The effect of iodinated contrast media on thyroid (dys)function in children

Excess iodine from iodinated contrast media (ICM) can lead to thyroid dysfunction. Children, especially neonates and premature infants, may be more vulnerable due to their immature thyroid physiology.

A systematic review was conducted using EMBASE, MEDLINE (PubMed), Cochrane, Web of Science, and Scopus. Inclusion criteria were studies in children ≤ 18 years receiving ICM and that reported effects on thyroid function. Exclusion criteria included topical iodine exposure, prenatal administration, and irrelevant endpoints. Case reports, reviews, and abstracts were also excluded.

Most studies reported temporary thyroid function disturbances following ICM exposure in children, particularly subclinical hypothyroidism. Overt hypothyroidism was rare and occurred mainly in neonates and high-risk groups. In certain studies, up to 25% of neonates showed TSH abnormalities, with a subset requiring levothyroxine treatment. Although even more rare, some studies also reported cases of thyrotoxicosis after ICM exposure.

ICM exposure can lead to thyroid dysfunction in children, especially in neonates, preterm infants, and those with risk factors. Risk-based screening and monitoring are recommended to allow timely detection and treatment.