O-4
Low Risk of Thyroid Dysfunction in Children <3 Years After Exposure to Iodine-Containing Contrast Agents in Cardiac Catheterization
Presenter
Ashley Kiene, MD, The University of Tennessee Health Science Center, Memphis, TN
Ashley Kiene, MD1, Jason Johnson, MD2, Neil C Tailor, M.D.2, Benjamin R. Waller III, M.D.2 and Shyam K. Sathanandam, M.D., FSCAI2, (1)The University of Tennessee Health Science Center, Memphis, TN, (2)Le Bonheur Children's Hospital, Memphis, TN
Keywords: Congenital Heart Disease (CHD), Imaging & Physiology and Pharmacotherapy
Background
Angiography during cardiac catheterization procedures in children is performed using iodinated contrast media (ICM). On March 31, 2022, the U.S. Food and Drug Administration (FDA) released a drug safety communication recommending evaluation for thyroid dysfunction in all patients < 3 years of age after exposure to ICM.
Methods
This is a single center cohort study of patients < 3 years of age who received ICM during cardiac catheterization from May 2022 to January 2023. Thyroid stimulating hormone (TSH) and free thyroxine (FT4) levels were measured in each patient before and after exposure to ICM.
Results
164 patients were evaluated in total. 74 were term infants with prospective evaluations (Group-A), whilst 90 were extremely premature infants with retrospective evaluations (Group-B). Six patients had pre-existing hypothyroidism receiving thyroid replacement therapy and were excluded from the final analysis. The median age and weight of patients in Group-A was 5.5 months (1 day to 35 months), and 6 (0.6 – 15.5) kg respectively, and for Group-B was 29 (12-39) days, and 900 (500-1400) grams, respectively. The median contrast volumes used were 4.5 (0.6-17) mL/kg for Group-A and 1.9 (1.4-3) mL/kg for Group-B. The median time of testing after exposure to ICM was 26 (9-190) days and 12 (6-42) days for Group-A and Group-B, respectively. On follow-up, no patients in Group-A have either abnormal laboratory results concerning for thyroid dysfunction or clinical signs of hypothyroidism (median TSH pre- and post-ICM = 3.1 and 2.2 mcU/mL; P=0.89 and median FT4 pre-and post-ICM = 1.2 and 1.1 ng/dL; P=0.77). Among the premature infants in Group-B, two patients developed persistently elevated TSH (>10 mU/mL), but still with normal FT4, but were treated with levothyroxine. There was no correlation between ICM volume and TSH level or with FT4 level (R
2<0.001 for both).
Conclusions
No patients in this cohort developed hypothyroidism post-ICM exposure. A small percentage of infants born premature, had persistently elevated TSH but with normal FT4 levels. Based on this study, it may not be necessary to perform routine thyroid monitoring in children receiving ICM during cardiac catheterization.