Pijpers Adinda G H, Zoetelief Sandra E, Eeftinck Schattenkerk Laurens D, de Vries Ralph, Onland Wes, van Schuppen Joost, van Trotsenburg A S Paul, van Heurn L W Ernest, Derikx Joep P M, Zwaveling-Soonawala Nitash, Mooij Christiaan F
Department of Pediatric Surgery, Emma Children's Hospital, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands.
Amsterdam Gastroenterology Endocrinology and Metabolism Research Institute, Amsterdam, The Netherlands.
J Clin Res Pediatr Endocrinol. 2024 Aug 28. doi: 10.4274/jcrpe.galenos.2024.2023-12-2.
Excessive iodine intake triggers the Wolff-Chaikoff effect resulting in downregulation of thyroid hormone synthesis to prevent hyperthyroidism. Failure to escape the Wolff-Chaikoff effect can be seen especially in (premature born) infants and may result in prolonged iodine induced hypothyroidism. We describe a rare case of a preterm infant who developed severe iodinated contrast induced hypothyroidism after the use and prolonged stasis of enteral iodinated contrast media (ICM). In addition a systematic literature search was performed to evaluate all available data on this complication.
A systematic literature search was performed in PubMed and Embase. Studies describing the effect of enteral ICM on thyroid function were considered eligible. The primary outcome was to determine the frequency of contrast induced hypothyroidism in infants after administration of enteral ICM.
The premature infant in our center developed severe iodinated contrast induced hypothyroidism after enteral ICM. In total, only two studies met our eligibility data, reporting eight patients. Out of these eight patients, four premature infants developed a contrast induced hypothyroidism after enteral administration of ICM.
Data on severity, length and frequency of contrast induced hypothyroidism after exposure to enteral ICM is very scarce. The herein reported case and literature search illustrate the potential severity of the complication and underline the necessity of future studies on this topic. We recommend standardized monitoring of thyroid function after exposure to enteral ICM in newborns to prevent delayed diagnosis of severe contrast induced hypothyroidism until evidence based recommendations can be made.
碘摄入过量会引发沃夫-柴可夫效应，导致甲状腺激素合成下调以预防甲状腺功能亢进。尤其是在（早产）婴儿中可见无法摆脱沃夫-柴可夫效应的情况，这可能会导致碘诱导的甲状腺功能减退持续时间延长。我们描述了一例罕见的早产儿病例，该患儿在使用肠内碘化造影剂（ICM）并长期滞留后发生了严重的碘化造影剂诱导的甲状腺功能减退。此外，还进行了系统的文献检索，以评估关于这一并发症的所有现有数据。
在PubMed和Embase中进行了系统的文献检索。描述肠内ICM对甲状腺功能影响的研究被认为符合条件。主要结果是确定婴儿在给予肠内ICM后造影剂诱导的甲状腺功能减退的发生率。
我们中心的这名早产儿在使用肠内ICM后发生了严重的碘化造影剂诱导的甲状腺功能减退。总共只有两项研究符合我们的纳入标准，报告了8例患者。在这8例患者中，有4例早产儿在肠内给予ICM后发生了造影剂诱导的甲状腺功能减退。
关于接触肠内ICM后造影剂诱导的甲状腺功能减退的严重程度、持续时间和发生率的数据非常稀少。本文报告的病例和文献检索说明了该并发症的潜在严重性，并强调了未来对此主题进行研究的必要性。我们建议对新生儿接触肠内ICM后进行甲状腺功能的标准化监测，以防止严重造影剂诱导的甲状腺功能减退的延迟诊断，直到能够提出基于证据的建议。
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