van der Molen Aart J, Thomsen Henrik S, Morcos Sameh K
Department of Radiology, Leiden University Medical Center, P.O. Box 9600, 2300 RC Leiden, The Netherlands.
Eur Radiol. 2004 May;14(5):902-7. doi: 10.1007/s00330-004-2238-z. Epub 2004 Feb 28.
Excess free iodide in the blood (ingested or injected) may cause thyrotoxicosis in patients at risk. Iodinated contrast medium solutions contain small amounts of free iodide and may be of significance for patients at risk. The free iodide may also interfere with nuclear medicine diagnostic studies and treatment. Therefore the Contrast Media Safety Committee of the European Society of Urogenital Radiology reviewed the literature on this subject in order to prepare guidelines. A report and guidelines were prepared based on an extensive Medline search. The report was discussed with the participants attending the Tenth European Symposium on Urogenital Radiology, Uppsala, Sweden, September 2003. Contrast medium induced thyrotoxicosis is rare. Contrast medium injection does not affect thyroid function tests (e.g., T3, T4, TSH) in patients with a normal thyroid. Routine monitoring of thyroid function tests before contrast medium injection in patients with a normal thyroid is not indicated even in areas where there is dietary iodine deficiency. Patients at risk of developing thyrotoxicosis after contrast medium injection are patients with Graves' disease and patients with multinodular goiter with thyroid autonomy, especially elderly patients and patients living in areas of iodine deficiency. Patients at high-risk should be carefully monitored by endocrinologists after contrast medium examinations. Prophylaxis in these groups is not generally recommended, although it may offer some protection in selected high-risk individuals. The free iodide load of contrast media injections interferes with iodide uptake in the thyroid and therefore compromises diagnostic thyroid scintigraphy and radio-iodine treatment of thyroid malignancies for 2 months after administration of contrast media. Simple guidelines on the subject are proposed.
血液中过量的游离碘（摄入或注射）可能会使有风险的患者发生甲状腺毒症。碘化造影剂溶液含有少量游离碘，对有风险的患者可能具有重要意义。游离碘还可能干扰核医学诊断研究和治疗。因此，欧洲泌尿生殖放射学会造影剂安全委员会审查了关于该主题的文献，以制定指南。基于广泛的医学文献数据库检索编写了一份报告和指南。该报告在2003年9月于瑞典乌普萨拉举行的第十届欧洲泌尿生殖放射学研讨会上与参会人员进行了讨论。造影剂诱发的甲状腺毒症很罕见。注射造影剂对甲状腺功能正常的患者的甲状腺功能检查（如T3、T4、TSH）没有影响。即使在饮食缺碘地区，也不建议对甲状腺功能正常的患者在注射造影剂前常规监测甲状腺功能检查。注射造影剂后有发生甲状腺毒症风险的患者包括患有格雷夫斯病的患者以及具有甲状腺自主性的多结节性甲状腺肿患者，尤其是老年患者和生活在缺碘地区的患者。造影剂检查后，高危患者应由内分泌科医生仔细监测。虽然对这些人群一般不建议进行预防，但对某些选定的高危个体可能会提供一些保护。造影剂注射中的游离碘负荷会干扰甲状腺对碘的摄取，因此在注射造影剂后2个月内会影响甲状腺恶性肿瘤的诊断性甲状腺闪烁扫描和放射性碘治疗。本文提出了关于该主题的简单指南。
