Methimazole for Prevention of Iodinated Contrast Media–Induced Exacerbation of Thyrotoxicosis in Susceptible Patients

IF 3.7 3区医学 Q2 ENDOCRINOLOGY & METABOLISM

Endocrine Practice Pub Date : 2025-02-01 DOI:10.1016/j.eprac.2024.11.008

Irit Ayalon-Dangur MD, BSc , Einat Magid-Ohayon , Ilan Shimon MD , Eyal Robenshtok MD

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Abstract

Objective

Iodinated contrast media (ICMs) are widely used in a variety of examinations and procedures. The aim of the current study was to investigate the efficacy of methimazole (MMI) in prevention of thyrotoxicosis after ICM exposure.

Methods

A retrospective cohort study included patients aged ≥18 years admitted to a tertiary medical center who underwent ICM examination or procedure and received MMI prior to iodine exposure.

Results

A total of 179 patients with 202 hospitalizations were included. The mean age was 72.3 ± 13.5 years (female, 64%). Nearly all patients (99%) had a history of thyroid disease, and 91% were treated with MMI prior to admission. Seventy-five patients had low thyroid-stimulating hormone (TSH) levels prior to ICM exposure. In this high-risk group, MMI led to normalization of TSH after discharge in 19%, and 64% remained with low TSH levels after discharge but with a small median difference in free thyroxine levels of −0.5 (interquartile range [IQR], −5.9 to 5.2) pmol/L. In the 8 patients with dose increase during hospitalization, treatment with MMI was beneficial with a median free thyroxine decrease of −6.2 (IQR, −9.2 to −1) pmol/L and TSH increase of 0.2 (IQR, 0.02-0.7) mIU/L. In 110 patients with normal TSH levels before admission, with MMI treatment, most (71%) remained euthyroid after discharge, 13% had low TSH levels, and 9% had high TSH levels. In the 15 patients with high TSH levels prior to admission, the TSH levels of only 2 patients normalized, 47% remained with high TSH levels, and 27% had low TSH levels after discharge.

Conclusion

In patients with pre-existing thyrotoxicosis treated with antithyroid drugs, MMI therapy before ICM exposure prevented exacerbations. In patients with low TSH levels before admission, increasing the dose of MMI before exposure led to improvement in thyroid functions after discharge.

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甲巯咪唑用于预防碘化造影剂诱发的易感患者甲亢加重。

目的：碘化造影剂（ICM）广泛用于各种检查和手术。本研究旨在探讨甲巯咪唑对预防 ICM 暴露后甲状腺中毒的疗效：方法：回顾性队列研究，纳入在一家三级医疗中心住院、接受 ICM 检查或手术并在碘暴露前接受甲巯咪唑治疗的 18 岁以上患者：共纳入 179 名患者，202 次住院。平均年龄为 72.3±13.5 岁，64% 为女性。几乎所有患者（99%）都有甲状腺疾病史，91%的患者在入院前接受了甲巯咪唑治疗。75 名患者在接触 ICM 之前 TSH 水平较低。在这一高风险群体中，甲巯咪唑使 19% 的患者出院后 TSH 水平恢复正常，64% 的患者出院后 TSH 水平仍然较低，但 FT4 水平的中位数差异很小，为-0.5，IQR (-5.9)-(5.2) pmol/L。在住院期间剂量增加的 8 名患者中，使用甲巯咪唑治疗是有益的，FT4 下降的中位数为-6.2，IQR 为（-9.2）-（-1）pmol/L，TSH 上升的中位数为 0.2，IQR 为（0.02）-（0.7）mIU/L。在入院前 TSH 水平正常的 110 名患者中，经过甲巯咪唑治疗后，大多数（71%）患者在出院后仍保持甲状腺功能正常，13% 的患者 TSH 水平较低，9% 的患者 TSH 水平较高。入院前促甲状腺激素水平偏高的15名患者中，只有2人的促甲状腺激素水平恢复正常，47%的患者出院后促甲状激素水平仍然偏高，27%的患者促甲状激素水平偏低：结论：对于使用抗甲状腺药物（ATD）治疗的原有甲亢患者，在接触 ICM 前使用甲巯咪唑治疗可防止病情恶化。对于入院前促甲状腺激素水平较低的患者，在暴露前增加甲巯咪唑的剂量可改善出院后的甲状腺功能。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Endocrine Practice ENDOCRINOLOGY & METABOLISM-

CiteScore

7.60

自引率

2.40%

发文量

546

审稿时长

41 days

期刊介绍： Endocrine Practice (ISSN: 1530-891X), a peer-reviewed journal published twelve times a year, is the official journal of the American Association of Clinical Endocrinologists (AACE). The primary mission of Endocrine Practice is to enhance the health care of patients with endocrine diseases through continuing education of practicing endocrinologists.