascular consequences, including heart failure. This study was performed to investigate the relationships between iodine-induced hypothyroidism and incident heart failure. Methods and Results This cohort study of the US Veterans Health Administration (1998-2021) included adults aged ≥18 years with a serum thyroid-stimulating hormone (thyrotropin) <60 days of iodine contrast administration, and <1 year of a baseline normal serum thyroid-stimulating hormone. Cox proportional hazards regression ascertained risk of incident heart failure following iodine-induced hypothyroidism, adjusting for age, sex, race and ethnicity, body mass index, and history of coronary heart disease, dyslipidemia, diabetes, and hypertension. Of 45 470 veterans (mean±SD age, 61.1±14.1 years; 88% men), 3361 (7.4%) developed iodine-induced hypothyroidism. Heart failure developed in 5685 (12.5%) individuals over a median follow-up of 3.6 years (interquartile range, 1.9-7.2 years). Adjusted for risk factors, iodine-induced hypothyroidism was associated with increased risk of heart failure, compared with those who remained euthyroid after iodine exposure (adjusted hazard ratio [HR], 1.11 [95% CI, 1.01-1.22]). Women were at greater risk than men (adjusted HR: women, 1.65 [95% CI, 1.13-2.40]; men, 1.08 [95% CI, 0.98-1.19]; P for interaction, 0.02). Conclusions In the largest US study of this topic, hypothyroidism following iodine exposure was associated with an increased risk of incident heart failure, particularly in women. These findings support the need for further research to address the clinical significance of this issue, including the possible sex-specific risks of incident heart failure in more diverse data sets and study populations.
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Affiliation(s)
- Kosuke Inoue
- Department of Social Epidemiology, Graduate School of MedicineKyoto UniversityKyotoJapan
| | - Rong Guo
- Research ServiceVeterans Affairs Greater Los Angeles Healthcare SystemLos AngelesCAUSA
- Division of General Internal Medicine and Health Services Research, Department of MedicineUniversity of California Los Angeles David Geffen School of MedicineLos AngelesCAUSA
| | - Martin L. Lee
- Veterans Affairs Health Services Research and Development Center for the Study of Health Care Innovation, Implementation, and Policy, Veterans Affairs Greater Los Angeles Healthcare SystemCALos AngelesUSA
- Department of BiostatisticsUniversity of California Los Angeles Fielding School of Public HealthLos AngelesCAUSA
| | - Natalia V. Neverova
- Division of Cardiology, Department of MedicineVeterans Affairs Greater Los Angeles Healthcare SystemLos AngelesCAUSA
- Division of Cardiology, Department of MedicineUniversity of California Los Angeles David Geffen School of MedicineLos AngelesCAUSA
| | - Ramin Ebrahimi
- Division of Cardiology, Department of MedicineVeterans Affairs Greater Los Angeles Healthcare SystemLos AngelesCAUSA
- Division of Cardiology, Department of MedicineUniversity of California Los Angeles David Geffen School of MedicineLos AngelesCAUSA
| | - Jesse W. Currier
- Division of Cardiology, Department of MedicineVeterans Affairs Greater Los Angeles Healthcare SystemLos AngelesCAUSA
- Division of Cardiology, Department of MedicineUniversity of California Los Angeles David Geffen School of MedicineLos AngelesCAUSA
| | - Muhammad T. Bashir
- Research ServiceVeterans Affairs Greater Los Angeles Healthcare SystemLos AngelesCAUSA
| | - Angela M. Leung
- Division of Endocrinology, Diabetes, and Metabolism, Department of MedicineVeterans Affairs Greater Los Angeles Healthcare SystemLos AngelesCAUSA
- Division of Endocrinology, Diabetes, and Metabolism, Department of MedicineUniversity of California Los Angeles David Geffen School of MedicineLos AngelesCAUSA
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Daowtak K, Pilapong C, Tochaikul G, Moonkum N. Effect of iodinated contrast media on peripheral blood mononuclear cells in terms of cell viability, cell cycle and oxidative stress in an in vitro system. Toxicol Mech Methods 2023; 33:667-674. [PMID: 37403420 DOI: 10.1080/15376516.2023.2230486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 06/19/2023] [Accepted: 06/20/2023] [Indexed: 07/06/2023]
Abstract
Iodine contrast agents are essential for diagnostic purposes in radiology and have significant medical benefits. However, they pose a risk of causing allergic reactions or adverse cellular effects. In this study, we examine the in vitro effects of iodine contrast agents (Iopamiro 370, Ultravist 370, Visipaque 320, and Optiray 350) on cellular functions of human peripheral blood mononuclear. The findings reveal that a concentration of 50 mgI/ml of iodine contrast agents causes a 50% reduction in cell viability, but lower concentrations of 2.5, 5.0, and 10.0 mgI/ml do not affect the cell cycle. Furthermore, the contrast agents decrease oxidative stress levels in cells. In conclusion, this study demonstrates that iodine contrast agents can be used safely in appropriate concentrations for diagnostic purposes without affecting the cell cycle and preventing oxidative stress on normal cells. The insights gained from this study could aid in the development of diagnostic contrast agents in the future of medicine.
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Affiliation(s)
- Krai Daowtak
- Department of Medical Technology, Naresuan University, Phitsanulok, Thailand
| | - Chalermchai Pilapong
- Department of Radiologic Technology, Chiang Mai University, Chiang Mai, Thailand
| | | | - Nutthapong Moonkum
- Faculty of Radiological Technology, Rangsit University, Patumthani, Thailand
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20
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Spahia N, Rroji M, Barbullushi M, Spasovski G. Subclinical Hypothyroidism, Kidney, and Heart from Normal to Uremic Milieu. Metab Syndr Relat Disord 2023; 21:415-425. [PMID: 37433213 DOI: 10.1089/met.2023.0057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/13/2023] Open
Abstract
Thyroid hormone (TH) imbalances, particularly subclinical hypothyroidism (SCHT), are associated with chronic kidney disease (CKD) and end-stage kidney disease (ESKD). SCHT is more prevalent in CKD and ESKD patients than in the general population, and this condition increases the risk of cardiovascular disease (CVD) morbidity and mortality. The risk of CVD is higher in CKD and ESKD patients compared with the general population. Traditional and nontraditional risk factors, including TH abnormalities, contribute to the high CVD burden in CKD and ESKD patients. The review discusses the link between CKD and hypothyroidism, with a focus on SCHT, and the mechanisms that lead to CVD burden.
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Affiliation(s)
- Nereida Spahia
- Department of Nephrology, University Hospital Center "Mother Teresa," Tirana, Albania
| | - Merita Rroji
- Department of Nephrology, University Hospital Center "Mother Teresa," Tirana, Albania
| | - Myftar Barbullushi
- Department of Nephrology, University Hospital Center "Mother Teresa," Tirana, Albania
| | - Goce Spasovski
- Department of Nephrology, Medical Faculty, University Sts. Cyril and Methodius, Skopje, North Macedonia
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21
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Inoue K, Guo R, Lee ML, Ebrahimi R, Neverova NV, Currier JW, Bashir MT, Leung AM. Iodine-Induced Hyperthyroidism and Long-term Risks of Incident Atrial Fibrillation and Flutter. J Clin Endocrinol Metab 2023; 108:e956-e962. [PMID: 37146179 PMCID: PMC10584637 DOI: 10.1210/clinem/dgad250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 04/14/2023] [Accepted: 05/02/2023] [Indexed: 05/07/2023]
Abstract
CONTEXT Although iodine-induced hyperthyroidism is a potential consequence of iodinated radiologic contrast administration, its association with long-term cardiovascular outcomes has not been previously studied. OBJECTIVE To investigate the relationships between hyperthyroidism observed after iodine contrast administration and incident atrial fibrillation/flutter. METHODS Retrospective cohort study of the U.S. Veterans Health Administration (1998-2021) of patients age ≥18 years with a normal baseline serum thyrotropin (TSH) concentration, subsequent TSH <1 year, and receipt of iodine contrast <60 days before the subsequent TSH. Cox proportional hazards regression was employed to ascertain the adjusted hazard ratio (HR) with 95% CI of incident atrial fibrillation/flutter following iodine-induced hyperthyroidism, compared with iodine-induced euthyroidism. RESULTS Iodine-induced hyperthyroidism was observed in 2500 (5.6%) of 44 607 Veterans (mean ± SD age, 60.9 ± 14.1 years; 88% men) and atrial fibrillation/flutter in 10.4% over a median follow-up of 3.7 years (interquartile range 1.9-7.4). Adjusted for sociodemographic and cardiovascular risk factors, iodine-induced hyperthyroidism was associated with an increased risk of atrial fibrillation/flutter compared with those who remained euthyroid after iodine exposure (adjusted HR 1.19, 95% CI 1.06-1.33). Females were at greater risk for incident atrial fibrillation/flutter than males (females, HR 1.81, 95% CI 1.12-2.92; males, HR 1.15, 95% CI 1.03-1.30; P for interaction = .04). CONCLUSION Hyperthyroidism following a high iodine load was associated with an increased risk of incident atrial fibrillation/flutter, particularly among females. The observed sex-based differences should be confirmed in a more sex-diverse study sample, and the cost-benefit analysis of long-term monitoring for cardiac arrhythmias following iodine-induced hyperthyroidism should be evaluated.
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Affiliation(s)
- Kosuke Inoue
- Department of Social Epidemiology, Graduate School of Medicine, Kyoto University, Kyoto 606-8501, Japan
| | - Rong Guo
- Research Service, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA 90073, USA
- Division of General Internal Medicine and Health Services Research, Department of Medicine, University of California Los Angeles David Geffen School of Medicine, Los Angeles, CA 90095, USA
| | - Martin L. Lee
- Veterans Affairs Health Services Research & Development Center for the Study of Health Care Innovation, Implementation, and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, CA 90073, USA
- Department of Biostatistics, University of California Los Angeles Fielding School of Public Health, Los Angeles, CA 90095, USA
| | - Ramin Ebrahimi
- Division of Cardiology, Department of Medicine, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA 90073, USA
- Division of Cardiology, Department of Medicine, University of California Los Angeles David Geffen School of Medicine, Los Angeles, CA 90095, USA
| | - Natalia V. Neverova
- Division of Cardiology, Department of Medicine, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA 90073, USA
- Division of Cardiology, Department of Medicine, University of California Los Angeles David Geffen School of Medicine, Los Angeles, CA 90095, USA
| | - Jesse W. Currier
- Division of Cardiology, Department of Medicine, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA 90073, USA
- Division of Cardiology, Department of Medicine, University of California Los Angeles David Geffen School of Medicine, Los Angeles, CA 90095, USA
| | - Muhammad T. Bashir
- Research Service, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA 90073, USA
| | - Angela M. Leung
- Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA 90073, USA
- Division of Endocrinology, Diabetes, and Metabolism, University of California Los Angeles David Geffen School of Medicine, Los Angeles, CA 90095, USA
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22
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Panova IG, Tatikolov AS. Endogenous and Exogenous Antioxidants as Agents Preventing the Negative Effects of Contrast Media (Contrast-Induced Nephropathy). Pharmaceuticals (Basel) 2023; 16:1077. [PMID: 37630992 PMCID: PMC10458090 DOI: 10.3390/ph16081077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Revised: 07/20/2023] [Accepted: 07/24/2023] [Indexed: 08/27/2023] Open
Abstract
The use of conventional contrast media for diagnostic purposes (in particular, Gd-containing and iodinated agents) causes a large number of complications, the most common of which is contrast-induced nephropathy. It has been shown that after exposure to contrast agents, oxidative stress often occurs in patients, especially in people suffering from various diseases. Antioxidants in the human body can diminish the pathological consequences of the use of contrast media by suppressing oxidative stress. This review considers the research studies on the role of antioxidants in preventing the negative consequences of the use of contrast agents in diagnostics (mainly contrast-induced nephropathy) and the clinical trials of different antioxidant drugs against contrast-induced nephropathy. Composite antioxidant/contrast systems as theranostic agents are also considered.
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Affiliation(s)
- Ina G. Panova
- International Scientific and Practical Center of Tissue Proliferation, 29/14 Prechistenka Str., 119034 Moscow, Russia;
| | - Alexander S. Tatikolov
- N.M. Emanuel Institute of Biochemical Physics, Russian Academy of Sciences, 4 Kosygin Str., 119334 Moscow, Russia
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23
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Varrias D, Spanos M, Kokkinidis DG, Zoumpourlis P, Kalaitzopoulos DR. Venous Thromboembolism in Pregnancy: Challenges and Solutions. Vasc Health Risk Manag 2023; 19:469-484. [PMID: 37492280 PMCID: PMC10364824 DOI: 10.2147/vhrm.s404537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 07/13/2023] [Indexed: 07/27/2023] Open
Abstract
Venous thromboembolism (VTE) is a serious medical condition that can lead to severe morbidity and mortality, making it a significant public health concern. VTE is a multifactorial condition that results from the interaction of genetic, acquired, and environmental factors. Physiological changes during pregnancy increase the risk of VTE as they express Virchow's triad (increased coagulation factors, decreased fibrinolysis, trauma, and venous stasis). Moreover, pregnancy-related risk factors, such as advanced maternal age, obesity, multiple gestations, and cesarean delivery, further increase the risk of VTE. Managing VTE in pregnancy is challenging due to the complexity of balancing the risks and benefits of anticoagulant therapy for both the mother and the fetus. A multidisciplinary approach involving obstetricians, hematologists, and neonatologists, is necessary to ensure optimal outcomes for both the mother and baby. This review aims to discuss the current challenges associated with VTE in pregnancy and identify potential solutions for improving outcomes for pregnant women at risk for VTE.
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Affiliation(s)
- Dimitrios Varrias
- Department of Medicine, Jacobi Medical Center, Bronx, NY, 10461, USA
- Albert Einstein College of Medicine, Bronx, NY, 10461, USA
| | - Michail Spanos
- Cardiovascular Research Center, Massachusetts General Hospital, Boston, MA, USA
| | - Damianos G Kokkinidis
- Section of Cardiovascular Medicine, Yale University School of Medicine, Yale New Haven Hospital, New Haven, CT, USA
| | - Panagiotis Zoumpourlis
- Department of Medicine, Jacobi Medical Center, Bronx, NY, 10461, USA
- Albert Einstein College of Medicine, Bronx, NY, 10461, USA
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24
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Houshyar S, Saha T, Yin H, Zizhou R, Dekiwadia C, Pirogova E, Hill-Yardin EL, Yeung JM, Fox K, Cole I. Advanced flexible transvaginal mesh with high visibility under computerized tomography (CT) scan. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2023; 2023:1-4. [PMID: 38083162 DOI: 10.1109/embc40787.2023.10340322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
Pelvic floor disorders, including pelvic organ prolapse (POP) and stress urinary incontinence (SUI), are serious and very common. Surgery is commonly undertaken to restore the strength of the vaginal wall using transvaginal surgical mesh (TVM). However, up to 15% of TVM implants result in long-term complications, including pain, recurrent symptoms, and infection.Clinical Relevance- In this study, a new bioengineered TVM has been developed to address these issues. The TVM is visible using noninvasive imaging techniques such as computed tomography (CT); it has a highly similar structural profile to human tissue and potential to reduce pain and inflammation. These combined technological advances have the potential to revolutionize women's health.
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25
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Hofmann AG, Shoumariyeh T, Domenig C, Skrabal F, Kovarik JJ. Abdominal Aortic Aneurysm Detection in Bioelectrical Impedance Cardiovascular Screenings-A Pilot Study. J Clin Med 2023; 12:jcm12113726. [PMID: 37297921 DOI: 10.3390/jcm12113726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 05/20/2023] [Accepted: 05/23/2023] [Indexed: 06/12/2023] Open
Abstract
Screening and diagnosing abdominal aortic aneurysms (AAA) are currently dependent on imaging studies such as ultrasound or computed tomography angiography. All imaging studies offer distinct advantages but also suffer from inherent limitations such as examiner dependency or ionizing radiation. Bioelectrical impedance analysis has previously been investigated with respect to its use in the detection of several cardiovascular and renal pathologies. The present pilot study assessed the feasibility of AAA detection based on bioimpedance analysis. In this single-center exploratory pilot study, measurements were conducted among three different cohorts: patients with AAA, end-stage renal disease patients without AAA, and healthy controls. The device used in the study, CombynECG, is an open-market accessible device for segmental bioelectrical impedance analysis. The data was preprocessed and used to train four different machine learning models on a randomized training sample (80% of the full dataset). Each model was then evaluated on a test set (20% of the full dataset). The total sample included 22 patients with AAA, 16 chronic kidney disease patients, and 23 healthy controls. All four models showed strong predictive performance in the test partitions. Specificity ranged from 71.4 to 100%, while sensitivity ranged from 66.7 to 100%. The best-performing model had 100% accuracy for classification when applied to the test sample. Additionally, an exploratory analysis to approximate the maximum AAA diameter was conducted. An association analysis revealed several impedance parameters that might possess predictive ability with respect to aneurysm size. AAA detection via bioelectrical impedance analysis is technically feasible and appears to be a promising technology for large-scale clinical studies and routine clinical screening assessments.
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Affiliation(s)
- Amun G Hofmann
- Department of Internal Medicine III, Division of Nephrology and Dialysis, Medical University of Vienna, 1090 Vienna, Austria
| | - Tarik Shoumariyeh
- Department of Internal Medicine III, Division of Nephrology and Dialysis, Medical University of Vienna, 1090 Vienna, Austria
| | - Christoph Domenig
- Department of General Surgery, Division of Vascular Surgery, Medical University of Vienna, 1090 Vienna, Austria
| | - Falko Skrabal
- Institute of Cardiovascular & Metabolic Medicine, 8010 Graz, Austria
| | - Johannes J Kovarik
- Department of Internal Medicine III, Division of Nephrology and Dialysis, Medical University of Vienna, 1090 Vienna, Austria
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Manso J, Piva I, Censi S, Clausi C, Bardi M, Schiavon B, Merante Boschin I, Tona F, Mian C. Safety and efficacy of prophylactic treatment for hyperthyroidism induced by iodinated contrast media in a high-risk population. Front Endocrinol (Lausanne) 2023; 14:1154251. [PMID: 37255974 PMCID: PMC10225693 DOI: 10.3389/fendo.2023.1154251] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 04/27/2023] [Indexed: 06/01/2023] Open
Abstract
Introduction The use of iodinated contrast media (ICM) can lead to thyrotoxicosis, especially in patients with risk factors, such as Graves' disease, multinodular goiter, older age, and iodine deficiency. Although hyperthyroidism may have clinically relevant effects, whether high-risk patients should receive prophylactic treatment before they are administered ICM is still debated. Aim of the study We aimed to demonstrate the safety and efficacy of prophylactic treatment with sodium perchlorate and/or methimazole to prevent ICM-induced hyperthyroidism (ICMIH) in a population of high-risk cardiac patients. We ran a cost analysis to ascertain the most cost-effective prophylactic treatment protocol. We also aimed to identify possible risk factors for the onset of ICMIH. Materials and methods We performed a longitudinal retrospective study on 61 patients admitted to a tertiary-level cardiology unit for diagnostic and/or therapeutic ICM-procedures. We included patients with available records of thyroid function tests performed before and after ICM were administered, who were at high risk of developing ICMIH. Patients were given one of two different prophylactic treatments (methimazole alone or both methimazole and sodium perchlorate) or no prophylactic treatment. The difference between their thyroid function at the baseline and 11-30 days after the ICM-related procedure was considered the principal endpoint. Results Twenty-three (38%) of the 61 patients were given a prophylactic treatment. Thyroid function deteriorated after the administration of ICM in 9/61 patients (15%). These cases were associated with higher plasma creatinine levels at admission, higher baseline TSH levels, lower baseline FT4 levels, and no use of prophylactic treatment. The type of prophylaxis provided did not influence any onset of ICMIH. A cost-benefit analysis showed that prophylactic treatment with methimazole alone was less costly per person than the combination protocol. On multivariate analysis, only the use of a prophylactic treatment was independently associated with a reduction in the risk of ICMIH. Patients not given any prophylactic treatment had a nearly five-fold higher relative risk of developing ICMIH. Conclusion Prophylactic treatment can prevent the onset of ICMIH in high-risk populations administered ICM. Prophylaxis is safe and effective in this setting, especially in cardiopathic patients. Prophylaxis with methimazole alone seems to be the most cost-effective option.
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Affiliation(s)
- Jacopo Manso
- Endocrinology Unit, Department of Medicine (DIMED), University of Padua, Padua, Italy
- Pediatric Endocrinology Unit, Department of Women’s and Children’s Health, Padua University Hospital, Padova, Italy
| | - Ilaria Piva
- Endocrinology Unit, Department of Medicine (DIMED), University of Padua, Padua, Italy
| | - Simona Censi
- Endocrinology Unit, Department of Medicine (DIMED), University of Padua, Padua, Italy
| | - Cristina Clausi
- Endocrinology Unit, Department of Medicine (DIMED), University of Padua, Padua, Italy
| | - Maria Bardi
- Endocrinology Unit, Department of Medicine (DIMED), University of Padua, Padua, Italy
| | - Benedetta Schiavon
- Cardiology Unit, Department of Cardiac, Thoracic and Vascular Sciences, Padua University Hospital, Padua, Italy
| | - Isabella Merante Boschin
- Department of Surgical, Oncological, and Gastroenterological Sciences, University of Padova, Padova, Italy
| | - Francesco Tona
- Cardiology Unit, Department of Cardiac, Thoracic and Vascular Sciences, Padua University Hospital, Padua, Italy
| | - Caterina Mian
- Endocrinology Unit, Department of Medicine (DIMED), University of Padua, Padua, Italy
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Campos ADC, Cruz Carvalho I, Sarmento S, Fonseca T. Iodine-Induced Hypothyroidism After Chemoembolization With Ethiodized Oil: A Case of Failure to Escape From Wolff-Chaikoff Effect (WCE). Cureus 2023; 15:e39352. [PMID: 37351229 PMCID: PMC10284623 DOI: 10.7759/cureus.39352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/18/2023] [Indexed: 06/24/2023] Open
Abstract
Wolff-Chaikoff effect (WCE) is an acute physiologic response of the thyroid gland to high levels of iodine. The WCE is usually temporary, and the thyroid gland adjusts to high iodine levels within days or weeks. It is a protective mechanism and a failure to escape from it can result in thyroid dysfunction. Hypothyroidism is rare but more likely in patients who have had thyroid disease, are under stress, or are exposed to high iodine concentrations for a long time. The use of iodinated contrast media in radiologic studies or invasive medical procedures is a common source of excessive iodine exposure and can lead to thyroid disfunction. Despite the frequent use of contrast media in health care, the thyroid dysfunction associated with their use is poorly recognized. We report a patient who developed iodine-induced hypothyroidism after chemoembolization of recurrent chylothorax with ethiodized oil (Lipiodol®, Villepinte, France). This case report raises awareness of the importance of the physiologic WCE as well as the relevance of monitoring thyroid function when using iodinated contrast media in patients with specific risk factors.
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Affiliation(s)
- Ana de Carmo Campos
- Pulido Valente Hospital, North Lisbon University Hospital Centre (CHULN), Lisbon, PRT
- Health Promotion and Prevention of Non-Communicable Disease, National Health Institute Doutor Ricardo Jorge, Lisbon, PRT
| | - Isabel Cruz Carvalho
- Pulido Valente Hospital, North Lisbon University Hospital Centre (CHULN), Lisbon, PRT
| | - Sara Sarmento
- Pulido Valente Hospital, North Lisbon University Hospital Centre (CHULN), Lisbon, PRT
- Medicine, Lisbon University, Lisbon, PRT
| | - Teresa Fonseca
- Pulido Valente Hospital, North Lisbon University Hospital Centre (CHULN), Lisbon, PRT
- Medicine, Lisbon University, Lisbon, PRT
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28
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Wu SY, Chambers M, Khan M, Chinweze M, Cao TM, Zhao H. The Etiology of Abnormal TSH in Veterans Cared by a VA Medical Center - One High Serum Thyrotropin is Associated with Higher 5-Years Mortality. ENDOCRINOLOGY AND DISORDERS : OPEN ACCESS 2023; 7:133. [PMID: 38292141 PMCID: PMC10826222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/01/2024]
Abstract
Objective By analyzing the etiology of abnormal TSH in randomly selected veteran patients, we set our heart on improving future clinical care/management of the clinical/subclinical hyper- and hypothyroidism in the aging veteran population. Methods A total of 1100 patients' charts in alphabetical order were selected. Excluded cases of insufficient information, 897 patients' charts were reviewed and analyzed for causes of abnormal TSH. Among them, 602 for the cause of low TSH (below 0.55 uU/mL) and 295 for high TSH (above 4.78 uU/mL) were reviewed retrospectively. Findings Among the 1100 patients selected, 680 (61.8%) were 60 y or older (female=44, 6.8%); 420 were under 60 y (female=80, 19.0%); significantly more female patients were found in the younger age group (P<0.001). After excluding patients with insufficient data, the most common cause of suppressed TSH is iodine-induced, CT iodinated contrast and betadine use caused 35.0% in the older group (n=126) compared to 23.6% in the younger group(n=57) (P = 0.027). The significant difference is that older veterans received more contrast CTs (P < 0.05 compared to the younger group). In both age groups with concurrent FT4 study, we found four high FT4 among 90 studies, 4.4% overt hyperthyroidism. The second most common cause of suppressed TSH is due to thyroid hormone (TH) replacement in the older group (119 patients, 33.1%) with age > 60y, significantly more frequent compared to the younger group, P<0.001. There is significantly more overt hyperthyroidism, 27.8/%, than the iodine-load induced suppression of TSH, P<0.001, due to 17 patients on TSH suppression therapy after total thyroidectomy for thyroid cancer. Among the 295 patients with elevated TSH, the most common cause of high TSH was due to hypothyroidism on T4 replacement: a total of 128 (59.3%) in the older group (N=216) is, similar to 47 (59.5%) in the younger group (N=79). In both age groups, there were 139 patients with concomitant FT4 measurement; 17 overt hypothyroidism were found, 12.2%. No significant difference is seen in the two age groups. The next most common causes of elevated TSH are CT contrast infusion, 23 (10.6%) in the older group and 7 (8.9%) in the younger group. We find high TSH is associated with a higher death rate of 101/238 (42.4%) in a 5-year follow-up (from 2016 to 2021), as compared to low TSH of 68/238 (28.6%), in the older age group, p<0.03; both were significantly higher than the age- and sex-matched general US population, 19.7%, P<0.01. Conclusion Even though most, ~ 90%, were subclinical, the suppressed and elevated TSH are associated with severe consequences in CV/CNS and immune-suppression complications in aging veterans. Therefore, cautious use (and more frequent check of TSH) of TH replacement and CT contrast in aging veterans is recommended. The alarming increase in 5 years death rate in older patients with elevated TSH deserves further study.
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Affiliation(s)
- Sing-Yung Wu
- Department of Radiology/Nuclear Medicine, VA Medical Center, Long Beach, California
- Department of Radiological Sciences, University of California, Irvine, California
- Research and Development Service, VA Long Beach Healthcare System, Long Beach, California
| | - Mark Chambers
- Department of Radiology/Nuclear Medicine, VA Medical Center, Long Beach, California
- Department of Radiological Sciences, University of California, Irvine, California
| | - Mazhar Khan
- Department of Radiology/Nuclear Medicine, VA Medical Center, Long Beach, California
| | - Maureen Chinweze
- Department of Radiology/Nuclear Medicine, VA Medical Center, Long Beach, California
| | - Thao-My Cao
- Research and Development Service, VA Long Beach Healthcare System, Long Beach, California
| | - Haibo Zhao
- Research and Development Service, VA Long Beach Healthcare System, Long Beach, California
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29
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Nedić O. Iodine: Physiological importance and food sources. EFOOD 2023. [DOI: 10.1002/efd2.63] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023] Open
Affiliation(s)
- Olgica Nedić
- Department of Metabolism, Institute for the Application of Nuclear Energy (INEP) University of Belgrade Belgrade Republic of Serbia
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30
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Langenbach MC, Sandstede J, Sieren MM, Barkhausen J, Gutberlet M, Bamberg F, Lehmkuhl L, Maintz D, Naehle CP. German Radiological Society and the Professional Association of German Radiologists Position Paper on Coronary computed tomography: Clinical Evidence and Quality of Patient Care in Chronic Coronary Syndrome. ROFO-FORTSCHR RONTG 2023; 195:115-134. [PMID: 36634682 DOI: 10.1055/a-1973-9687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
This position paper is a joint statement of the German Radiological Society (DRG) and the Professional Association of German Radiologists (BDR), which reflects the current state of knowledge about coronary computed tomography. It is based on preclinical and clinical studies that have investigated the clinical relevance as well as the technical requirements and fundamentals of cardiac computed tomography. CITATION FORMAT: · Langenbach MC, Sandstede J, Sieren M et al. DRG and BDR Position Paper on Coronary CT: Clinical Evidence and Quality of Patient Care in Chronic Coronary Syndrome. Fortschr Röntgenstr 2023; 195: 115 - 133.
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Affiliation(s)
- Marcel C Langenbach
- Institute for Diagnostic and Interventional Radiology, University Hospital Cologne, Koln, Germany.,Cardiovascular Imaging Research Center, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Jörn Sandstede
- Radiologische Allianz, Hamburg, Germany.,Berufsverband der deutschen Radiologen e. V. (BDR), München, Deutschland
| | - Malte M Sieren
- Department of Radiology and Nuclear Medicine, University Hospital Schleswig-Holstein Campus Luebeck, Lübeck, Germany
| | - Jörg Barkhausen
- Department of Radiology and Nuclear Medicine, University Hospital Schleswig-Holstein Campus Luebeck, Lübeck, Germany
| | - Matthias Gutberlet
- Department of Diagnostic and Interventional Radiology, Leipzig Heart Centre University Hospital, Leipzig, Germany
| | - Fabian Bamberg
- Department of Diagnostic and Interventional Radiology, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Lukas Lehmkuhl
- Department for Diagnostic and Interventional Radiology, RHÖN Clinic, Campus Bad Neustadt, Germany
| | - David Maintz
- Institute for Diagnostic and Interventional Radiology, University Hospital Cologne, Koln, Germany
| | - Claas P Naehle
- Institute for Diagnostic and Interventional Radiology, University Hospital Cologne, Koln, Germany.,Radiologische Allianz, Hamburg, Germany
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31
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Wang Y, Sun Y, Yang B, Wang Q, Kuang H. The management and metabolic characterization: hyperthyroidism and hypothyroidism. Neuropeptides 2023; 97:102308. [PMID: 36455479 DOI: 10.1016/j.npep.2022.102308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 10/21/2022] [Accepted: 11/08/2022] [Indexed: 11/13/2022]
Abstract
Hyperthyroidism and hypothyroidism are common diseases resulting from thyroid dysfunction, and are simple to diagnose and treat. The traditional treatment for hypothyroidism is thyroid hormone replacement therapy. The traditional treatments for hyperthyroidism include antithyroid drug, iodine radiotherapy, and surgery. Thyroid disease can be fatal in severe cases if untreated. Current statistical reference ranges used for diagnosis based on relevant biochemical parameters have been debated, and insufficient treatment can result in long-term thyroid hormone deficiency, which is associated with increased risk of cardiovascular disease and persistent symptoms. In contrast, overtreatment can result in heart disease and osteoporosis, particularly in older people and pregnant women. Therefore, under- or over-treatment should be avoided and treatment regimens should be monitored closely. A significant proportion of patients who achieve biochemical treatment goals still complain of significant symptoms. Systematic literature review was performed through the Embase (Elsevier), PubMed and Web of Science databases, and studies summarized evidence regarding treatment and management of hypothyroidism and hyperthyroidism, and reviewed clinical practice guidelines. We also reviewed the latest research on the metabolic mechanisms of hyperthyroidism and hypothyroidism, which contributed to understanding of thyroid diseases in the clinic. A reliable algorithm is needed to management, assessment, and treatment patients with hyperthyroidism and hypothyroidism, which can not only improve management efficiency, but also providing a broad application. In addition, the thyroid disorder showed a lipid metabolism tissue specificity in the Ventromedial Hypothalamus, and effect oxidative stress and energy metabolism of whole body. This review summarizes an algorithm for thyroid disease and the latest pathogenesis that would be useful to generalist and subspecialty physicians and others providing care for patients with this condition.
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Affiliation(s)
- Yangyang Wang
- Key Laboratory of Basic and Application Research of Beiyao (Heilongjiang University of Chinese Medicine), Ministry of Education, Harbin, China
| | - YanPing Sun
- Key Laboratory of Basic and Application Research of Beiyao (Heilongjiang University of Chinese Medicine), Ministry of Education, Harbin, China
| | - Bingyou Yang
- Key Laboratory of Basic and Application Research of Beiyao (Heilongjiang University of Chinese Medicine), Ministry of Education, Harbin, China
| | - Qiuhong Wang
- School of Traditional Chinese Medicine, Guangdong Pharmaceutical University, Guangzhou, China.
| | - Haixue Kuang
- Key Laboratory of Basic and Application Research of Beiyao (Heilongjiang University of Chinese Medicine), Ministry of Education, Harbin, China.
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32
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Is Thyroid Monitoring Warranted in Infants and Young Children After Intravascular Administration of Iodine-Based Contrast Media? AJR Am J Roentgenol 2023; 220:144-145. [PMID: 35731099 DOI: 10.2214/ajr.22.28007] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
On March 30, 2022, the U.S. FDA issued a drug safety communication recommending that infants and young children through 3 years of age undergo monitoring of thyroid function within 3 weeks of intravascular administration of iodine-based contrast media. This article considers the literature that was referenced for this decision and provides an outlook on thyroid monitoring after diagnostic imaging from pediatric radiology and pediatric endocrinology perspectives.
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33
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Langenbach MC, Sandstede J, Sieren MM, Barkhausen J, Gutberlet M, Bamberg F, Lehmkuhl L, Maintz D, Nähle CP. [German Radiological Society and the Professional Association of German Radiologists position paper on coronary computed tomography: clinical evidence and quality of patient care in chronic coronary syndrome]. RADIOLOGIE (HEIDELBERG, GERMANY) 2023; 63:1-19. [PMID: 36633613 PMCID: PMC9838426 DOI: 10.1007/s00117-022-01096-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 11/14/2022] [Indexed: 01/13/2023]
Abstract
This position paper is a joint statement of the German Radiological Society (DRG) and the Professional Association of German Radiologists (BDR), which reflects the current state of knowledge about coronary computed tomography (CT). It is based on preclinical and clinical studies that have investigated the clinical relevance as well as the technical requirements and fundamentals of cardiac computed tomography.
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Affiliation(s)
- M. C. Langenbach
- grid.411097.a0000 0000 8852 305XInstitut für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Köln, Köln, Deutschland ,grid.32224.350000 0004 0386 9924Cardiovascular Imaging Research Center, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Boston, MA USA
| | - J. Sandstede
- Radiologische Allianz, Hamburg, Deutschland ,Berufsverband der deutschen Radiologen e. V. (BDR), München, Deutschland
| | - M. M. Sieren
- grid.412468.d0000 0004 0646 2097Klinik für Radiologie und Nuklearmedizin, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Lübeck, Deutschland
| | - J. Barkhausen
- grid.412468.d0000 0004 0646 2097Klinik für Radiologie und Nuklearmedizin, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Lübeck, Deutschland
| | - M. Gutberlet
- grid.513819.70000 0004 0489 7230Abteilung für Diagnostische und Interventionelle Radiologie, Herzzentrum Leipzig – Universität Leipzig, Leipzig, Deutschland
| | - F. Bamberg
- grid.7708.80000 0000 9428 7911Medizinische Fakultät, Abteilung für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Freiburg, Freiburg, Deutschland
| | - L. Lehmkuhl
- Abteilung für Diagnostische und Interventionelle Radiologie, RHÖN Klinik, Campus Bad Neustadt, Bad Neustadt, Deutschland
| | - D. Maintz
- grid.411097.a0000 0000 8852 305XInstitut für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Köln, Köln, Deutschland
| | - C. P. Nähle
- grid.411097.a0000 0000 8852 305XInstitut für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Köln, Köln, Deutschland ,Radiologische Allianz, Hamburg, Deutschland
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34
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Oliveira BB, Ferreira D, Fernandes AR, Baptista PV. Engineering gold nanoparticles for molecular diagnostics and biosensing. WILEY INTERDISCIPLINARY REVIEWS. NANOMEDICINE AND NANOBIOTECHNOLOGY 2023; 15:e1836. [PMID: 35932114 DOI: 10.1002/wnan.1836] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 06/22/2022] [Accepted: 07/13/2022] [Indexed: 01/31/2023]
Abstract
Advances in nanotechnology and medical science have spurred the development of engineered nanomaterials and nanoparticles with particular focus on their applications in biomedicine. In particular, gold nanoparticles (AuNPs) have been the focus of great interest, due to their exquisite intrinsic properties, such as ease of synthesis and surface functionalization, tunable size and shape, lack of acute toxicity and favorable optical, electronic, and physicochemical features, which possess great value for application in biodetection and diagnostics purposes, including molecular sensing, photoimaging, and application under the form of portable and simple biosensors (e.g., lateral flow immunoassays that have been extensively exploited during the current COVID-19 pandemic). We shall discuss the main properties of AuNPs, their synthesis and conjugation to biorecognition moieties, and the current trends in sensing and detection in biomedicine and diagnostics. This article is categorized under: Diagnostic Tools > Biosensing Diagnostic Tools > In Vitro Nanoparticle-Based Sensing Diagnostic Tools > In Vivo Nanodiagnostics and Imaging.
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Affiliation(s)
- Beatriz B Oliveira
- UCIBIO, Departamento de Ciências da Vida, Faculdade de Ciências e Tecnologia, Universidade NOVA de Lisboa, Caparica, Portugal.,i4HB, Associate Laboratory-Institute for Health and Bioeconomy, Faculdade de Ciências e Tecnologia, Universidade NOVA de Lisboa, Caparica, Portugal
| | - Daniela Ferreira
- UCIBIO, Departamento de Ciências da Vida, Faculdade de Ciências e Tecnologia, Universidade NOVA de Lisboa, Caparica, Portugal.,i4HB, Associate Laboratory-Institute for Health and Bioeconomy, Faculdade de Ciências e Tecnologia, Universidade NOVA de Lisboa, Caparica, Portugal
| | - Alexandra R Fernandes
- UCIBIO, Departamento de Ciências da Vida, Faculdade de Ciências e Tecnologia, Universidade NOVA de Lisboa, Caparica, Portugal.,i4HB, Associate Laboratory-Institute for Health and Bioeconomy, Faculdade de Ciências e Tecnologia, Universidade NOVA de Lisboa, Caparica, Portugal
| | - Pedro Viana Baptista
- UCIBIO, Departamento de Ciências da Vida, Faculdade de Ciências e Tecnologia, Universidade NOVA de Lisboa, Caparica, Portugal.,i4HB, Associate Laboratory-Institute for Health and Bioeconomy, Faculdade de Ciências e Tecnologia, Universidade NOVA de Lisboa, Caparica, Portugal
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35
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Akiba Y, Leung AM, Bashir MT, Ebrahimi R, Currier JW, Neverova N, Kaunitz JD. Excess iodine exposure acutely increases salivary iodide and antimicrobial hypoiodous acid concentrations in humans. Sci Rep 2022; 12:20935. [PMID: 36463312 PMCID: PMC9719529 DOI: 10.1038/s41598-022-23803-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 11/06/2022] [Indexed: 12/07/2022] Open
Abstract
The lactoperoxidase (LPO)-hydrogen peroxide-halides reaction (LPO system) converts iodide and thiocyanate (SCN-) into hypoiodous acid (HOI) and hypothiocyanite (OSCN-), respectively. Since this system has been implicated in defense of the airways and oropharynx from microbial invasion, in this proof-of-concept study we measured the concentrations of these analytes in human saliva from a convenience clinical sample of 40 qualifying subjects before and after acute iodine administration via the iodinated contrast medium used in coronary angiography to test the hypothesis that an iodide load increases salivary iodide and HOI concentrations. Saliva was collected and salivary iodide, SCN-, HOI and OSCN- were measured using standard methodology. The large iodine load delivered by the angiographic dye, several 100-fold in excess of the U.S. Recommended Daily Allowance for iodine (150 µg/day), significantly increased salivary iodide and HOI levels compared with baseline levels, whereas there was no significant change in salivary SCN- and OSCN- levels. Iodine load and changes of salivary iodide and HOI levels were positively correlated, suggesting that higher iodide in the circulation increases iodide output and salivary HOI production. This first of its kind study suggests that a sufficient but safe iodide supplementation less than the Tolerable Upper Limit for iodine set by the U.S. Institute of Medicine (1,100 µg/day) may augment the generation of antimicrobial HOI by the salivary LPO system in concentrations sufficient to at least in theory protect the host against susceptible airborne microbial pathogens, including enveloped viruses such as coronaviruses and influenza viruses.
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Affiliation(s)
- Yasutada Akiba
- Medical Service, Section of Gastroenterology and Hepatology, Greater Los Angeles VA Healthcare System, Los Angeles, CA, USA
- Division of Gastroenterology, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, 90095, USA
| | - Angela M Leung
- Medical Service, Section of Endocrinology, Diabetes, and Metabolism, Greater Los Angeles VA Healthcare System, Los Angeles, USA
- Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, 90095, USA
| | - Muhammad-Tariq Bashir
- Research Service, Greater Los Angeles VA Healthcare System, Los Angeles, USA
- Division of Hematology and Oncology, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, 90095, USA
| | - Ramin Ebrahimi
- Medical Service, Section of Cardiology, Greater Los Angeles VA Healthcare System, Los Angeles, USA
- Division of Cardiology, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, 90095, USA
| | - Jesse W Currier
- Medical Service, Section of Cardiology, Greater Los Angeles VA Healthcare System, Los Angeles, USA
- Division of Cardiology, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, 90095, USA
| | - Natalia Neverova
- Medical Service, Section of Cardiology, Greater Los Angeles VA Healthcare System, Los Angeles, USA
- Division of Cardiology, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, 90095, USA
| | - Jonathan D Kaunitz
- Medical Service, Section of Gastroenterology and Hepatology, Greater Los Angeles VA Healthcare System, Los Angeles, CA, USA.
- Division of Gastroenterology, Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, 90095, USA.
- West Los Angeles VA Medical Center, Bldg. 114, Suite 217, 11301 Wilshire Blvd., Los Angeles, CA, 90073, USA.
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Al-Salameh A, Scherman N, Adda I, André J, Zerbib Y, Maizel J, Lalau JD, Brochot E, Andrejak C, Desailloud R. Thyrotropin Levels in Patients with Coronavirus Disease 2019: Assessment during Hospitalization and in the Medium Term after Discharge. LIFE (BASEL, SWITZERLAND) 2022; 12:life12122014. [PMID: 36556379 PMCID: PMC9781661 DOI: 10.3390/life12122014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 11/11/2022] [Accepted: 11/29/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND The objectives of this study were (1) to compare TSH levels between inpatients with critical versus non-critical coronavirus disease 19 (COVID-19), and (2) to describe the status of TSH levels three months after hospitalization. METHODS We collected data on adult patients hospitalized with COVID-19 at Amiens University Hospital. We compared TSH levels between inpatients with critical (intensive care unit admission and/or death) versus non-critical COVID-19. Thereafter, survivors were invited to return for a three-month post-discharge visit where thyroid function tests were performed, regardless of the availability of TSH measurement during hospitalization. RESULTS Among 448 inpatients with COVID-19, TSH assay data during hospitalization were available for 139 patients without prior thyroid disease. Patients with critical and non-critical forms of COVID-19 did not differ significantly with regard to the median (interquartile range) TSH level (0.96 (0.68-1.71) vs. 1.27 mIU/L (0.75-1.79), p = 0.40). Abnormal TSH level was encountered in 17 patients (12.2%); most of them had subclinical thyroid disease. TSH assay data at the three-month post-discharge visit were available for 151 patients without prior thyroid disease. Only seven of them (4.6%) had abnormal TSH levels. Median TSH level at the post-discharge visit was significantly higher than median TSH level during hospitalization. CONCLUSIONS Our findings suggest that COVID-19 is associated with a transient suppression of TSH in a minority of patients regardless of the clinical form. The higher TSH levels three months after COVID-19 might suggest recovery from non-thyroidal illness syndrome.
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Affiliation(s)
- Abdallah Al-Salameh
- Department of Endocrinology, Diabetes Mellitus and Nutrition, Amiens University Hospital, F-80054 Amiens, France
- PériTox UMR-I 01, University of Picardie Jules Verne, Chemin du Thil, F-80025 Amiens, France
- Correspondence: ; Tel.: +33-322-455-889; Fax: +33-322-455-334
| | - Noémie Scherman
- Department of Endocrinology, Diabetes Mellitus and Nutrition, Amiens University Hospital, F-80054 Amiens, France
| | - Imane Adda
- Department of Endocrinology, Diabetes Mellitus and Nutrition, Amiens University Hospital, F-80054 Amiens, France
- Medical Intensive Care Unit, Amiens University Hospital, F-80054 Amiens, France
| | - Juliette André
- Department of Endocrinology, Diabetes Mellitus and Nutrition, Amiens University Hospital, F-80054 Amiens, France
| | - Yoann Zerbib
- Medical Intensive Care Unit, Amiens University Hospital, F-80054 Amiens, France
| | - Julien Maizel
- Medical Intensive Care Unit, Amiens University Hospital, F-80054 Amiens, France
| | - Jean-Daniel Lalau
- Department of Endocrinology, Diabetes Mellitus and Nutrition, Amiens University Hospital, F-80054 Amiens, France
- PériTox UMR-I 01, University of Picardie Jules Verne, Chemin du Thil, F-80025 Amiens, France
| | - Etienne Brochot
- Laboratory of Virology, Amiens University Hospital, F-80054 Amiens, France
| | - Claire Andrejak
- Department of Pulmonary Diseases, Amiens University Hospital, F-80054 Amiens, France
| | - Rachel Desailloud
- Department of Endocrinology, Diabetes Mellitus and Nutrition, Amiens University Hospital, F-80054 Amiens, France
- PériTox UMR-I 01, University of Picardie Jules Verne, Chemin du Thil, F-80025 Amiens, France
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37
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Tsai K, Inoue K, McClean M, Kaunitz JD, Akiba Y, Lee ML, Neverova NV, Currier JW, Ebrahimi R, Bashir MT, Leung AM. Iodine contrast exposure and incident COVID-19 infection. Front Med (Lausanne) 2022; 9:1033601. [PMID: 36530869 PMCID: PMC9751341 DOI: 10.3389/fmed.2022.1033601] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 11/18/2022] [Indexed: 08/11/2024] Open
Abstract
Background Iodine and particularly its oxidated forms have long been recognized for its effective antiseptic properties. Limited in vitro and in vivo data suggest that iodine exposure may rapidly inactivate, reduce transmission, and reduce infectivity of SARS-CoV-2. We hypothesized that iodine exposure may be associated with decreased incident COVID-19 infection. Methods A retrospective population-level cohort analysis was performed of the U.S. Veterans Health Administration between 1 March 2020 and 31 December 2020, before the widespread availability of vaccines against SARS-CoV-2. Multivariable logistic regression models estimated the adjusted odds ratios (OR) and 95% confidence intervals (CI) of the associations between iodinated contrast exposure and incident COVID-19 infection, adjusting for age, sex, race/ethnicity, place of residence, socioeconomic status, and insurance status. Results 530,942 COVID-19 tests from 333,841 Veterans (mean ± SD age, 62.7 ± 15.2 years; 90.2% men; 61.9% non-Hispanic Whites) were analyzed, of whom 9% had received iodinated contrast ≤60 days of a COVID-19 test. Iodine exposure was associated with decreased incident COVID-19 test positivity (OR, 0.75 95% CI, 0.71-0.78). In stratified analyses, the associations between iodinated contrast use and decreased COVID-19 infection risk did not differ by age, sex, and race/ethnicity. Conclusion Iodine exposure may be protective against incident COVID-19 infection. Weighed against the risks of supraphysiologic iodine intake, dietary, and supplemental iodine nutrition not to exceed its Tolerable Upper Limit may confer an antimicrobial benefit against SARS-CoV-2. A safe but antimicrobial level of iodine supplementation may be considered in susceptible individuals, particularly in geographic regions where effective COVID-19 vaccines are not yet readily available.
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Affiliation(s)
- Karen Tsai
- Endocrinology, Diabetes, and Metabolism Section, Medical Service, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA, United States
- Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
| | - Kosuke Inoue
- Department of Social Epidemiology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
- Department of Internal Medicine, Ito Hospital, Tokyo, Japan
| | - Michael McClean
- Research Service, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA, United States
| | - Jonathan D. Kaunitz
- Gastroenterology Section, Medical Service, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA, United States
- Division of Gastroenterology, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
- Department of Surgery, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
| | - Yasutada Akiba
- Gastroenterology Section, Medical Service, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA, United States
- Division of Gastroenterology, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
| | - Martin L. Lee
- Veterans Affairs Health Services Research and Development, Center for the Study of Health Care Innovation, Implementation, and Policy, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA, United States
- Department of Biostatistics, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, CA, United States
| | - Natalia V. Neverova
- Cardiology Section, Medical Service, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA, United States
- Division of Cardiology, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
| | - Jesse W. Currier
- Cardiology Section, Medical Service, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA, United States
- Division of Cardiology, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
| | - Ramin Ebrahimi
- Cardiology Section, Medical Service, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA, United States
- Division of Cardiology, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
| | - Muhammad T. Bashir
- Research Service, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA, United States
| | - Angela M. Leung
- Endocrinology, Diabetes, and Metabolism Section, Medical Service, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, CA, United States
- Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
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Kidney disease and thyroid dysfunction: the chicken or egg problem. Pediatr Nephrol 2022; 37:3031-3042. [PMID: 35737115 DOI: 10.1007/s00467-022-05640-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 05/04/2022] [Accepted: 05/19/2022] [Indexed: 01/10/2023]
Abstract
Patients with non-dialysis-dependant chronic kidney disease (NDD-CKD) and dialysis-dependant chronic kidney disease (DD-CKD) frequently also suffer from thyroid disorders, especially hypothyroidism which is found two to five times more often among them compared to the general population. Emerging research has illustrated the potential prognostic implications of this association as NDD-CKD and DD-CKD patients with hypothyroidism have been shown to have higher mortality rates, and treatment of subclinical hypothyroidism in NDD-CKD patients has been reported to attenuate the decline of glomerular filtration rate over time. This review illustrates the bidirectional, multi-layered interplay between the kidneys and the thyroid gland explaining how pathologies in one organ will affect the other and vice versa. Additionally, it outlines the impact of thyroid disorders on routine parameters of kidney function (especially serum creatinine and serum cystatin C) that nephrologists should be aware of in their clinical practice. Lastly, it summarizes the emerging evidence from clinical studies on how treatment of subclinical hypothyroidism in NDD-CKD and DD-CKD patients may potentially have beneficial effects on kidney function as well as mortality. While most of the research in this area has been performed on adult patients, we specifically discuss what is currently known about thyroid dysfunctions in paediatric CKD patients as well and provide management suggestions. The evidence accumulated so far clearly indicates that further, prospective studies with meticulous methodology are warranted to refine our understanding of thyroid disorders in paediatric and adult CKD patients and establish optimal treatment pathways.
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Houshyar S, Yin H, Pope L, Zizhou R, Dekiwadia C, Hill-Yardin EL, Yeung JMC, John S, Fox K, Tran N, Cole I, Elbourne A, Truong VK, Truskewycz A. Smart Suture with Iodine Contrasting Nanoparticle for Computed Tomography. OPENNANO 2022. [DOI: 10.1016/j.onano.2022.100120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Righini M, Robert-Ebadi H, Cremonesi A, Elias A, Sanchez O, Le Moigne E, Schmidt J, Le Gall C, Cornuz J, Aujesky D, Roy PM, Chauleur C, Rouyer F, Poletti PA, Moreau C, Le Gal G. Risk of neonatal hypothyroidism in newborns from mothers exposed to CTPA during pregnancy: Ancillary data from a prospective outcome study. J Thromb Haemost 2022; 20:2550-2555. [PMID: 35950611 DOI: 10.1111/jth.15843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 08/02/2022] [Accepted: 08/03/2022] [Indexed: 01/07/2023]
Abstract
BACKGROUND Neonatal hypothyroidism is often raised as a potential concern for the use of computed tomography pulmonary angiography (CTPA) in pregnant women with suspected pulmonary embolism (PE). OBJECTIVES To assess the incidence of neonatal hypothyroidism among newborns from mothers exposed to CTPA. PATIENTS/METHODS Pregnant women with clinically suspected PE were included in a multicenter, multinational prospective diagnostic management outcome study, based on pretest clinical probability assessment, high-sensitivity D-dimer testing, bilateral lower limb venous compression ultrasonography, and CTPA. Results of Guthrie tests were systematically collected for newborns of all women who required CTPA as part of the diagnostic strategy. A thyroid-stimulating hormone (TSH) level above 15 U/ml was used to define hypothyroidism. RESULTS Out of the 166 women included in the Swiss participating centers, 149 underwent a CTPA including 14 with twin pregnancies. Eight women suffered a pregnancy loss and results of the Guthrie test could not be retrieved for four newborns. All TSH levels were reported as being below 15 U/ml. The incidence of neonatal hypothyroidism was 0/151 (0.0%, 95% confidence interval: 0.0%-2.5%). CONCLUSIONS We did not identify any cases of neonatal hypothyroidism in our cohort of 149 pregnant women investigated for suspected PE using a CTPA. Along with previous literature data, this provides further reassuring data regarding the use of CTPA in this indication.
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Affiliation(s)
- Marc Righini
- Division of Angiology and Hemostasis, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Helia Robert-Ebadi
- Division of Angiology and Hemostasis, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Alessio Cremonesi
- Division of Clinical Biochemistry and Swiss Newborn Screening, University Children's Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Antoine Elias
- Médecine Vasculaire, Centre Hospitalier de Toulon, Toulon, France
| | - Olivier Sanchez
- Service de Pneumologie et Soins Intensifs, Hôpital Européen Georges Pompidou, AP-HP, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
- INSERM UMR S 1140, Paris, France
- F-CRIN INNOVTE, Saint-Etienne, France
| | | | - Jeannot Schmidt
- Centre Hospitalier Universitaire de Clermont-Ferrand, Clermont-Ferrand, France
| | | | - Jacques Cornuz
- Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Drahomir Aujesky
- Department of General Internal Medicine, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Pierre-Marie Roy
- Department of Emergency Medicine, University Hospital of Angers, Angers, France
| | - Céline Chauleur
- INSERM U1059, Saint-Etienne, France
- University of Lyon, Saint-Etienne, France
- Department of Gynecology and Obstetrics, University Hospital, Saint-Etienne, France
| | - Frédéric Rouyer
- Division of Emergency Medicine, Geneva University Hospitals, Geneva, Switzerland
| | | | | | - Grégoire Le Gal
- EA3878 GETBO, Université de Brest, Brest, France
- Department of Hematology, Ottawa Health Research Institute, Ottawa, Ontario, Canada
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Karbownik-Lewińska M, Stępniak J, Iwan P, Lewiński A. Iodine as a potential endocrine disruptor-a role of oxidative stress. Endocrine 2022; 78:219-240. [PMID: 35726078 PMCID: PMC9584999 DOI: 10.1007/s12020-022-03107-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 06/02/2022] [Indexed: 12/19/2022]
Abstract
PURPOSE Iodine is an essential micronutrient required for thyroid hormone biosynthesis. However, overtreatment with iodine can unfavorably affect thyroid physiology. The aim of this review is to present the evidence that iodine-when in excess-can interfere with thyroid hormone synthesis and, therefore, can act as a potential endocrine-disrupting chemical (EDC), and that this action, as well as other abnormalities in the thyroid, occurs-at least partially-via oxidative stress. METHODS We reviewed published studies on iodine as a potential EDC, with particular emphasis on the phenomenon of oxidative stress. RESULTS This paper summarizes current knowledge on iodine excess in the context of its properties as an EDC and its effects on oxidative processes. CONCLUSION Iodine does fulfill the criteria of an EDC because it is an exogenous chemical that interferes-when in excess-with thyroid hormone synthesis. However, this statement cannot change general rules regarding iodine supply, which means that iodine deficiency should be still eliminated worldwide and, at the same time, iodine excess should be avoided. Universal awareness that iodine is a potential EDC would make consumers more careful regarding their diet and what they supplement in tablets, and-what is of great importance-it would make caregivers choose iodine-containing medications (or other chemicals) more prudently. It should be stressed that compared to iodine deficiency, iodine in excess (acting either as a potential EDC or via other mechanisms) is much less harmful in such a sense that it affects only a small percentage of sensitive individuals, whereas the former affects whole populations; therefore, it causes endemic consequences.
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Affiliation(s)
- Małgorzata Karbownik-Lewińska
- Department of Oncological Endocrinology, Medical University of Lodz, 90-752, Lodz, Poland.
- Polish Mother's Memorial Hospital-Research Institute, 93-338, Lodz, Poland.
| | - Jan Stępniak
- Department of Oncological Endocrinology, Medical University of Lodz, 90-752, Lodz, Poland
| | - Paulina Iwan
- Department of Oncological Endocrinology, Medical University of Lodz, 90-752, Lodz, Poland
| | - Andrzej Lewiński
- Polish Mother's Memorial Hospital-Research Institute, 93-338, Lodz, Poland
- Department of Endocrinology and Metabolic Diseases, Medical University of Lodz, 93-338, Lodz, Poland
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Sungworawongpana C, Chaochankit W. Ruptured appendicitis with undiagnosed Graves’ disease: Contrast-induced impending thyroid storm. Ann Med Surg (Lond) 2022; 82:104600. [PMID: 36268445 PMCID: PMC9577527 DOI: 10.1016/j.amsu.2022.104600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 09/04/2022] [Accepted: 09/04/2022] [Indexed: 11/17/2022] Open
Affiliation(s)
- Chutida Sungworawongpana
- Department of Anesthesiology, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
| | - Wongsakorn Chaochankit
- Department of Surgery, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
- Corresponding author. Department of Surgery, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, 90110, Thailand.
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Dijck-Brouwer DAJ, Muskiet FAJ, Verheesen RH, Schaafsma G, Schaafsma A, Geurts JMW. Thyroidal and Extrathyroidal Requirements for Iodine and Selenium: A Combined Evolutionary and (Patho)Physiological Approach. Nutrients 2022; 14:3886. [PMID: 36235539 PMCID: PMC9571367 DOI: 10.3390/nu14193886] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 09/14/2022] [Accepted: 09/16/2022] [Indexed: 11/16/2022] Open
Abstract
Iodide is an antioxidant, oxidant and thyroid hormone constituent. Selenoproteins are needed for triiodothyronine synthesis, its deactivation and iodine release. They also protect thyroidal and extrathyroidal tissues from hydrogen peroxide used in the 'peroxidase partner system'. This system produces thyroid hormone and reactive iodine in exocrine glands to kill microbes. Exocrine glands recycle iodine and with high urinary clearance require constant dietary supply, unlike the thyroid. Disbalanced iodine-selenium explains relations between thyroid autoimmune disease (TAD) and cancer of thyroid and exocrine organs, notably stomach, breast, and prostate. Seafood is iodine unconstrained, but selenium constrained. Terrestrial food contains little iodine while selenium ranges from highly deficient to highly toxic. Iodine vs. TAD is U-shaped, but only low selenium relates to TAD. Oxidative stress from low selenium, and infection from disbalanced iodine-selenium, may generate cancer of thyroid and exocrine glands. Traditional Japanese diet resembles our ancient seashore-based diet and relates to aforementioned diseases. Adequate iodine might be in the milligram range but is toxic at low selenium. Optimal selenoprotein-P at 105 µg selenium/day agrees with Japanese intakes. Selenium upper limit may remain at 300-400 µg/day. Seafood combines iodine, selenium and other critical nutrients. It brings us back to the seashore diet that made us what we currently still are.
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Affiliation(s)
- D A Janneke Dijck-Brouwer
- University of Groningen, University Medical Center Groningen, Department of Laboratory Medicine, Hanzeplein 1, 9713 GZ Groningen, The Netherlands
| | - Frits A J Muskiet
- University of Groningen, University Medical Center Groningen, Department of Laboratory Medicine, Hanzeplein 1, 9713 GZ Groningen, The Netherlands
| | - Richard H Verheesen
- Regionaal Reuma Centrum Z.O. Brabant Máxima Medisch Centrum, Ds. Th. Fliednerstraat 1, 5631 BM Eindhoven, The Netherlands
| | - Gertjan Schaafsma
- Schaafsma Advisory Services in Food, Health and Safety, Rembrandtlaan 12, 3925 VD Scherpenzeel, The Netherlands
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Independent Association of Thyroid Dysfunction and Inflammation Predicts Adverse Events in Patients with Heart Failure via Promoting Cell Death. J Cardiovasc Dev Dis 2022; 9:jcdd9090290. [PMID: 36135435 PMCID: PMC9503390 DOI: 10.3390/jcdd9090290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 08/24/2022] [Accepted: 08/26/2022] [Indexed: 12/03/2022] Open
Abstract
Thyroid dysfunction and inflammation are individually implicated in the increased risk of heart failure. Given the regulatory role of thyroid hormones on immune cells, this study aimed to investigate their joint association in heart failure. Patients with pre-existing heart failure were enrolled when hospitalized between July 2019 and September 2021. Thyroid function and inflammatory markers were measured at the enrollment. The composite of all-cause mortality or rehospitalization for heart failure were studied in the following year. Among 451 participants (mean age 66.1 years, 69.4% male), 141 incident primary endpoints were observed during a median follow-up of 289 days. TT3 and FT3 levels were negatively correlated with BNP levels (r: −0.40, p < 0.001; r: −0.40, p < 0.001, respectively) and NT-proBNP levels (r: −0.39, p < 0.001; r: −0.39, p < 0.001). Multivariate COX regression analysis revealed that FT3 (adjusted HR: 0.677, 95% CI: 0.551−0.832) and NLR (adjusted HR: 1.073, 95% CI: 1.036−1.111) were associated with adverse event, and similar results for TT3 (adjusted HR: 0.320, 95% CI: 0.181−0.565) and NLR (adjusted HR: 1.072, 95% CI: 1.035−1.110). Restricted cubic splines analysis indicated a linear relationship between T3 level and adverse events. Mechanistically, primary cardiomyocytes showed strong resistance to TNF-α induced apoptosis under optimal T3 concentrations, as evidenced by TUNEL staining, flow cytometry analysis, and LDH release assay as well as increased expression of Bcl-2. Thyroid dysfunction and inflammation are independently associated with cardiovascular risk in heart failure patients, which may concurrently contribute to the ongoing cardiomyocyte loss in the disease progression.
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Safety considerations related to intravenous contrast agents in pediatric imaging. Pediatr Radiol 2022:10.1007/s00247-022-05470-z. [PMID: 35941280 DOI: 10.1007/s00247-022-05470-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 05/25/2022] [Accepted: 07/22/2022] [Indexed: 10/15/2022]
Abstract
Intravenous contrast media are used in MRI, CT and US studies for anatomical evaluation and lesion characterization. Safety is always of paramount importance when administering any contrast media to children, and it is important for radiologists and ordering providers to be knowledgeable of the safety profiles and potential adverse events that can occur. This manuscript reviews the frequency and types of adverse events associated with intravenous contrast agents reported in the pediatric literature. Overall, intravenous contrast agents are very safe to use in children. However, familiarity with how to treat and prevent these uncommon events is crucial in preventing poor outcomes. In addition, an understanding of gadolinium deposition in tissues can help facilitate conversations with concerned physicians and parents. This review provides a concise yet comprehensive reference for radiologists and ordering providers on intravenous contrast safety considerations in the pediatric patient.
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Maughan BC, Marin M, Han J, Gibbins KJ, Brixey AG, Caughey AB, Kline JA, Jarman AF. Venous Thromboembolism During Pregnancy and the Postpartum Period: Risk Factors, Diagnostic Testing, and Treatment. Obstet Gynecol Surv 2022; 77:433-444. [PMID: 35792687 PMCID: PMC10042329 DOI: 10.1097/ogx.0000000000001043] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Importance The risk of venous thromboembolism (VTE) increases during pregnancy and the postpartum period. Deep vein thrombosis is the most common VTE during pregnancy, but pulmonary embolism is typically of greater concern as it contributes to far higher morbidity and mortality. Diagnosis and treatment of VTE during pregnancy differ substantially from the general nonpregnant population. Objective This review describes the epidemiology, risk factors, clinical presentation, diagnosis, and treatment of VTE during pregnancy and the postpartum period. Evidence Acquisition First, we reviewed the VTE guidelines from professional societies in obstetrics, cardiology, hematology, emergency medicine, pulmonology, and critical care. Second, we examined references from these documents and used PubMed to identify recent articles that cited the guidelines. Finally, we searched PubMed and Google Scholar for articles published since 2018 that included terms for pregnancy and the epidemiology, risk factors, diagnostic imaging, or treatment of VTE. Results Venous thromboembolism risk increases throughout pregnancy and peaks shortly after delivery. More than half of pregnancy-related VTE are associated with thrombophilia; other major risks include cesarean delivery, postpartum infection, and the combination of obesity with immobilization. Most VTE can be treated with low molecular weight heparin, but cases of limb- or life-threatening VTE require consideration of thrombolysis and other reperfusion therapies. Conclusions and Relevance Venous thromboembolism is far more frequent in antepartum and postpartum women than age-matched controls, and clinical suspicion for VTE in this population should incorporate pregnancy-specific risks. Treatment of limb- or life-threatening antepartum or postpartum VTE requires multispecialty coordination to optimize maternal and fetal outcomes.
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Affiliation(s)
- Brandon C Maughan
- Assistant Professor, Department of Emergency Medicine, Oregon Health & Science University School of Medicine, Portland, OR
| | - Maria Marin
- Medical Student, College of Osteopathic Medicine of the Pacific, Western University of Health Sciences, Pomona, CA
| | - Justin Han
- Medical Student, College of Medicine, Northeast Ohio Medical University, Rootstown, OH
| | - Karen J Gibbins
- Assistant Professor, Division of Perinatology, Department of Obstetrics and Gynecology
| | - Anupama G Brixey
- Assistant Professor, Section of Cardiothoracic Imaging, Department of Diagnostic Radiology
| | - Aaron B Caughey
- Professor and Chair, Department of Obstetrics and Gynecology, Oregon Health & Science University School of Medicine, Portland, OR
| | - Jeffrey A Kline
- Professor and Associate Chair of Research, Department of Emergency Medicine, Wayne State University, Detroit, MI
| | - Angela F Jarman
- Assistant Professor, Department of Emergency Medicine, University of California Davis, Davis, CA
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Peters C, Schoenmakers N. MECHANISMS IN ENDOCRINOLOGY: The pathophysiology of transient congenital hypothyroidism. Eur J Endocrinol 2022; 187:R1-R16. [PMID: 35588090 PMCID: PMC9254299 DOI: 10.1530/eje-21-1278] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Accepted: 05/19/2022] [Indexed: 11/08/2022]
Abstract
Transient congenital hypothyroidism (TCH) refers to congenital hypothyroidism which spontaneously resolves in the first few months or years of life. Currently, there is a paucity of reliable markers predicting TCH at diagnosis, and the diagnosis is established following the withdrawal of levothyroxine therapy around 3 years of age. The incidence of TCH is increasing, and it is a major contributor to the overall increase in the incidence of CH in recent studies. Both genetic factors, in particular mutations affecting DUOX2 and DUOXA2, and environmental factors, for example, iodine deficiency and excess, anti- TSHR antibodies and exposure to antithyroid or iodine-rich medications, may cause TCH. Resolution of TCH in childhood may reflect both normal thyroid physiology (decreased thyroid hormone biosynthesis requirements after the neonatal period) and clearance or cessation of environmental precipitants. The relative contributions and interactions of genetic and environmental factors to TCH, and the extent to which TCH may be prevented, require evaluation in future population-based studies.
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Affiliation(s)
- Catherine Peters
- Department of Endocrinology, Great Ormond Street Hospital for Children, London, UK
| | - Nadia Schoenmakers
- University of Cambridge Metabolic Research Laboratories, Wellcome Trust-MRC Institute of Metabolic Science, University of Cambridge, Cambridge, UK
- Correspondence should be addressed to N Schoenmakers;
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Kobayashi Y, Okumura G, Morizumi T, Nagamatsu K, Shimizu Y, Sasaki T, Sato A, Sekijima Y, Hongo K. Thyroid hormone decreasing after mechanical thrombectomy for cerebral infarction. Clin Neurol Neurosurg 2022; 219:107335. [PMID: 35724614 DOI: 10.1016/j.clineuro.2022.107335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Revised: 05/05/2022] [Accepted: 06/07/2022] [Indexed: 11/03/2022]
Abstract
OBJECTIVE Mechanical thrombectomy (MT) is an established treatment for large vessel occlusion in patients with cerebral infarction. The use of iodine contrast agent decreases thyroid hormone levels via the Wolff-Chaikoff effect. Low triiodothyronine (T3) syndrome caused due to severe illness status can contribute to decreased levels of thyroid hormones. Reportedly, a low T3 level is associated with poor prognosis in patients with cerebral infarction. This study aimed to clarify the changes in thyroid hormone levels in the acute phase after MT and the effects of the iodine contrast agent on these hormones. METHODS This was a single-center, prospective, and single-arm trial. Thyroid stimulating hormone (TSH), free T3 (FT3), and free T4 (FT4) levels were tested on admission and 24 h postoperatively in patients who were approved for MT. RESULTS A total of 37 patients were screened during the study period and 31 patients were enrolled in this study. Significant decreases were observed in TSH (P < 0.001) and FT3 (P < 0.001) levels 24 h after MT. Moreover, there was a correlation between the decrease in ratio of change in FT3 levels and the amount of iodine contrast agent used per body surface area (r = 0.43, P = 0.019), while no such correlations were detected for TSH and FT4. CONCLUSION We demonstrated that TSH and FT3 levels decreased in the acute phase after MT and that FT3 levels were associated with the amount of iodine contrast agent used.
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Affiliation(s)
- Yuya Kobayashi
- Department of Neurology, Ina Central Hospital, 1313-1, Ina, Nagano, 396-8555, Japan.
| | - Gaku Okumura
- Department of Neurology, Ina Central Hospital, 1313-1, Ina, Nagano, 396-8555, Japan
| | - Teruya Morizumi
- Department of Neurology, Ina Central Hospital, 1313-1, Ina, Nagano, 396-8555, Japan
| | - Kiyoshiro Nagamatsu
- Department of Neurology, Ina Central Hospital, 1313-1, Ina, Nagano, 396-8555, Japan
| | - Yusaku Shimizu
- Department of Neurology, Ina Central Hospital, 1313-1, Ina, Nagano, 396-8555, Japan
| | - Tetsuo Sasaki
- Department of Neurosurgery, Ina Central Hospital, 1313-1, Ina, Nagano, 396-8555, Japan
| | - Atsushi Sato
- Department of Neurosurgery, Ina Central Hospital, 1313-1, Ina, Nagano, 396-8555, Japan
| | - Yoshiki Sekijima
- Department of Medicine (Neurology & Rheumatology), Shinshu University School of Medicine, 3-1-1 Asahi, Matsumoto 390-8621, Japan
| | - Kazuhiro Hongo
- Department of Neurosurgery, Ina Central Hospital, 1313-1, Ina, Nagano, 396-8555, Japan
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Dierks S, Andag R, Gauss F, Budde K, Francke P, Peschka M, Fischer A, Schanz J, Petersmann A. Evaluation of the AFIAS-1 thyroid-stimulating hormone point of care test and comparison with laboratory-based devices. Clin Chem Lab Med 2022; 60:1031-1038. [PMID: 35451300 DOI: 10.1515/cclm-2022-0054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 03/31/2022] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Thyroid-stimulating hormone (TSH) is the routine primary screening test to assess thyroid function and rapid measurement of TSH levels is highly desirable especially in emergency situations. In the present study, we compared the analytical performance of a commercially available point-of-care test (AFIAS-1) and five laboratory-based systems. METHODS Left over material of 60 patient plasma samples was collected from patient care and used in the respective assay. For statistical analysis of the produced data Bland-Altman and Passing-Bablok regression analysis were applied. RESULTS Good correlation (r=0.982 or higher) was found between all devices. Slopes from regression analysis ranged from 0.972 (95% CI: 0.927-1.013) to 1.276 (95% CI: 1.210-1.315). Among the compared devices, imprecision was high in terms of coefficient of variation (CV=10.3%) for low TSH concentrations and lower (CV=7.3%) for high TSH concentrations. Independent of the method used, we demonstrated a poor standardization of TSH assays, which might impact clinical diagnosis e.g. of hyperthyreosis. CONCLUSIONS This study shows that the point-of-care (POC) test AFIAS-1 can serve as an alternative to laboratory-based assays. In addition the data imply that better standardization of TSH measurements is needed.
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Affiliation(s)
- Sascha Dierks
- Institute of Clinical Chemistry, University Medical Center Göttingen, Göttingen, Germany
| | - Reiner Andag
- Institute of Clinical Chemistry, University Medical Center Göttingen, Göttingen, Germany
| | - Friederike Gauss
- Institute of Clinical Chemistry and Laboratory Medicine, University Medicine Oldenburg, Oldenburg, Germany.,Institute of Clinical Chemistry and Laboratory Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Kathrin Budde
- Institute of Clinical Chemistry and Laboratory Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Paul Francke
- Institute of Clinical Chemistry and Laboratory Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Manuela Peschka
- Institute of Clinical Chemistry and Laboratory Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Andreas Fischer
- Institute of Clinical Chemistry, University Medical Center Göttingen, Göttingen, Germany.,Division Vascular Signaling and Cancer, German Cancer Research Center, Heidelberg, Germany
| | - Julie Schanz
- Institute of Clinical Chemistry, University Medical Center Göttingen, Göttingen, Germany
| | - Astrid Petersmann
- Institute of Clinical Chemistry and Laboratory Medicine, University Medicine Oldenburg, Oldenburg, Germany.,Institute of Clinical Chemistry and Laboratory Medicine, University Medicine Greifswald, Greifswald, Germany
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50
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Bougias H, Stogiannos N. Breast MRI: Where are we currently standing? J Med Imaging Radiat Sci 2022; 53:203-211. [DOI: 10.1016/j.jmir.2022.03.072] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 03/22/2022] [Accepted: 03/31/2022] [Indexed: 01/07/2023]
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