Gadolinium as an alternative contrast agent during cardiac catheterization in patient with iodine-induced hyperthyroidism

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We report the first case of a male patient with iodine-induced hyperthyroidism and unstable angina pectoris in whom a diagnostic cardiac catheterization with gadolinium as contrast agent was chosen. N.K., a 63-year-old caucasian male, underwent percutaneous transluminal angioplasty requiring visualisation with an iodinated contrast agent. Subsequent to this intervention he developed symptomatic hyperthyroidism with persistent arrhythmia and chest pain, necessitating hospitalization. The patient was started on high dose thiamazole and propronolol. During hospitalization coronary angiography seemed necessary. As the iodine load of conventional angiography was decided to pose a high risk of thyroid storm, the procedure was performed with the non-iodine based gadolinium. Gadolinium is not nephrotoxic and does not affect thyroid function. The exam was completed without side effects, revealing no significant stenoses of the coronary arteries. Three months later, when the patient had normal thyroid levels, cardioversion succeded to revert the atrial fibrillation to sinus rhythm. Patients with iodine induced hyperthyreoidism may develop cardiac complications such as unstable angina pectoris up to an acute coronary syndrome. A diagnostic or therapeutic coronary angiography with iodinated contrast agent often aggravates hyperthyroidism. Although imaging quality with gadolinium is not as good as with iodinated contrast agent, clinically useful angiogramms can be produced. Thus, gadolinium appears to be a low risk alternative for angiography, especially in patients with overt hyperthyroidism.