Ifnalpha therapy likely caused our patients thyrotoxicosis, but iodideinduced hyperthyroidism may occur after use of iodinated contrast media. If your thyroid is too active, it makes more thyroid hormones than your body needs. Iodineinduced hyperthyroidism due to nonionic contrast. Iodineinduced hyperthyroidismcan develop even in the presence of an otherwise normal gland. Effect of iodine intake on thyroid diseases in china nejm. Risks of iodineinduced hyperthyroidism after correction. Iodineinduced hyperthyroidism in a patient with a normal.
Type 1 ait ait 1 is a form of iodineinduced hyperthyroidism caused by excessive, uncontrolled biosynthesis of. The iodine containing drug most commonly associated with iodine induced hyperthyroidism is amiodarone, an antiarrhythmic cardiac drug used for refractory arrhythmias. Hypothyroidism can easily be treated with a thyroid hormone supplement taken once a day see hypothyroidism brochure. Topical iodine and hyperthyroidism annals of internal. The condition resolved after povidone iodine was replaced by a iodinefree antiseptic solution. Iodineinduced hyperthyroidism can develop even in the presence of an otherwise normal gland. Potential iodine sources include dietary supplements, drugs, iodinerich antiseptic solutions, or iodinated contrast agents used for imaging tests. Thus, we are in agreement that the neonate in our report received 2. Iodineinduced hyperthyroidisman old clinical entity that.
We report a case of iodineinduced hyperthyroidism due to the ingestion of a kelpcontaining tea. Contrast induced hyperthyroidism due to iodine excess. The aim of the research is to explore the relationship between hyperthyroidism, iodine, antithyroid drugs propylthiouracil and vascular endothelial injury. Enter your email address to receive your free pdf download. Jeffrey dach md iodine induced hyperthyroidism by jeffrey. Tu sum up, a case of subclinical hyperthyroidism induced by excess topical iodine is reported in a patient with no prior thyroid disease. Case report iodineinduced hyperthyroidism an old clinical. She had evidence of hyperthyroidism four hours after receiving. Iodine induced hyperthyroidism is frequently observed in patients affected by euthyroid iodine deficient goiter when suddenly exposed to excess iodine. Iodineinduced hyperthyroidism in a newborn american.
Etiologies of thyrotoxicosis are diverse, one of them being caused by iodine induced hyperthyroidism. Patients treated with amiodarone may manifest altered thyroid hormone profile without thyroid dysfunction, or they may present with clinically significant amiodaroneinduced. It is known to produce thyroid abnormalities ranging from abnormal thyroid function testing to overt hypothyroidism or hyperthyroidism. In 1972, however, iodine thyrotoxicosis was first reported from an iodinesufficient area 3. Despite antithyroid drug therapy, some patients demonstrated refractory hyperthyroidism 28. Hyperthyroidism has been described as elevated serum free t3 andor free t4 levels with decreased thyrotropin tsh concentrations.
Iodineinduced hyperthyroidism in a patient with a normal thyroid. The use of iodine for goiter still was not used as it was seen as toxic and or irrational. She underwent computed tomography angiogram of the chest to rule out pulmonary. Iodine solutions, such as saturated solutions of potassium iodide sski or potassium iodide iodine lugols solution, replaced burnt sponge extract in the 19 th century as treatment for endemic goiter. The thyroid is a small butterfly shaped gland that lies just under the skin below the adams apple in the neck. Although she had been in the us for twenty years, she was born and grew up in a foreign country noted for low iodine levels. Iodideinduced hyperthyroidism within four hours of. To identify the number of cases of hyperthyroidism that followed the performance of contrast radiography in elderly patients at a geriatric hospital in a noniodinedeficient area and to determine the clinical course of the condition. The condition resolved after povidone iodine was replaced by a iodine free antiseptic solution. Iodine induced hyperthyroidism is a thyrotoxic condition caused by exposure to excessive iodine.
Iodineinduced hyperthyroidism can last from one month to 18 months and is treated by discontinuing iodine and, if indicated, administering a. Iodine in the treatment of hyperthyroidism uptodate. Certain medications, such as amiodarone cordarone, which is used in the treatment of heart problems, contain a large amount of iodine and may be associated with thyroid function. Iodineinduced thyrotoxicosis after ingestion of kelp. Iodineinduced hyperthyroidism can occur after intake of excess iodine in the diet, exposure to radiographic contrast media, or medications. Only 2% of patients developed subclinical hyperthyroidism following a standard dose of iodinated contrast for ct investigations. One of the less common sources of iodine is tablets of seaweed. Most cases of iodineinduced hyperthyroidism are selflimited and resolve when exposure ceases. Management of iodine induced hyperthyroidism consists primarily of discontinuation of the source of excess iodine. Amiodaroneinduced toxic nodular goiter, a form of iodineinduced thyrotoxicosis, was described in europe where large nodular goiters are more prevalent than in the united states. Gd is overall the most common cause of hyperthyroidism in the united 229. Scintigraphic manifestations of thyrotoxicosis radiographics. Complementary medication is en vogue and an increasing number of patients consume herbal medicine without reporting their use to physicians.
Iodine induced hyperthyroidism in a patient with a normal thyroid gland shmuel shilo and harry j. Hyperthyroidism in patients with ischaemic heart disease after iodine load induced by coronary angiography. Amiodaroneinduced thyrotoxicosis ait is a clinically. The presence of thyroid autoimmunity in patients residing in. We wish to report what may be the first described case of iodineinduced hyperthyroidism resulting from cutaneous absorption of a topical preparation. Hyperthyroidism in patients with ischaemic heart disease. Hyperthyroidism and other causes of thyrotoxicosis. However, it may also occur in patients with and without previous thyroid disease residing in iodinesufficient areas.
Iodineinduced hyperthyroidisman old clinical entity that is still. Iodine induced hyperthyroidism has been reported with exposure to iodine containing drugs, povidone iodine, 2 dietary supplements kelp, seaweed, and radiographic contrast dyes. Iodineinduced subclinical hyperthyroidism in a patient with. Amiodarone is a highly effective agent for the prophylaxis and treatment of many cardiac rhythm disturbances, ranging from paroxysmal atrial fibrillation to life threatening ventricular tachyarrhythmias. In fact, until 1972, when iodineinduced hyperthyroidism was reported in a group of patients with goiter in boston, it was thought that iodineinduced hyperthyroidism could occur only in iodinedeficient regions. These include how fast you burn calories and how fast your heart beats. However, it might be caused due to a longterm topical exposure iodine solution dressing or by intravenous administration of iodinecontaining substances. We report the case of a 72 year old female who developed clinical and laboratory evidence of hyperthyroidism while ingesting seakelp vitalia tablets. The most common cause of hyperthyroidism in iodine sufficient areas is graves disease. Although amiodarone is regarded as a highly effective antiarrhythmic agent, its use may lead to alterations in thyroid gland function andor thyroid hormone metabolism, partly because of its rich iodine content. The recommended amount of iodide consumption for the majority of adults is approximately 150 mcg per day. In the article entitled iodineinduced hyperthyroidism in a newborn that appeared in the march 1995 issue of pediatrics, the iodine content of povidoneiodine is estimated at 10 mgml rather than the estimate that we employed which was 10% or 10 gdl. A combination of potassium perchlorate and carbimazole should be tried. A young woman, brenda, was found to have essentially no urinary iodine excretion, indicating iodine deficiency.
Pdf iodineinduced thyroid dysfunction researchgate. Signs and symptoms vary between people and may include irritability, muscle weakness, sleeping problems. Specifically, patients treated with antithyroid drugs for graves disease are prone to develop iodineinduced hyperthyroidism. Cureus iodideinduced hyperthyroidism within four hours. In sweden, the annual incidence of graves disease is increasing, with 1530 new cases per 100 000 inhabitants in the 2000s. Iodineinduced hyperthyroidism has been frequently described when iodine is introduced into an iodinedeficient area. Study on the relationship between hyperthyroidism and.
Pdf iodine excess and hyperthyroidism researchgate. Iodideinduced hyperthyroidism within four hours of iodide load. Iodine induced hyperthyroidism pdf download dospfecache. Thyrotoxicosis is the condition that occurs due to excessive thyroid hormone of any cause and therefore includes hyperthyroidism. Hirsch shaare zedek medical centre, jerusalem 91002, israel summary. Iodine solutions, such as saturated solutions of potassium iodide sski or potassium iodideiodine lugols solution, replaced burnt sponge extract in the 19 th century as treatment for endemic goiter. Iodine induced hyperthyroidism is frequently observed in patients affected by euthyroid iodine deficient goiter when suddenly exposed. Amiodaroneinduced hyperthyroidism sometimes responds to thionamide antithyroid drugs but may also be very resistant to treatment. Guidelines by the us institute of medicine recommend a daily iodine intake of 150. Iodineinduced hyperthyroidism is usually seen in patients who already have an underlying abnormal thyroid gland. Most cases of iodine induced hyperthyroidism are selflimited and resolve when exposure ceases. Iodine induced hyperthyroidism can develop even in the presence of an otherwise normal gland. Pdf to summarize the mechanisms of iodineinduced hypothyroidism and hyperthyroidism. Possibly the presence of autonomous thyroid function permits the synthesis and release of excess quantities of thyroid hormones.
Iodine induced hyperthyroidism pdf download 16ncmy. By extension, they were sometimes used to treat graves disease, but by the end of the century, they were considered to be a dangerous form of therapy. Iodine is required for the synthesis of the thyroid hormones. Primary care physicians 2018 thyroid patient care resolutions.
Iodine induced hyperthyroidism can occur after intake of excess iodine in the diet, exposure to radiographic contrast media, or medications. We present a case of iodineinduced hyperthyroidism in a critically ill icu patient caused by excessive iodine containing antiseptic solution washes and contrast. Amiodarone is an iodinebased, potent antiarrhythmic drug bearing a structural resemblance to thyroxine t4. Therefore, a multicenter study was conducted in these 7 countries to evaluate whether the occurrence of iodineinduced hyperthyroidism iih after the introduction of iodized salt was a general phenomenon or corresponded to specific local situations in the 2 affected countries.
Hyperthyroidism induced by topical iodine endocrinologia. Hyperthyroidism is more common in women, people with other thyroid problems, and those over 60 years old. One of the less common sources of iodine is tablets of seaweed, sold over the counter without prescription. It is possible that iodineinduced hyperthyroidism peaked between 1996 when salt iodization began in china and 1999, but in a retrospective study by our group, no significant difference was. All patients over a 20month period with biochemical hyperthyroidism plasma free thyroxine level greater than 25. The radioactive iodine assessment should help to distinguish graves hyperthyroidism from iodineinduced hyperthyroidism.
In populations with chronic iodine deficiency, an increase in iodine intake may result in iodineinduced hyperthyroidism thyro. The prevalence of iodine induced hyperthyroidism is lower in iodine sufficient geographic areas such as north america, 22. Iodineinduced subclinical hyperthyroidism in a patient with hashimotos disease. Prevention and treatment of iodineinduced thyrotoxicosis.
Administration of iodine in almost any chemical form may induce an episode of thyrotoxicosis iih. Hypothyroidism and hyperthyroidism sharon witemeyer md pediatrician introduction. A 39yearold woman with multinodular goiter presented with typical signs of hyperthyroidism, which was confirmed by endocrine tests. Iodineinduced hyperthyroidism definition of iodine. Treatments for hyperthyroidismtreatments for hyperthyroidism medical therapy with antithyroid drugs such as propylthiouracil or methimazole ablation of the thyroid gland with radioactive iodine subtotal thyroidectomy selflimited causes of hyperthyroidism, such as subacute thyroiditis, iodine induced hyperthyroidism, and exogenous. Radioactive iodine has been used to treat patients for hyperthyroidism for over 60 years and has been shown. The most common cause of hyperthyroidism in iodinesufficient areas is graves disease.