Key result
Infant CHD catheterization links to ~12% hypothyroidism incidence, predicted by higher iCM doses.
Why the study?
The incidence, onset, clinical course, and predictors of hypothyroidism following cardiac catheterization in infants with congenital heart disease were not established.
Does exposure to iodinated contrast media and fluoroscopy during cardiac catheterization increase the risk of hypothyroidism in infants with congenital heart disease?
Observational (n=102)
No
Does exposure to iodinated contrast media and fluoroscopy during cardiac catheterization increase the risk of hypothyroidism in infants with congenital heart disease?
Relative Risk: 1 (95% CI 1–1.01)
p-value: p=0.04
Exposure to higher doses of iodinated contrast media (>8.7 gm/kg) and longer fluoroscopy duration (>24 minutes) during cardiac catheterization in infants with congenital heart disease is associated with an increased risk of acquired hypothyroidism.
Supports thyroid monitoring after catheterization in infants with CHD; leaves open whether limiting contrast exposure reduces hypothyroidism risk.
This study aims to determine the incidence, potential onset and clinical course of hypothyroidism following cardiac catheter (CC) in infants with congenital heart diseases (CHD) and to evaluate the predictors for hypothyroidism in this vulnerable group. This prospective study included 102 patients with CHD, aged ≤ 3 years who underwent CC. Thyroid function tests were assessed before CC, one day, one week, two weeks and four weeks after the procedure. 12% of the studied group showed hypothyroidism four weeks after CC. Univariate analysis revealed that the significant predictors of hypothyroidism following CC are aortic stenosis (RR=10.0 (1.49-66.99), P=0.018), duration of fluoroscopy (RR=1.12 (0.99-1.26), P=0.05), and total cumulative dose of iodinated contrast media (iCM) (RR=1.01 (1.003 -1.01), P=0.019). Multivariate analysis revealed that iCM cumulative dose was the only significant predictor of developing hypothyroidism (RR=1.00 (1.00-1.01), P=0.04). ROC curve analysis showed that the cut-off point of iCM dose for prediction of hypothyroidism evolution is 8.7 gm/kg (26.1 ml/kg), (sensitivity: 83.3%, specificity: 65.1%), while the cut-off point of fluoroscopy duration which predicts development of hypothyroidism is 24 minutes, (sensitivity: 83.3%, specificity: 65.9%). In a median follow-up duration of 20 months, acquired hypothyroidism after CC persists in 5% of this cohort. Conclusion: Exposure to higher dose of iCM and longer duration of fluoroscopy during CC are risk factors for evolution of hypothyroidism. We recommend assessment of thyroid profile 4 weeks after CC particularly in patients who received a dose of iCM higher than 8.7 gm/kg and/or exposed to fluoroscopy for more than 24 minutes.
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Elbaz et al. (2021) conducted an observational in Congenital heart diseases (n=102). Iodinated contrast media (iCM) vs. Lower cumulative dose was evaluated on Development of hypothyroidism 4 weeks after cardiac catheterization (multivariate predictor analysis for iCM dose) (RR 1.00, 95% CI 1.00-1.01, p=0.04). In infants with congenital heart disease, 12% developed hypothyroidism 4 weeks after cardiac catheterization, with higher cumulative iodinated contrast media dose identified as a significant predictor (RR 1.00, p=0.04).
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