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Abstract：
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.
摘要：
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诱导的甲状腺功能障碍（TD）。由于造影剂溶液中碘的超生理浓度，ICM可以诱导甲状腺功能亢进（Hyper）或甲状腺功能减退（Hypo）。ICM诱导的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潜在结节性甲状腺肿或隐匿性Graves病患者。有ICM诱导的Hypo风险的患者包括患有自身免疫性甲状腺炎的患者，生活在碘供应充足的地区。ICM诱导的TD的大多数病例是轻度和短暂的。在缺乏关于ICM诱导的TD管理的前瞻性临床试验的情况下，个性化的预防和治疗方法，根据病人的年龄，临床症状,先前存在的甲状腺疾病，必须建议并存的发病率和碘摄入量。对于严重或长期甲状腺功能亢进症状的患者或患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诱导的Hyper（在某些情况下与高氯酸钠联合使用）。在ICM给药之前使用甲咪唑和/或高氯酸盐进行预防性治疗是否合理存在争议。在ICM诱导的公开Hypo中，有Hypo症状的年轻患者可考虑使用临时左甲状腺素，患有潜在的自身免疫性甲状腺炎和计划怀孕的妇女。有必要进行具有临床相关终点的其他临床试验，以进一步帮助ICM诱导的TD患者的临床决策。
