Department of Radiology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
Department of Radiology, Sahlgrenska University Hospital, Gothenburg, Sweden.
Eur Thyroid J. 2024 Nov 11;13(6). doi: 10.1530/ETJ-24-0244. Print 2024 Dec 1.
When exposed to iodine contrast medium (ICM), thyroid dysfunction may develop, due to excess amounts of iodide. The incidence of contrast-induced thyroid dysfunction has been difficult to interpret, because of the observational and retrospective designs of most previous studies. With the Swedish CArdioPulmonary bioImage Study (SCAPIS), where randomly selected individuals aged 50-65 years, underwent contrast-enhanced coronary CT angiography (CCTA), we were able to prospectively assess the incidence, magnitude and clinical impact of contrast-induced thyroid dysfunction.
In 422 individuals, thyroid hormone levels were analysed before and 4-12 weeks after CCTA. Thyroid-related patient-reported outcome questionnaires (ThyPRO) at the time of pre and post-CCTA blood samplings were provided by 368 of those individuals. Thyroid peroxidase antibodies (TPOab) were analysed and an ultrasound of the thyroid gland was performed to detect any thyroid nodules.
There was a small statistically significant effect on thyroid hormone levels but no cases of overt hypo- or hyperthyroidism after ICM. Subclinical hypo- or hyperthyroidism or isolated low/high levels of free thyroxine (fT4) developed in 3.5% of the population with normal hormone levels pre-CCTA but without any increased thyroid-related symptoms compared to the remaining cohort. Elevated TPOab and being born outside Sweden were risk factors for developing subclinical hypothyroidism. The presence of thyroid nodules was not associated with ICM-induced thyroid dysfunction.
The results of this prospective study support the notion that in iodine-sufficient countries, ICM-associated thyroid dysfunction is rare, usually mild, self-limiting and oligo/asymptomatic in subjects aged 50-65 years.
由于碘化物过量，接触碘造影剂（ICM）可能会导致甲状腺功能障碍。由于大多数先前研究的观察性和回顾性设计，很难解释对比剂诱导的甲状腺功能障碍的发生率。通过瑞典心肺生物影像学研究（SCAPIS），我们对 50-65 岁的随机个体进行了对比增强冠状动脉 CT 血管造影（CCTA），从而能够前瞻性评估对比剂诱导的甲状腺功能障碍的发生率、程度和临床影响。
在 422 名个体中，在 CCTA 前后 4-12 周分析甲状腺激素水平。其中 368 名个体提供了 CCTA 前后采血时与甲状腺相关的患者报告结局问卷（ThyPRO）。分析甲状腺过氧化物酶抗体（TPOab）并进行甲状腺超声检查以检测任何甲状腺结节。
ICM 后甲状腺激素水平有统计学上的微小但无显著影响，也没有出现明显的甲状腺功能减退或甲状腺功能亢进。在 CCTA 前激素水平正常的人群中，3.5%出现亚临床甲状腺功能减退或甲状腺功能亢进或游离甲状腺素（fT4）水平单独升高，但与其余队列相比，甲状腺相关症状无增加。甲状腺过氧化物酶抗体升高和出生在瑞典以外是发生亚临床甲状腺功能减退的危险因素。甲状腺结节的存在与 ICM 诱导的甲状腺功能障碍无关。
这项前瞻性研究的结果支持这样的观点，即在碘充足的国家，50-65 岁的碘造影剂相关甲状腺功能障碍很少见，通常是轻度的、自限性的和寡症状或无症状的。
