Skip to main content
SpringerLink
Log in

Effect of iodinated contrast media on thyroid function in adults

  • Contrast media
  • Published:
European Radiology Aims and scope Submit manuscript

Abstract

Excess free iodide in the blood (ingested or injected) may cause thyrotoxicosis in patients at risk. Iodinated contrast medium solutions contain small amounts of free iodide and may be of significance for patients at risk. The free iodide may also interfere with nuclear medicine diagnostic studies and treatment. Therefore the Contrast Media Safety Committee of the European Society of Urogenital Radiology reviewed the literature on this subject in order to prepare guidelines. A report and guidelines were prepared based on an extensive Medline search. The report was discussed with the participants attending the Tenth European Symposium on Urogenital Radiology, Uppsala, Sweden, September 2003. Contrast medium induced thyrotoxicosis is rare. Contrast medium injection does not affect thyroid function tests (e.g., T3, T4, TSH) in patients with a normal thyroid. Routine monitoring of thyroid function tests before contrast medium injection in patients with a normal thyroid is not indicated even in areas where there is dietary iodine deficiency. Patients at risk of developing thyrotoxicosis after contrast medium injection are patients with Graves’ disease and patients with multinodular goiter with thyroid autonomy, especially elderly patients and patients living in areas of iodine deficiency. Patients at high-risk should be carefully monitored by endocrinologists after contrast medium examinations. Prophylaxis in these groups is not generally recommended, although it may offer some protection in selected high-risk individuals. The free iodide load of contrast media injections interferes with iodide uptake in the thyroid and therefore compromises diagnostic thyroid scintigraphy and radio-iodine treatment of thyroid malignancies for 2 months after administration of contrast media. Simple guidelines on the subject are proposed.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Roti E, Uberti ED (2001) Iodine excess and hyperthyroidism. Thyroid 11:493–500

    CAS  PubMed  Google Scholar 

  2. Braverman LE (1994) Iodine and the thyroid: 33 years of study. Thyroid 4:351–356

    CAS  PubMed  Google Scholar 

  3. Stanbury JB, Ermans AE, Bourdoux P et al (1998) Iodine-induced hyperthyroidism: occurrence and epidemiology. Thyroid 8:83–100

    CAS  PubMed  Google Scholar 

  4. Hehrmann R, Klein D, Mayer D, Ploner O (1996) Hyperthyreoserisiko bei Kontrastmitteluntersuchungen. Akt Radiol 6:243–248

    CAS  Google Scholar 

  5. Rendl J, Saller B (2001) Schilddrüse und Röntgenkontrastmittel: Pathophysiologie, Häufigkeit und Prophylaxe der jodinduzierten Hyperthyreose. Dt Ärztebl 98:A402–A406

    Google Scholar 

  6. Conn JJ, Sebastian MJ, Deam D, Tam M, Martin FIR (1996) A prospective study of the effect of ionic media on thyroid function. Thyroid 6:107–110

    CAS  PubMed  Google Scholar 

  7. Martin FIR, Deam DR (1996) Hyperthyroidism in elderly hospitalized patients. Clinical features and treatment outcomes. Med J Aust 164:200–203

    CAS  PubMed  Google Scholar 

  8. Dunn JT, Semigran MJ, Delange F (1998) The prevention and management of iodine-induced hyperthyroidism and its cardiac features. Thyroid 8:101–106

    CAS  PubMed  Google Scholar 

  9. Grainger RG, Pennington GW (1981) A study of the effect of sodium/meglumine ioxaglate (Hexabrix) on thyroid function. Br J Radiol 54:768–772

    CAS  PubMed  Google Scholar 

  10. De Bruin TJW (1994) Iodide induced hyperthyroidism with computed tomography contrast fluids [letter]. Lancet 343:1160–1161

    Google Scholar 

  11. Nygaard B, Nygaard T, Jensen LI et al (1998) Iohexol: effects on uptake of radioactive iodine in the thyroid and on thyroid function. Acad Radiol 5:409–414

    CAS  PubMed  Google Scholar 

  12. Martin FIR, Tress BW, Colman PG, Deam DR (1993) Iodine-induced hyperthyroidism due to non-ionic contrast radiography in the elderly. Am J Med 95:78–82

    CAS  PubMed  Google Scholar 

  13. Stiedle B (1989) Iodine-induced hyperthyroidism after contrast media. Animal experimental and clinical studies. In: Tänzer V, Wend S (eds) Recent developments in non-ionic contrast media. Thieme, New York, pp 6–14

  14. Hintze G, Blombach O, Fink H, Burkhardt U, Köbberling J (1999) Risk of iodine-induced thyrotoxicosis after coronary angiography: an investigation in 788 unselected subjects. Eur J Endocrinol 140:264–267

    CAS  PubMed  Google Scholar 

  15. Fassbender WJ, Schlüter S, Stracke H, Bretzel RG, Waas W, Tillmans H (2001) Schilddrüsenfunktion nach Gabe jodhaltigen Röntgenkontrastmittels bei Koronarangiographie—eine prospektive Untersuchung euthyroiden Patienten. Z Kardiol 90:751–759

    Article  CAS  PubMed  Google Scholar 

  16. Laurie AJ, Lyon SG, Lasser EC (1992) Contrast material iodides: potential effects on radioactive iodine thyroid uptake. J Nucl Med 33:237–238

    PubMed  Google Scholar 

  17. Coel M, Talner B, Lang H (1975) Mechanism of radioactive iodine uptake depression following intravenous urography. Br J Radiol 48:146–147

    CAS  PubMed  Google Scholar 

  18. Wilson GA, O’Mara RE (1997) Uptake tests, thyroid and whole body imaging with isotopes. In: Falk SA (ed) Thyroid disease: endocrinology, surgery, nuclear medicine and radiotherapy. Lippincott-Raven, Philadelphia, pp 113–133

  19. Martin WH, Sandler MP (2003) Thyroid imaging. In: Sandler MP, Coleman RE, Patton JE, Wackers FJTh, Gottschalk A (eds) Diagnostic nuclear medicine, 4th edn. Lippincott, Williams & Wilkins, Baltimore, pp 607–651

  20. Tuttle RM, Becker DV, Hurley JR (2003) Radioiodine treatment of thyroid disease. In: Sandler MP, Coleman RE, Patton JE, Wackers FJTh, Gottschalk A (eds) Diagnostic nuclear medicine, 4th edn. Lippincott, Williams & Wilkins, Baltimore, pp 653–670

  21. Joseph K (1995) Leser fragen—Experten Antworten. Welche Empfehlungen zur Prophylaxe liegen vor für Patienten mit erhöhtem Hyperthyreoserisiko, wenn eine Untersuchung mit jodhaltigen Kontrastmitteln durchgeführt werden müβ? Internist 36:1014–1015

    CAS  PubMed  Google Scholar 

  22. Emrich D, Erlenmaier U, Pohl M, Luig H (1993) Determination of the autonomously functioning volume of the thyroid. Eur J Nucl Med 20:410–414

    CAS  PubMed  Google Scholar 

  23. Van Guldener C, Blom DM, Lips P, Strack van Schijndel RJ (1998) Hyperthyreoidie door jodiumhoudende röntgencontrastmiddelen. Ned Tijdschr Geneeskd 142:1641–1644

    PubMed  Google Scholar 

  24. Nolte W, Müller R, Siggelkow H, Emrich D, Hüfner M (1996) Prophylactic application of thyrostatic drugs during excessive iodine exposure in euthyroid patients with thyroid autonomy: a randomized study. Eur J Endocrinol 134:337–341

    CAS  PubMed  Google Scholar 

  25. Lawrence JE, Lamm SH, Braverman LE (1999) The use of perchlorate for the prevention of thyrotoxicosis in patients given iodine rich contrast agents. J Endocrinol Invest 22:405–407

    CAS  PubMed  Google Scholar 

  26. Mann K, Rendl J, Busley R, Saller B, Seybold S, Hörmann R et al (1994) Systemic iodine absorption during endoscopic application of radiographic contrast agents for endoscopic retrograde cholangiopancreaticography. Eur J Endocrinol 130:498–501

    CAS  PubMed  Google Scholar 

  27. Fassbender WJ, Vogel C, Doppl W, Stracke H, Bretzel RG, Klor HU (2001) Thyroid function, thyroid immunoglobulin status, and urinary iodine excretion after enteral contrast-agent administration by endoscopic retrograde cholangiopancreatography. Endoscopy 33:245–252

    Article  CAS  PubMed  Google Scholar 

  28. Thomsen HS, Almén T, Morcos SK, Members of the Contrast Media Safety Committee of the European Society of Urogenital Radiology (2002) Gadolinium-containing contrast media for radiographic examinations: a position paper. Eur Radiol 12:2600–2605

    PubMed  Google Scholar 

  29. Christensen CR, Glowniak JV, Brown PH, Morton KA (2000) The effect of gadolinium contrast media on radioiodine uptake by the thyroid gland. J Nucl Med Technol 28:41–44

    CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Radiology, Leiden University Medical Center, P.O. Box 9600, 2300, RC Leiden, The Netherlands

    Aart J. van der Molen

  2. Department of Diagnostic Radiology 54E2, Copenhagen University Hospital at Herlev, Herlev Ringvej 75, 2730, Herlev, Denmark

    Henrik S. Thomsen

  3. Department of Diagnostic Imaging, Northern General Hospital, Sheffield Teaching Hospitals NHS Trust, Sheffield, S5 7AU, UK

    Sameh K. Morcos

Authors
  1. Aart J. van der Molen
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Henrik S. Thomsen
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Sameh K. Morcos
    View author publications

    You can also search for this author in PubMed Google Scholar

Consortia

Members of Contrast Media Safety Committee of European Society of Urogenital Radiology (ESUR)

Corresponding author

Correspondence to Henrik S. Thomsen.

Additional information

The members of the Contrast Media Safety Committee of ESUR are H.S. Thomsen (Chairman, Denmark), S.K. Morcos (Secretary, UK), T. Almén (Sweden), P. Aspelin (Sweden), M.F. Bellin (France), H. Flaten (Amersham Health, Norway), J.Å. Jakobsen (Norway), G.P. Krestin (The Netherlands), A. Löwe (Schering, Germany), R. Oyen (Belgium), F. Stacul (Italy), and J.A.W. Webb (UK).

Rights and permissions

Reprints and permissions

About this article

Cite this article

van der Molen, A.J., Thomsen, H.S., Morcos, S.K. et al. Effect of iodinated contrast media on thyroid function in adults. Eur Radiol 14, 902–907 (2004). https://doi.org/10.1007/s00330-004-2238-z

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00330-004-2238-z

Keywords

Search

Navigation