Martin F I, Tress B W, Colman P G, Deam D R
Northwest Hospital, Melbourne, Australia.
Am J Med. 1993 Jul;95(1):78-82. doi: 10.1016/0002-9343(93)90235-h.
To identify the number of cases of hyperthyroidism that followed the performance of contrast radiography in elderly patients at a geriatric hospital in a non-iodine-deficient area and to determine the clinical course of the condition.
All patients over a 20-month period with biochemical hyperthyroidism (plasma free thyroxine level greater than 25.0 pmol/L and thyroid-stimulating hormone level less than 0.10 IU/L) were identified. Clinical features of hyperthyroidism and exposure to nonionic contrast media radiographs within the previous 12 months were sought. Follow-up extended from 6 to 22 months.
A total of 28 patients with hyperthyroidism (aged 70 to 96 years) were identified. Seven patients (25%) had documented biochemical development of hyperthyroidism (five) or subsequent hyperthyroidism (two) 3 to 8 weeks after nonionic contrast media radiography. The four patients who underwent scanning had a multinodular thyroid, and thyroid antibodies were not detected in five of five patients. Although the condition appeared self-limited and six of six patients were euthyroid after 18 months, the condition was not benign; progress and recovery were adversely affected by hyperthyroidism. Four patients had a good response to treatment with an antithyroid drug (carbimazole).
Iodine-induced thyrotoxicosis following contrast radiography was found in 7 of 28 cases of hyperthyroidism seen at a geriatric hospital. Although the condition appears ultimately self-limited, pharmacologic control of severe clinical features may be required. The frequency of this condition in a non-iodine-deficient area appears related to the more common occurrence of autonomous thyroid nodules in the elderly. Because performance of contrast radiography is more common in this age group, the recognition and treatment of iodine-induced thyrotoxicosis are of increasing clinical importance.
确定在非缺碘地区一家老年医院中，老年患者进行造影X线摄影后发生甲状腺功能亢进症的病例数，并确定该病症的临床病程。
确定了在20个月期间内所有生化性甲状腺功能亢进（血浆游离甲状腺素水平大于25.0 pmol/L且促甲状腺激素水平小于0.10 IU/L）的患者。探寻甲状腺功能亢进的临床特征以及在过去12个月内是否接触过非离子型造影剂X线片。随访时间为6至22个月。
共确定了28例甲状腺功能亢进患者（年龄70至96岁）。7例患者（25%）在非离子型造影剂X线摄影后3至8周有生化性甲状腺功能亢进（5例）或随后发生甲状腺功能亢进（2例）的记录。接受扫描的4例患者有甲状腺多发结节，5例患者中有5例未检测到甲状腺抗体。尽管病情似乎具有自限性，6例患者中有6例在18个月后甲状腺功能正常，但病情并非良性；甲状腺功能亢进对病情进展和恢复产生了不利影响。4例患者对抗甲状腺药物（卡比马唑）治疗反应良好。
在一家老年医院所见的28例甲状腺功能亢进病例中，发现7例造影X线摄影后发生碘致甲状腺毒症。尽管病情最终似乎具有自限性，但可能需要对严重临床特征进行药物控制。在非缺碘地区，这种病症的发生率似乎与老年人中自主性甲状腺结节更常见有关。由于造影X线摄影在该年龄组中更常见，因此对碘致甲状腺毒症的认识和治疗在临床上的重要性日益增加。
