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[Thyroid function alterations in children with congenital cardiac disease after catheterization with iodinated
M del Cerro Marín1, A Fernández Ruiz, L García-Guereta
1Servicios de Cardiología Pediátrica. Hospital Infantil La Paz. Madrid.
Insights
Thyroid function disturbances are common in children with congenital heart disease after iodinated contrast angiography. Multiple malformation syndromes are a key risk factor for developing and prolonging hypothyroidism post-procedure.
Area of Science:
- Pediatric Endocrinology
- Cardiology
- Radiology
Context:
- Congenital heart disease (CHD) necessitates interventions like cardiac catheterization.
- Iodinated contrast agents used in angiography can interfere with thyroid hormone synthesis.
- Pediatric patients with CHD are vulnerable to thyroid dysfunction post-procedure.
Purpose:
- To determine the incidence of thyroid function disturbances in children with CHD after cardiac catheterization.
- To identify risk factors associated with post-angiography hypothyroidism.
- To ascertain the duration of hypothyroidism following contrast angiography.
Summary:
- Thyroid-stimulating hormone (TSH) and free thyroxine (FT4) levels were monitored in 99 children under three with CHD before and after cardiac catheterization.
- Patients with elevated TSH underwent weekly monitoring; risk factors including age, contrast exposure, and malformations were analyzed.
- Hypothyroidism occurred in 10% of patients, with multiple malformation syndromes being a significant risk factor for both development and prolonged dysfunction.
Impact:
- Highlights the need for thyroid function monitoring in pediatric patients with CHD undergoing contrast angiography.
- Identifies multiple malformation syndromes as a critical risk factor, guiding targeted screening.
- Informs clinical practice regarding the potential for prolonged hypothyroidism and the need for follow-up or treatment.
Introduction And Objectives:
Iodinated contrast agents can block thyroid hormone synthesis. The aims of this study were: 1st) to study the incidence of thyroid function disturbances in children with congenital heart disease after cardiac catheterization, 2nd) to analyze the predisposing factors that may lead to the development of hypothyroidism after angiography, and 3rd) to determine the duration of these hypothyroidism states.
Patients And Methods:
From february 1993 to April 1997 thyrotropine (TSH) and free thyroxine (FT4) serum values were analyzed before cardiac catheterization and in the two following weeks, in 99 children under three years of age, with congenital cardiac disease. Those patients who showed any postangiography increase in TSH were further evaluated by weekly measures of serum thyroid hormones and TSH until normal values were obtained or until the initiation of hormonal replacement therapy. The patients' data (age, previous exposure to contrast agents, cardiac disease, associated extracardiac malformations, renal failure, severity of illness, treatment) and the catheterism data (the dose and type of contrast and the fluoroscopy time) were included in the univariant analysis.
Results:
10 mUI/ml), that persisted beyond three weeks in six cases. The occurrence of multiple malformation syndromes was the most clearly associated risk factor (p < 0,01) not only in the development of postangiography hypothyroidism but also in longer hormonal dysfunction.
Conclusions:
Thyroid function should be tested in every patient with multiple malformation syndrome that undergo angiocardiography with iodinated contrast agents.