Research Article
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Published Online: 14 February 2023

Iodinated Contrast Administration and Risks of Thyroid Dysfunction: A Retrospective Cohort Analysis of the U.S. Veterans Health Administration System

Publication: Thyroid
Volume 33, Issue Number 2

Abstract

Background: Iodine-induced thyroid dysfunction is a potential risk among susceptible individuals. Iodinated contrast media is a common source of an acute iodine load used in the health care setting and is frequently required for diagnostic computed tomography scans, coronary angiograms, and other radiologic studies. However, the epidemiologic risks of iodine-thyroid dysfunction have not been fully established in the United States.
Methods: This population-based retrospective cohort study used the U.S. Veterans Health Administration database between 1998 and 2021 and included adults aged ≥18 years with a serum thyrotropin (TSH) measurement. Multivariable logistic regression was used to ascertain the risk of incident thyroid dysfunction (defined by repeated measurements of serum thyroid function) following iodine exposure, adjusting for age, sex, race/ethnicity, baseline serum TSH concentration, and duration between baseline and follow-up TSH concentration.
Results: The cohort was composed of N = 4,253,119 veterans (mean ± SD = 63.5 ± 14.3 years; 92.9% men; 65.6% non-Hispanic Whites) with 8,729,155 corresponding pairs of serum TSH measurements, from which there were 499,897 TSH pairs with intervening iodine exposure. Thyroid dysfunction occurred in 4.8% of those pairs who had received iodine contrast and 3.6% of those without iodine exposure. Iodinated exposure was associated with an increased risk of thyroid dysfunction (odds ratio [OR] = 1.39, 95% confidence intervals [CI] = 1.37–1.41, p < 0.001) and consistent for all types of serum thyroid dysfunction (overt or subclinical hypo-/hyperthyroidism). Men were at higher risk for the development of thyroid dysfunction than women (men: OR = 1.42, 95% CI = 1.40–1.44; women: OR = 1.16, 95% CI = 1.11–1.21; p-for-interaction <0.001).
Conclusions: In this largest analysis of U.S. adults to date, iodine exposure was associated with only clinically small absolute increased risks of thyroid dysfunction, particularly in men. These findings suggest that screening of thyroid function following iodinated contrast administration should be targeted to high-risk individuals.

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cover image Thyroid®
Thyroid
Volume 33Issue Number 2February 2023
Pages: 230 - 238
PubMed: 36173108

History

Published online: 14 February 2023
Published in print: February 2023
Published ahead of print: 25 January 2023
Published ahead of production: 29 September 2022

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Kosuke Inoue
Department of Social Epidemiology, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
Rong Guo
Research Service, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California, USA.
Division of General Internal Medicine and Health Services Research, Department of Medicine, University of California Los Angeles David Geffen School of Medicine, Los Angeles, California, USA.
Martin L. Lee
Veterans Affairs Health Services Research & Development Center for the Study of Health Care Innovation, Implementation, and Policy; VA Greater Los Angeles Healthcare System, Los Angeles, California, USA.
Department of Biostatistics, University of California Los Angeles Fielding School of Public Health, Los Angeles, California, USA.
Ramin Ebrahimi
Division of Cardiology, Department of Medicine, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California, USA.
Division of Cardiology, Department of Medicine, University of California Los Angeles David Geffen School of Medicine, Los Angeles, California, USA.
Natalia V. Neverova
Division of Cardiology, Department of Medicine, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California, USA.
Division of Cardiology, Department of Medicine, University of California Los Angeles David Geffen School of Medicine, Los Angeles, California, USA.
Jesse W. Currier
Division of Cardiology, Department of Medicine, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California, USA.
Division of Cardiology, Department of Medicine, University of California Los Angeles David Geffen School of Medicine, Los Angeles, California, USA.
Muhammad T. Bashir
Research Service, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California, USA.
Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California, USA.
Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, University of California Los Angeles David Geffen School of Medicine, Los Angeles, California, USA.

Notes

Address correspondence to: Angela M. Leung, MD, MSc, Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, Veterans Affairs Greater Los Angeles Healthcare System, 11301 Wilshire Boulevard (111D), Los Angeles, CA 90073, USA [email protected]

Authors' Contributions

K.I.: conceptualization, methodology, writing (initial draft, review, editing); R.G.: formal analysis, writing (review, editing); M.L.L.: methodology, writing (review, editing); R.E.: writing (review, editing); N.V.N.: writing (review, editing); J.W.C.: writing (review, editing); M.T.B.: writing (review, editing); A.M.L.: conceptualization, writing (initial draft, review, editing).

Author Disclosure Statement

None of the authors have any relevant disclosures.

Funding Information

This work was supported by Merit Review Award 5|01CX0011845 (AML) from the U.S. Department of Veterans Affairs Clinical Sciences Research and Development Service. No funding was received by K.I., R.G., M.L.L., R.E., N.V.N, J.W.C., and M.T.B.

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