Given the fact that a large number of radiological examinations using iodine-based contrast media (ICM) are performed in everyday practice, clinicians should be aware of potential ICM-induced thyroid dysfunction (TD). ICM can induce hyperthyroidism (Hyper) or hypothyroidism (Hypo) due to supraphysiological concentrations of iodine in the contrast solution. The prevalence of ICM-induced TD varies from 1 to 15%. ICM-induced Hyper is predominantly found in regions with iodine deficiency and in patients with underlying nodular goiter or latent Graves’ disease. Patients at risk for ICM-induced Hypo include those with autoimmune thyroiditis, living in areas with sufficient iodine supply. Most cases of ICM-induced TD are mild and transient. In the absence of prospective clinical trials on the management of ICM-induced TD, an individualized approach to prevention and treatment, based on patient’s age, clinical symptoms, pre-existing thyroid diseases, coexisting morbidities and iodine intake must be advised. Treatment of ICM-induced Hyper with antithyroid drugs (in selected cases in combination with sodium perchlorate) should be considered in patients with severe or prolonged hyperthyroid symptoms or in older patients with underlying heart disease. It is debated whether preventive therapy with methimazole and/or perchlorate prior to ICM administration is justified. In ICM-induced overt Hypo, temporary levothyroxine may be considered in younger patients with symptoms of Hypo, with an underlying autoimmune thyroiditis and in women planning pregnancy. Additional clinical trials with clinically relevant endpoints are warranted to further aid in clinical decision-making in patients with ICM-induced TD.
Eur Thyroid J

中文翻译：

---

2021 年欧洲甲状腺协会碘造影剂所致甲状腺功能障碍管理指南

鉴于在日常实践中进行了大量使用碘基造影剂 (ICM) 的放射学检查，临床医生应该意识到潜在的 ICM 诱发的甲状腺功能障碍 (TD)。由于对比溶液中碘的超生理浓度，ICM 可诱发甲状腺功能亢进 (Hyper) 或甲状腺功能减退 (Hypo)。ICM 引起的 TD 的患病率从 1% 到 15% 不等。ICM 诱导的 Hyper 主要见于碘缺乏地区和有潜在结节性甲状腺肿或潜伏 Graves 病的患者。有 ICM 诱发的低血糖风险的患者包括患有自身免疫性甲状腺炎、生活在碘供应充足地区的患者。大多数 ICM 诱导的 TD 病例是轻微和短暂的。在缺乏关于 ICM 诱导的 TD 管理的前瞻性临床试验的情况下，必须建议根据患者的年龄、临床症状、先前存在的甲状腺疾病、合并症和碘摄入量采取个体化的预防和治疗方法。有严重或长期甲状腺功能亢进症状的患者或有潜在心脏病的老年患者应考虑使用抗甲状腺药物治疗 ICM 诱发的甲状腺功能亢进症（在某些情况下与高氯酸钠联合使用）。在 ICM 给药前使用甲巯咪唑和/或高氯酸盐进行预防性治疗是否合理存在争议。在 ICM 诱导的明显性低血糖症中，对于有低血糖症症状、潜在自身免疫性甲状腺炎的年轻患者和计划怀孕的女性，可以考虑暂时使用左旋甲状腺素。
欧洲甲状腺杂志