Chen C C, Huang W S, Huang S C, Won G S, Lin H D
Department of Internal Medicine, China Medical College Hospital, Taichung, Taiwan, R.O.C.
Zhonghua Yi Xue Za Zhi (Taipei). 1994 Jun;53(6):379-82.
Thyrotoxicosis may be aggravated by the administration of either iodinated contrast medium or inorganic iodide. A case of subclinical hyperthyroidism aggravated by iodinated contrast medium is presented here. The patient had received right subtotal lobectomy of the thyroid gland for thyroid cyst in 1969. She had been well until February 1981, when she was found by 131I thyroid scan to have left nodular goiter. Thyroid function was in euthyroid state. Progressive enlargement of the left nodular goiter was noted in October 1987, with thyroid function still in the euthyroid state. Therefore, suppression therapy with L-thyroxine (Eltroxin 0.1 mg per day) was given for eight months until July 1988. The patient was lost to follow-up thereafter until she was admitted to the endocrine ward of the Veterans General Hospital-Taipei in August 1992 because of a progressively enlarged goiter associated with body weight loss. Serum T3 (127 ng/dl) and T4 (11.36 micrograms/dl) were within normal range, but TSH (0.06 microU/ml) was very low. The patient had exacerbated symptoms of hyperthyroidism and elevated serum T3 (216 ng/dl), T4 (18.19 micrograms/dl) levels one week after iodinated contrast medium injection, during a neck CT scan examination. The patient eventually received thyroid operation for her goiter and hyperthyroidism. Caution should be done in the administration of iodine-containing drugs, especially iodinated contrast medium in patients with pre-existing thyroid disease.
碘化造影剂或无机碘化物的使用可能会加重甲状腺毒症。本文报告一例因碘化造影剂而加重的亚临床甲状腺功能亢进病例。该患者于1969年因甲状腺囊肿接受了甲状腺右叶次全切除术。直到1981年2月她一直情况良好，当时经131I甲状腺扫描发现她患有左侧结节性甲状腺肿。甲状腺功能处于正常甲状腺状态。1987年10月注意到左侧结节性甲状腺肿逐渐增大，甲状腺功能仍处于正常甲状腺状态。因此，给予左旋甲状腺素（优甲乐0.1毫克/天）抑制治疗八个月，直至1988年7月。此后该患者失去随访，直到1992年8月因甲状腺肿逐渐增大伴体重减轻而入住台北荣民总医院内分泌病房。血清T3（127纳克/分升）和T4（11.36微克/分升）在正常范围内，但促甲状腺激素（TSH）（0.06微单位/毫升）非常低。在颈部CT扫描检查期间，患者在注射碘化造影剂一周后出现甲状腺功能亢进症状加重，血清T3（216纳克/分升）、T4（18.19微克/分升）水平升高。该患者最终因甲状腺肿和甲状腺功能亢进接受了甲状腺手术。对于已有甲状腺疾病的患者，在使用含碘药物时应谨慎，尤其是碘化造影剂。
