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[Prevention of iodine-induced hyperthyroidism after coronary angiography]
H Fritzsche1, W Benzer, W Furlan
1Abteilung für Nuklearmedizin, Landeskrankenhauses Feldkirch.
Insights
Coronary angiography (CA) can cause iodine-induced hyperthyroidism. Prophylactic medication with perchlorate and methimazole before CA significantly reduces thyroid dysfunction and iodine excess.
Area of Science:
- Endocrinology
- Radiology
- Nuclear Medicine
Context:
- Coronary angiography (CA) involves a significant iodine load, potentially impacting thyroid function.
- Subclinical thyroid abnormalities are common in patients undergoing CA, even without prior thyroid history.
Purpose:
- To investigate the incidence of thyroid dysfunction following coronary angiography.
- To evaluate the efficacy of prophylactic natrium-perchlorate and methimazole in preventing iodine-induced hyperthyroidism post-CA.
Summary:
- A study of 60 patients undergoing CA revealed thyroid abnormalities in 56, with 33 showing decreased technetium uptake and increased urine iodine excretion 12 weeks later.
- Prophylactic administration of natrium-perchlorate and methimazole to 27 patients prevented thyroid dysfunction and iodine excess post-CA, with only one case of overt hyperthyroidism in a patient who later underwent PTCA without premedication.
Impact:
- Iodine excess from CA can induce hyperthyroidism even in euthyroid individuals.
- Prophylaxis with perchlorate and methimazole is recommended for patients undergoing CA to mitigate the risk of iodine-induced hyperthyroidism.
Abstract:
Coronary angiography (CA) is followed by an iodine load of 15 to 20 mg for the thyroid and may be the cause of iodine-induced hyperthyroidism. 60 consecutive patients hospitalized for CA without any thyroid history were examined and 56 had thyroid diseases with normal thyroid function. 33 patients still showed a significant decrease of 20 min Technetium uptake (TcU) and an increase of urine iodine excretion because of iodine excess 12 weeks after CA. 3 patients developed latent hyperthyroidism. 27 patients received medication of 1 g natrium-perchlorate and 60 mg methimazole 24 hours before and on the day of CA. These patients showed normal TcU and urine iodine excretion 4 and 12 weeks after CA. 1 out of these 27 patients developed overt hyperthyroidism but had PTCA without premedication 2 weeks after CA. Since Iodine excess leads to iodine-induced hyperthyroidism even in euthyroids a prophylaxis with perchlorate and methimazole is generally recommended in patients with CA.