Sandberg Elizabeth S, Fisher Jacqueline S
Department of Pediatrics, Division of Endocrinology, C.S. Mott Children's Hospital, University of Michigan, Ann Arbor, Michigan, USA.
Children's Minnesota Division of Pediatric Endocrinology, Saint Paul, Minnesota, USA.
Case Rep Endocrinol. 2025 Jul 15;2025:6859739. doi: 10.1155/crie/6859739. eCollection 2025.
Jod-Basedow syndrome and iodine-induced hypothyroidism are rare but clinically significant complications of iodine exposure. We report a unique case of a 14-year-old boy with congenital heart disease, who developed sequential iodine-induced hypothyroidism due to failure to escape from the Wolff-Chaikoff effect, followed by hyperthyroidism (Jod-Basedow syndrome) after additional exposure to iodinated contrast. The patient is a 14-year-old male with a history of complex congenital cardiac defects. He underwent a Fontan procedure to manage his single-ventricle physiology, resulting in plastic bronchitis requiring lymphatic intervention and cardiac catheterization. At age 15, he developed hypothyroidism requiring levothyroxine, but 6 months later presented with symptoms and labs confirming hyperthyroidism following CT scan with IV iodinated contrast. Levothyroxine was discontinued, and methimazole was initiated to manage his hyperthyroidism. Iodine-induced hypothyroidism and Jod-Basedow syndrome should be considered potential complications for patients who undergo iodine exposure. This case highlights the importance of vigilant thyroid monitoring in congenital heart disease patients who are undergoing frequent radiation and iodine contrast exposure. In this patient, both his hypothyroidism and hyperthyroidism were successfully managed, but his overall condition deteriorated, ultimately requiring a heart transplant. This case underscores the importance of close monitoring of thyroid hormone levels in complex cardiac patients who undergo repeated exposure to iodinated contrast during procedures and imaging studies.
碘致巴塞多综合征和碘致甲状腺功能减退是碘暴露后罕见但具有临床意义的并发症。我们报告了一例独特的病例，一名14岁患有先天性心脏病的男孩，因未能摆脱 Wolff-Chaikoff 效应而先后发生碘致甲状腺功能减退，在额外接触碘化造影剂后又出现甲状腺功能亢进（碘致巴塞多综合征）。该患者是一名14岁男性，有复杂先天性心脏缺陷病史。他接受了 Fontan 手术以处理单心室生理状况，术后出现塑料支气管炎，需要进行淋巴介入和心脏导管插入术。15岁时，他出现甲状腺功能减退，需要服用左甲状腺素，但6个月后，在接受静脉注射碘化造影剂的CT扫描后，出现了甲状腺功能亢进的症状和实验室检查结果。停用左甲状腺素，开始使用甲巯咪唑治疗他的甲状腺功能亢进。碘致甲状腺功能减退和碘致巴塞多综合征应被视为碘暴露患者的潜在并发症。该病例强调了对频繁接受辐射和碘造影剂暴露的先天性心脏病患者进行甲状腺功能监测的重要性。在该患者中，他的甲状腺功能减退和甲状腺功能亢进均得到成功治疗，但他的整体状况恶化，最终需要进行心脏移植。该病例强调了在手术和影像学检查中反复接触碘化造影剂的复杂心脏病患者密切监测甲状腺激素水平的重要性。
