Department of Cardiology, Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Tianjin Institute of Cardiology, The Second Hospital of Tianjin Medical University, Tianjin 300211, China.
Department of Cardiovascular Disease, Tianjin Chest Hospital, Tianjin 300051, China.
Chin Med J (Engl). 2023 Sep 5;136(17):2044-2049. doi: 10.1097/CM9.0000000000002260.
More than 75 million procedures with intravascular iodine-based contrast media (ICM) are performed worldwide every year, and some patients undergoing these procedures do not have normal thyroid function. The long-term effects of ICM in patients with mild thyroid dysfunction (TD) are unclear.
This prospective cohort study was conducted in China. Patients with stable angina pectoris with total triiodothyronine (TT3) reduction, normal thyroid-stimulating hormone, and reverse triiodothyronine (rT3) were enrolled and divided into high-dose (≥100 mL ICM) and low-dose groups (<100 mL ICM). We dynamically investigated the trends in thyroid function, rT3, and thyroid antibodies one year after ICM exposure.
A total of 154 patients completed 6 months of follow-up and 149 completed 1 year of follow-up. Thyroglobulin antibody (TGAB) levels were elevated in 41 (26.6%) patients before ICM exposure, 11 (7.1%) of whom also had elevated thyroid peroxidase antibody levels. Transient subclinical TD occurred 6 months after ICM exposure; 75.5% (34/45) of post-operative TD occurred in the high-dose group. One patient developed severe hypothyroidism with myxedema, requiring drug intervention 1 year after ICM exposure. The level of rT3 showed no statistically significant changes during post-operative follow-up ( P = 0.848). The TGAB level decreased at 6th month ( P < 0.001), but increased at 1 year after ICM exposure ( P = 0.002).
Patients with T3 reduction are at a risk of transient subclinical TD and hypothyroidism after a single large dose of ICM. Follow-up of this population at 9-12 months after ICM exposure is warranted.
全世界每年有超过 7500 万例使用含碘的血管内造影剂（ICM）的操作，其中一些患者甲状腺功能正常。在轻度甲状腺功能障碍（TD）患者中，ICM 的长期影响尚不清楚。
这是一项在中国进行的前瞻性队列研究。纳入了总三碘甲状腺原氨酸（TT3）降低、甲状腺刺激激素正常和反三碘甲状腺原氨酸（rT3）的稳定型心绞痛患者，并根据 ICM 用量分为高剂量（≥100ml ICM）和低剂量组（＜100ml ICM）。我们动态研究了 ICM 暴露后 1 年内甲状腺功能、rT3 和甲状腺抗体的变化趋势。
共有 154 例患者完成了 6 个月的随访，149 例完成了 1 年的随访。在 ICM 暴露前，41 例（26.6%）患者甲状腺球蛋白抗体（TGAB）水平升高，其中 11 例（7.1%）甲状腺过氧化物酶抗体也升高。ICM 暴露后 6 个月发生一过性亚临床 TD，高剂量组术后 TD 发生率为 75.5%（34/45）。1 例患者在 ICM 暴露后 1 年发生严重甲状腺功能减退伴黏液性水肿，需要药物干预。rT3 水平在术后随访期间无统计学意义的变化（P=0.848）。TGAB 水平在第 6 个月时下降（P＜0.001），但在 ICM 暴露后 1 年时升高（P=0.002）。
单次大剂量 ICM 后 T3 降低的患者存在一过性亚临床 TD 和甲状腺功能减退的风险。需要在 ICM 暴露后 9-12 个月对该人群进行随访。
