Division of Endocrinology, Diabetology, and Metabolism, Department of Medical Sciences, University of Turin, Turin, Italy.
Division of Cardiology, Department of Medical Sciences, University of Turin, Turin, Italy.
Clin Endocrinol (Oxf). 2018 Feb;88(2):272-278. doi: 10.1111/cen.13494. Epub 2017 Nov 20.
To study the effect of a iodine load on thyroid function of patients with ischaemic heart disease (IHD) and the long-term influence of unknown subclinical hyperthyroidism.
Subclinical hyperthyroidism is considered an independent risk factors for cardiovascular morbidity of patients with IHD. They routinely undergo coronary angiography with iodine contrast media (ICM) which may induce or even worsen hyperthyroidism.
A cross-sectional study followed by a longitudinal study on patients with subclinical hyperthyroidism.
810 consecutive IHD outpatients without known thyroid diseases or treatment with drugs influencing thyroid activity undergoing elective coronary angiography.
We evaluated thyroid function either before and 1 month after ICM; patients with thyrotoxicosis at baseline or after ICM were then followed up for 1 year.
58 patients had hyperthyroidism at baseline (HB, 7.2%), independently associated to FT4 levels, thyroid nodules and family history of thyroid diseases. After ICM, the prevalence of hyperthyroidism was 81 (10%). Hyperthyroidism after ICM was positively predicted by baseline fT4 levels, thyroid nodules, age over 60, male gender, family history of thyroid diseases. Three months after ICM, 34 patients (4.2%) still showed hyperthyroidism (22 from HB, 13 treated with methimazole). One year after ICM, hyperthyroidism was still present in 20 patients (2.5%, all from HB, 13 treated).
The prevalence of spontaneous subclinical hyperthyroidism in IHD is surprisingly elevated and is further increased by iodine load, particularly in patients with thyroid nodules and familial history of thyroid diseases, persisting in a not negligible number of them even after one year.
研究碘负荷对缺血性心脏病（IHD）患者甲状腺功能的影响，以及亚临床甲状腺功能亢进的长期影响。
亚临床甲状腺功能亢进被认为是 IHD 患者心血管发病率的独立危险因素。他们通常接受碘对比剂（ICM）的冠状动脉造影检查，这可能导致甚至加重甲状腺功能亢进。
对亚临床甲状腺功能亢进患者进行横断面研究和纵向研究。
810 例连续的 IHD 门诊患者，无已知甲状腺疾病或影响甲状腺活动的药物治疗，行选择性冠状动脉造影。
我们评估了 ICM 前后 1 个月的甲状腺功能；基线或 ICM 后出现甲状腺毒症的患者随后进行了 1 年的随访。
58 例患者基线时有甲状腺功能亢进（HB，7.2%），与 FT4 水平、甲状腺结节和甲状腺疾病家族史独立相关。ICM 后，甲状腺功能亢进的患病率为 81（10%）。基线 fT4 水平、甲状腺结节、年龄大于 60 岁、男性、甲状腺疾病家族史均预测 ICM 后发生甲状腺功能亢进。ICM 后 3 个月，仍有 34 例患者（4.2%）出现甲状腺功能亢进（22 例来自 HB，13 例接受甲巯咪唑治疗）。ICM 后 1 年，仍有 20 例（2.5%，均来自 HB，13 例接受治疗）存在甲状腺功能亢进。
IHD 患者亚临床甲状腺功能亢进的患病率出人意料地升高，碘负荷进一步增加，特别是在有甲状腺结节和甲状腺疾病家族史的患者中，即使在 1 年后，仍有相当数量的患者存在这种情况。
