Meaghan L Barr1, Harvey K Chiu1, Ning Li1, Michael W Yeh1, Connie M Rhee1, Jacqueline Casillas1, Paul J Iskander1, Angela M Leung1. 1. University of California Los Angeles (UCLA) David Geffen School of Medicine (M.L.B.), Los Angeles 90073, California; Division of Pediatric Endocrinology (H.K.C.), Department of Pediatrics, UCLA David Geffen School of Medicine, Los Angeles, California 90073; Department of Biomathematics (N.L.), UCLA David Geffen School of Medicine, Los Angeles, California 90073; Section of Endocrine Surgery (M.W.Y.), Department of Surgery, UCLA David Geffen School of Medicine, Los Angeles, California 90073; Division of Nephrology and Hypertension (C.M.R.), University of California Irvine School of Medicine, Irvine, California 92697; Division of Pediatric Hematology and Oncology (J.C.), Department of Pediatrics, UCLA David Geffen School of Medicine, Los Angeles, California 90073; Department of Radiology (P.J.I.), UCLA David Geffen School of Medicine, Los Angeles, California 90073; Division of Endocrinology (A.M.L.), Department of Medicine, UCLA David Geffen School of Medicine, Los Angeles, California 90073; and Division of Endocrinology (A.M.L.), Veterans' Affairs Greater Los Angeles Healthcare System, Los Angeles, California 90073.
Abstract
CONTEXT: Iodinated contrast media (ICM) is routinely used in imaging studies and contains several 100-fold the recommended daily allowance of iodine. OBJECTIVE: To determine whether children exposed to ICM have a higher risk of iodine-induced thyroid dysfunction. DESIGN: This was a single-institution case-control study, examining patients with incident thyroid dysfunction aged less than 18 years from 2001 to 2015. Cases were matched 1:1 to euthyroid controls by age, sex, and race. SETTING: This was a single-institution case-control study occurring at tertiary care center. PARTICIPANTS: Cases were defined as those with thyroid dysfunction (by International Classification of Diseases, Ninth Revision diagnosis codes and/or 2 consecutive abnormal serum TSH values <6 mo apart). We analyzed 870 cases matched to 870 controls (64% female, 51% White). MAIN OUTCOMES MEASURES: Using conditional logistic regression, the association between ICM exposure and the primary outcome, thyroid dysfunction, occurring within 2 years of exposure was assessed. RESULTS: Sixty-nine patients received ICM, including 53 (6%) among cases and 16 (2%) among controls. The risk of incident hypothyroidism was significantly higher after ICM exposure (odds ratio 2.60; 95% confidence interval, 1.43-4.72; P < .01). The median interval between exposure and onset of hypothyroidism was 10.8 months (interquartile range, 6.6-17.9). In hypothyroid cases, the median serum TSH concentration was 6.5 mIU/L (interquartile range, 5.8-9.6). CONCLUSIONS: ICM exposure increases the risk of incident hypothyroidism in pediatric patients. Children receiving ICM should be monitored for iodine-induced thyroid dysfunction, particularly during the first year after exposure.
CONTEXT: Iodinated contrast media (ICM) is routinely used in imaging studies and contains several 100-fold the recommended daily allowance of iodine. OBJECTIVE: To determine whether children exposed to ICM have a higher risk of iodine-induced thyroid dysfunction. DESIGN: This was a single-institution case-control study, examining patients with incident thyroid dysfunction aged less than 18 years from 2001 to 2015. Cases were matched 1:1 to euthyroid controls by age, sex, and race. SETTING: This was a single-institution case-control study occurring at tertiary care center. PARTICIPANTS: Cases were defined as those with thyroid dysfunction (by International Classification of Diseases, Ninth Revision diagnosis codes and/or 2 consecutive abnormal serum TSH values <6 mo apart). We analyzed 870 cases matched to 870 controls (64% female, 51% White). MAIN OUTCOMES MEASURES: Using conditional logistic regression, the association between ICM exposure and the primary outcome, thyroid dysfunction, occurring within 2 years of exposure was assessed. RESULTS: Sixty-nine patients received ICM, including 53 (6%) among cases and 16 (2%) among controls. The risk of incident hypothyroidism was significantly higher after ICM exposure (odds ratio 2.60; 95% confidence interval, 1.43-4.72; P < .01). The median interval between exposure and onset of hypothyroidism was 10.8 months (interquartile range, 6.6-17.9). In hypothyroid cases, the median serum TSH concentration was 6.5 mIU/L (interquartile range, 5.8-9.6). CONCLUSIONS: ICM exposure increases the risk of incident hypothyroidism in pediatric patients. Children receiving ICM should be monitored for iodine-induced thyroid dysfunction, particularly during the first year after exposure.
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