Thyroiditis and iodide mumps following an angioplasty

A 51-year-old man on maintenance haemodialysis developed an acute and dramatic swelling of the thyroid and salivary glands, following administration of iodine containing contrast media. He underwent an aortofemoral angioplasty for peripheral vascular disease requiring 300 ml of Visipaque® 320 contrast media; the following day he developed a grossly enlarged, tender thyroid with swelling and tenderness of the sub-mandibular and parotid salivary glands ( Figure 1 ). He had refused haemodialysis immediately following the procedure as he complained of back pain. He subsequently underwent dialysis 24 h later. ... He was apyrexial, his CRP was 81 mg/l (reference range <10) and ESR 36 mm/h (RR 1–10). An ultrasound confirmed an enlarged, oedematous thyroid and salivary glands with swelling of surrounding soft tissue ( Figure 2 ). He had no dysphagia or dyspnoea. He had no past history or family history of thyroid disease. Initial thyroid function tests showed mild hypothyroidism [TSH 2.1 miu/l (RR 0.2–6.0), FT4 9.7 pmol/l, (RR10.0–25.0)] that recovered after a few days (TSH 4.2 miu/l, FT4 12.1 pmol/l). Thyroid peroxidase antibodies and thyrotrophin-binding inhibiting immunoglobulin were undetectable. We diagnosed acute thyroiditis and iodide mumps secondary to the iodinated contrast media. High-dose steroids (prednisolone 40 mg daily) were commenced and within 48 h the swelling and pain significantly improved. A repeat US confirmed normal size, echotexture and vascularity of the thyroid and salivary glands ( Figure 3 ). His prednisolone dosage was reduced and discontinued after a total of 2 weeks. Serial measurements of thyroid function have remained normal. Serum iodine levels were assayed before and during his second haemodialysis following the angioplasty and were grossly elevated ( Table 1 ). The serum iodine level was repeated 10 days later, after a further 4 dialysis treatments and remained grossly elevated (15,313 μg/l).