Frequency of thyroid dysfunction in pediatric patients with congenital heart disease exposed to iodinated contrast media – a long-term observational study

Rouven Kubicki; Jochen Grohmann; Klaus-Georg Kunz; Brigitte Stiller; Karl Otfried Schwab; Natascha van der Werf-Grohmann

doi:10.1515/jpem-2020-0032

Article

Frequency of thyroid dysfunction in pediatric patients with congenital heart disease exposed to iodinated contrast media – a long-term observational study

Rouven Kubicki , Jochen Grohmann , Klaus-Georg Kunz , Brigitte Stiller , Karl Otfried Schwab and Natascha van der Werf-Grohmann

Published/Copyright: October 1, 2020

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From the journal Journal of Pediatric Endocrinology and Metabolism Volume 33 Issue 11

Abstract

Background

The thyroid gland of patients with congenital heart disease may be exposed to large doses of iodine from various sources. We assessed the thyroid response after iodine exposure during conventional angiography in cardiac catheterization and angiographic computer tomography in childhood.

Methods

Retrospective mid- to long-term follow-up of 104 individuals (24% neonates, 51% infants, 25% children) with a median age and body weight of 104 days [0–8 years] and 5.3 kg [1.6–20]. Serum levels of thyroid-stimulating hormone, free triiodthyronine and free thyroxine were evaluated at baseline and after excess iodine. We also assessed risk factors that may affect thyroid dysfunction.

Results

Baseline thyroidal levels were within normal range in all patients. The mean cumulative iodinate contrast load was 6.6 ± 1.6 mL/kg. In fact, 75% had experienced more than one event involving iodine exposure, whose median frequency was three times per patient [1–12]. During the median three years follow-up period [0.5–10], the incidence of thyroid dysfunction was 15.4% (n=16). Those patients developed acquired hypothyroidism (transient n=14, long-lasting n=2 [both died]) with 10 of them requiring temporary replacement therapy for transient thyroid dysfunction, while four patients recovered spontaneously. 88 individuals (84.6%) remained euthyroid. Repeated cardiac interventions, use of drugs that interfere with the thyroid and treatment in the intensive care unit at the index date were strong predictors for acquired thyroid dysfunction.

Conclusions

The incidence of acquired hypothyroidism after iodine excess was 15.4%. However, most patients developed only transient hypothyroidism. Systemic iodine exposure seems to be clinically and metabolically well tolerated during long-term follow-up.

Keywords: cardiac catheterization; congenital heart disease; contrast media; hypothyroidism; iodine; pediatric; thyroid dysfunction

Corresponding author: Rouven Kubicki MD, Department of Congenital Heart Disease and Pediatric Cardiology, University Heart Center Freiburg – Bad Krozingen, Medical Center – University of Freiburg, Faculty of Medicine, University of Freiburg, Mathildenstrasse, 179106 Freiburg, Germany, Phone: + 49 (0) 761/270 43230, Fax: + 49 (0) 761/270 44680, E-mail: rouven.kubicki@universitaets-herzzentrum.de

Acknowledgments

We are grateful to Carole Cürten for language editing.

Research funding: This research group received no specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
Author contributions: All the authors have accepted responsibility for the entire content of this submitted manuscript and approved submission.
Competing interests: The authors declare that they have no conflict of interest.
Informed consent: Informed consent was obtained from all individuals included in this study.
Ethical Approval: The research related to human use has been complied with all the relevant national regulations, institutional policies and in accordance the tenets of the Helsinki Declaration, and has been approved by the authors’ institutional ethical committee.

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Received: 2020-01-23

Accepted: 2020-08-06

Published Online: 2020-10-01

Published in Print: 2020-11-26

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Articles in the same Issue

https://doi.org/10.1515/jpem-2020-0032

Keywords for this article

cardiac catheterization; congenital heart disease; contrast media; hypothyroidism; iodine; pediatric; thyroid dysfunction