背景:暴露于碘化造影剂(ICM)可导致甲状腺功能亢进,由于甲状腺激素调节的中断。虽然罕见,它可能会产生严重的后果,并可能导致致命的并发症。目前的指南不建议在ICM暴露之前对甲状腺功能进行标准的实验室检测。不建议对甲状腺功能亢进风险较高的患者进行预防性治疗。
方法:我们报告了一例82岁女性,在接受胸部计算机断层扫描(CT)后出现ICM诱发的甲状腺功能亢进。ICM管理一个月后,她在急诊科出现了肺炎。发现甲状腺功能亢进并伴有心动过速,这很难控制。由于甲状腺功能亢进和偶然肺炎,患者出现心力衰竭并死于心肌缺血。
结论:本病例报告强调了密切监测ICM暴露后高危患者的重要性。临床医生应该意识到甲状腺功能亢进和潜在的严重并发症的风险。ICM的使用需要仔细考虑,尤其是在患有多结节性甲状腺肿的老年人中。
BACKGROUND: exposure to iodinated contrast media (
ICM) can cause hyperthyroidism, due to disruption of thyroid hormone regulation. Although rare, it can have severe consequences and can lead to fatal complications. Current guidelines do not recommend standard laboratory testing of the thyroid function prior to ICM exposure. Prophylactic treatment of patients at higher risk of hyperthyroidism is not advised.
METHODS: we report the
case of an 82-year-old woman who developed
ICM induced hyperthyroidism after undergoing a chest computed tomography (CT). One month after
ICM administration she presented with pneumonia at the emergency department. Hyperthyroidism was found with concomitant tachycardia, which was hard to control. As a result of hyperthyroidism and coincidental pneumonia the patient developed heart failure and died of myocardial ischemia.
CONCLUSIONS: this
case report underlines the importance of close monitoring of high-risk patients after
ICM exposure. Clinicians should be aware of the risk of hyperthyroidism and potential severe complications. The use of ICM needs careful consideration, especially in the elderly who suffer more often from multinodular goitre.