碘化造影剂暴露与新发甲状腺功能亢进症和甲状腺功能减退症之间的关联。

Association between iodinated contrast media exposure and incident hyperthyroidism and hypothyroidism.

作者信息

Rhee Connie M, Bhan Ishir, Alexander Erik K, Brunelli Steven M

机构信息

Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA.

出版信息

Arch Intern Med. 2012 Jan 23;172(2):153-9. doi: 10.1001/archinternmed.2011.677.

DOI:10.1001/archinternmed.2011.677

PMID:22271121

Abstract

BACKGROUND

Sudden exposure to high iodide levels may cause thyroid dysfunction. Despite compelling biological plausibility and clinical implication, the association between iodinated contrast media exposure and incident hyperthyroidism and hypothyroidism has not been rigorously studied.

METHODS

We performed a nested case-control study of patients treated between January 1, 1990, and June 30, 2010, who did not have preexisting hyperthyroidism or hypothyroidism. In parallel analyses, incident hyperthyroid or hypothyroid cases were defined by a change in thyrotropin level from normal (at baseline) to low or high (follow-up measurement). Euthyroid controls were selected using an incidence density sampling approach and were matched to cases on the basis of age, sex, race/ethnicity, estimated glomerular filtration rate, follow-up thyrotropin measurement date, and interval between baseline and the follow-up thyrotropin measurement date. Iodinated contrast media exposure was assessed using claims data for contrast-enhanced computed tomography or cardiac catheterization.

RESULTS

In total, 178 and 213 incident hyperthyroid and hypothyroid cases, respectively, were matched to 655 and 779 euthyroid controls, respectively. Iodinated contrast media exposure was associated with incident hyperthyroidism (odds ratio [OR], 1.98; 95% CI, 1.08-3.60), but a statistically significant association with incident hypothyroidism was not observed (OR, 1.58; 95% CI, 0.95-2.62). In prespecified secondary analysis, iodinated contrast media exposure was associated with incident overt hyperthyroidism (follow-up thyrotropin level ≤ 0.1 mIU/L; OR, 2.50; 95% CI, 1.06-5.93) and with incident overt hypothyroidism (follow-up thyrotropin level >10 mIU/L; OR, 3.05; 95% CI, 1.07-8.72).

CONCLUSION

Iodinated contrast media exposure is associated with subsequent development of incident hyperthyroidism and incident overt hypothyroidism.

摘要

背景

突然暴露于高碘水平可能导致甲状腺功能障碍。尽管有令人信服的生物学合理性和临床意义，但碘化造影剂暴露与新发甲状腺功能亢进和甲状腺功能减退之间的关联尚未得到严格研究。

方法

我们对1990年1月1日至2010年6月30日期间接受治疗且既往无甲状腺功能亢进或甲状腺功能减退的患者进行了一项巢式病例对照研究。在平行分析中，新发甲状腺功能亢进或甲状腺功能减退病例定义为促甲状腺激素水平从正常（基线时）变为低或高（随访测量）。采用发病密度抽样方法选择甲状腺功能正常的对照，并根据年龄、性别、种族/民族、估计肾小球滤过率、随访促甲状腺激素测量日期以及基线与随访促甲状腺激素测量日期之间的间隔与病例进行匹配。使用增强计算机断层扫描或心脏导管插入术的索赔数据评估碘化造影剂暴露情况。

结果

分别有178例和213例新发甲状腺功能亢进和甲状腺功能减退病例，分别与655例和779例甲状腺功能正常的对照进行匹配。碘化造影剂暴露与新发甲状腺功能亢进相关（优势比[OR]，1.98；95%可信区间，1.08 - 3.60），但未观察到与新发甲状腺功能减退有统计学意义的关联（OR，1.58；95%可信区间，0.95 - 2.62）。在预先设定的二次分析中，碘化造影剂暴露与新发显性甲状腺功能亢进（随访促甲状腺激素水平≤0.1 mIU/L；OR，2.50；95%可信区间，1.06 - 5.93）以及新发显性甲状腺功能减退（随访促甲状腺激素水平>10 mIU/L；OR，3.05；95%可信区间，1.07 - 8.72）相关。