Thyroid Monitoring following Intravenous Iodinated Contrast Administration in Children: A Quality Improvement Initiative

Introduction: As of March 30, 2022, the Food and Drug Administration recommended thyroid function testing for children less than 4 years of age within 3 weeks of receiving intravenous iodinated contrast due to an increased risk of thyroid dysfunction. Multifaceted solutions are needed to identify patients at risk of hypothyroidism, ensure timely testing, interpret results, and communicate information to primary care providers and caregivers. Our objective was to increase compliance with thyroid function test (TFT) completion or communication of the need for TFTs to 20% within 3 months and to 75% within 12 months. Methods: We identified patients using the following inclusion criteria: age less than 4 years and receipt of intravenous iodinated contrast. Electronic medical record tools, including conditional and automated SmartText in radiology reports, discharge summaries, and after-visit summaries, were used to identify patients and improve cross-encounter communication. Results: We identified 446 children who met the inclusion criteria. Of these, 42% (n = 189) had high-risk comorbidities. Compliance with communicating the need for TFTs to primary care providers through discharge summaries increased from a mean of 5% to 60% and with caregivers through after-visit summaries from a mean of 5% to 81% in 13 months. The percentage of TFTs completed increased from a mean of 10% to 22%, of which 22% (n = 22) were abnormal. Four patients received thyroid hormone supplementation. Conclusions: This project has successfully achieved its aim. Although this recommendation is unique to a small cohort of patients, similar strategies could be used to identify patients and coordinate follow-up testing across encounters.