The use of iodine in graves hyperthyroidism jeffrey dach md. Although contrastinduced hyperthyroidism is generally transient and resolves after withdrawal of iodine, symptomatic patients may be treated with a. Excess iodine is generally well tolerated, but individuals with underlying thyroid disease. In this disorder, production of the thyroid hormones, such as thyroxine, is suppressed. Unusual episodes of iodineinduced hyperthyroidism have been observed in a few patients suffering from severe burns treated with povidone iodine 50 and in a patient who had metastatic thyroid carcinoma 51. Most of the contrast is cleared by the kidneys and in patients with normal renal function iodine is excreted rapidly.
Radiographic iodinated contrast mediainduced thyroid. A proper diet aims at easing the symptoms of hyperthyroidism and it basically comprises of reduced iodine intake as it helps to reverse iodine induced hyperthyroidism in many cases. Pdf iodineinduced thyroid dysfunction researchgate. Over the last 80 years, worldwide efforts have been made to eliminate iodine deficiency. Hyperthyroidism is more common in women, people with other thyroid problems, and those over 60 years old. A young woman, brenda, was found to have essentially no urinary iodine excretion, indicating iodine deficiency. A proper hyperthyroidism diet must ensure that there is as little iodine as possible. Iodine induced hyperthyroidism is usually seen in patients who already have an underlying abnormal thyroid gland. Finally, based on studies of iodine induced thyroid dysfunction associated with amiodarone use, 10 hyperthyroidism following administration of iodinated contrastmedium hyperthyroidism is likely to be more prevalent in iodine deficient regions, and hypothyroidism in iodine sufficient areas. Iodineinduced hyperthyroidism information including symptoms, causes, diseases, symptoms, treatments, and other medical and health issues. Effects of iodinebased contrast media on thyroid function.
However, it may also occur in patients with and without previous thyroid disease residing in iodine sufficient areas. 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. Combining lithium with one of the antithyroid drugs has been shown to. Hyperthyroidism is an excessive concentration of thyroid hormones in tissues caused by increased synthesis of thyroid hormones, exces sive release of preformed thyroid hormones, or an endogenous or. The radioactive iodine assessment should help to distinguish graves hyperthyroidism from iodine induced hyperthyroidism. Iodineinduced hyperthyroidism develops when iodine intake increases in patients with an enlarged.
Iodineinduced hyperthyroidism in a patient with a normal. Iodineinduced hyperthyroidism has been described previously in the medical literature. Iodideinduced hyperthyroidism within four hours of iodide load. Because of its high iodine content, amiodarone can cause changes in thyroid. In the united states, iodized salt contains 76 mcg of iodine per gram. Iodine induced hypothyroidism usually develops in patients who are susceptible to the effects of inhibiting doses of iodine on the thyroid gland. Carol is a 56 year old real estate agent who noticed a feeling of nervousness, warmth and rapid heart rate which worsened over a few days. It is known that prolonged exposure to or intake of high doses of the iodine containing drugs is accompanied by thyrotoxic reactions in the form of iodineinduced hypothyroidism 64. Iodineinduced hyperthyroidism the jodbasedow phenomenon was first described in the early 1800s, when thyrotoxicosis was observed to be more common among patients with endemic goiter treated with iodine supplementation than in individuals without goiter. 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. Pdf to summarize the mechanisms of iodineinduced hypothyroidism and hyperthyroidism, identify the risk factors for thyroid dysfunction.
These guidelines were developed to combine the best scientific evidence. Other causes include thyroid nodules, thyroiditis, consuming too much iodine, and taking too much synthetic thyroid hormone. Jeffrey dach md iodine induced hyperthyroidism by jeffrey. In 1999, the mandatory iodization of kitchen salt increased from 10 mg potassium iodide to 25 mgkg salt after an epidemiologic study in the early 1990s indicating that slovenia was an area with mild iodine deficiency, according to the researchers. Iodine is required for the synthesis of the thyroid hormones. Guidelines by the us institute of medicine recommend a daily iodine intake of 150. Iodide induced hyperthyroidism iodide induced hyperthyroidism is not a single etiologic entity. In hyperthyroid patients, iodine acutely inhibits hormonal secretion, but the responsible mechanisms are uncertain. In many countries, however, it contains less, and in some countries, iodized salt is not available. Patients should be monitored after subsequent icm exposure. One form of iodine, iodine 1, is radioactive and can be used to treat hyperthyroidism.
Iodineinduced hyperthyroidisman old clinical entity that is. Treatment of iodineinduced thyroid disorders georg zettinig schilddrusenpraxis josefstadt. Iodine in the treatment of hyperthyroidism uptodate. Iodineinduced hypothyroidism usually develops in patients who are susceptible to the effects of inhibiting doses of iodine on the thyroid gland. How should iodineinduced and amiodaroneinduced thyrotoxicosis be managed. The most common causes of hyperthyroidism are graves disease primarily in women, toxic multinodular goiter, and functional adenoma 3. We present a case of iodineinduced hyperthyroidism in a critically ill icu patient caused by excessive iodine containing antiseptic solution washes and contrast. Iodine induced hyperthyroidism information including symptoms, causes, diseases, symptoms, treatments, and other medical and health issues. See iodine induced thyroid dysfunction and thyroid hormone synthesis and physiology. Lack of iodine can lead to a disorder of the thyroid gland called as hypothyroidism. Mar 19, 2015 iodine supplementation through salt iodization is a worldwide, effective strategy for preventing iodine deficiencyrelated problems. In this case control study, patients n150, 50 male and 100 female, age 3575 years, d from northern region of pakistan, with goiter and hyperthyroidism. Thyroid disease and the heart circulation aha journals. Iodine induced hyperthyroidism can last from one month to 18 months and is treated by discontinuing iodine and, if indicated, administering a betaadrenergic antagonist, such as atenolol.
She had evidence of hyperthyroidism four hours after receiving iodinated contrast. Elimination of iodine deficiency has been a major goal of the iodine global network, unicef, and the world health. Iodine induced hyperthyroidism is a thyrotoxic condition caused by. Iodine induced hyperthyroidism has been frequently described when iodine is introduced into an iodine deficient area. The radioactive iodine enters the thyroid gland and while being made into thyroid hormone, it destroys some of the cells. In cases of established hyperthyroidism, administration of icm is contraindicated. Amiodarone induced hyperthyroidism was considered but was thought to be unlikely as the drug was stopped a year ago. Iodinebased contrast media contain free iodide in the solution, which may cause thyrotoxicosis in atrisk patients with graves disease or thyroid autonomy. Its safety and efficacy profile has been extensively investigated, and benefits far outweigh the potential iodine induced risks. One of the less common sources of iodine is tablets of seaweed, sold over the counter without prescription.
Some of the symptoms of hyperthyroidism include nervousness, irritability, increased perspiration, heart racing, hand tremors, anxiety, trouble sleeping, thinning of the skin, fine brittle hair, and muscular weaknessespecially in the upper arms and thighs. Exposure to excess iodine may come from several sources including enteral dietary supplements and iodinecontaining medications, topical iodine antiseptic solutions, and intravenous contrast radiographic agents 79. Iodineinduced hyperthyroidisman old clinical entity that. We report the case of a 72 year old female who developed clinical and laboratory evidence of hyperthyroidism while ingesting seakelp vitalia tablets. This way, the diet for hyperthyroidism can actually reverse the disease itself. Suppression of plasma tsh indicates that the hyperthyroidism is not pituitary in origin. Too often patients receive either a dose that causes hypothyroidism within a few months or a dose that produces an insufficient effect, resulting in prolongation of hyperthyroidism. Hyperthyroidism and iodine deficiency thyroid center. A better understanding of this geographic variation.
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. Medical management guidelines for acute chemical exposures is a guide for health care professionals. This is the most acute effect of iodine on thyroid status, occurring within hours of the. American thyroid association guidelines task force, kloos rt, eng c, evans db, francis.
As a result, iodine deficiency is the most common cause of goiter, hypothyroidism, and mental deficiency worldwide. The jodbasedow effect also jodbasedow syndrome and jodbasedow phenomenon is hyperthyroidism following administration of iodine or iodide, either as a dietary supplement or as iodinated contrast for medical imaging. Clinical thyroidology treatment of hyperthyroidism with. Hyperthyroidism may be asymptomatic or present with significant symptoms. Iodine induced hyperthyroidism has been reported with exposure to iodine containing drugs, povidone iodine, 2 dietary supplements kelp, seaweed, and radiographic contrast dyes. Hyperthyroidism can be caused by graves disease, in. To summarize the mechanisms of iodineinduced hypothyroidism and hyperthyroidism, identify the risk factors for thyroid dysfunction following an iodine load, and summarize the major sources of excess iodine exposure. In certain cases of iodine induced hyperthyroidism, the illness can be easily reversed if you reduce your intake of iodine.
These guidelines were developed to combine the best scientific. 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. Radioactive iodine i1 also called radioiodine i1 therapy is a treatment for an overactive thyroid, a condition called hyperthyroidism. Graves disease, an autoimmune disorder, is the most common cause. Too much radioactive iodine in your body can also cause thyroid nodules or cancer. The international council for the control of iodine deficiency disorders.
The ideal dose of radioactive iodine 1 rai to cure hyperthyroidism has not been determined, despite more than 60 years of experience with this treatment. Iodineinduced hyperthyroidisman old clinical entity that is still. Prevention and treatment of iodineinduced thyrotoxicosis. Etiologies of thyrotoxicosis are diverse, one of them being caused by iodine induced hyperthyroidism. Information for behavioral health providers in primary care.
Etiologies of thyrotoxicosis are diverse, one of them being caused by iodineinduced hyperthyroidism. Both iodine deficiency and excess can cause thyroid dysfunction. Iodineinduced hyperthyroidism april 15, 2009 a 33yearold woman began experiencing increased rate of hair loss, anxiety, insomnia, palpitations, heat intolerance and tremor in october. As your thyroid hormone levels fall, your pituitary produces more tsh to stimulate increased production of t3 and t4, but your thyroid is impaired by iodine excess and cannot respond normally to tsh. Prevention of iodine induced thyrotoxicosis in highrisk patients is important, as treatment with thyrostatic drugs is hindered by the high iodide concentrations and complications are more frequent than in other forms of thyrotoxicosis. These include how fast you burn calories and how fast your heart beats. Iodineinduced hyperthyroidism can occur after intake of excess iodine in the diet, exposure to radiographic contrast media, or medications. Apr 15, 2009 iodine induced hyperthyroidism april 15, 2009 a 33yearold woman began experiencing increased rate of hair loss, anxiety, insomnia, palpitations, heat intolerance and tremor in october. This phenomenon is thus iodine induced hyperthyroidism, typically presenting in a. May 28, 20 the danish investigation of iodine intake and thyroid diseases. Five patients with iodineinduced hyperthyroidism sciencedirect.
Radioactive iodine i1 therapy for hyperthyroidism what is radioiodine i 1 therapy and how is it used. Hyperthyroidism due to excess thyrotropin secretion is rare and, in most cases, is caused by pituitary resistance to thyroid hormone. These changes combine to promote an increase in blood volume and preload. Its generally considered safe, and it is used to treat more than 70% of adults with hyperthyroidism. Since the initial description by coindet in 1821 18 and the subsequent definition by breuer and kocher in 1904, iodine induced hyperthyroidism has been reported in pa. Iodineinduced hyperthyroidism caused by acne treatment. Iodine deficiency disorders and the therapeutic use of iodine in patients with hyperthyroidism are discussed separately. Postpartum thyroiditis can occur in up to 5 to 10 percent of women in the first three to six months after delivery. Doctors have used radioactive iodine to treat hyperthyroidism for over 60 years. Iodineinduced hyperthyroidism definition of iodineinduced.1521 858 1112 1305 1236 893 845 1475 1064 1186 498 1330 130 1143 1053 343 1335 262 598 524 326 1512 1411 962 1480 924 746 526 951 1422 179 1008 719 508 882 1376 677 1173 495 435 1445 1299 1223 300 236 156 827 800 1044 1343