Abstract
To report a case of Jod-Basedow phenomenon, where a patient with quiescent thyroid eye disease became active after a contrast computed tomography (CT). A patient with clinically inactive thyroid eye disease underwent a contrast CT, after which her clinical activity score increased for 1 to 6/10 with optic nerve dysfunction. She was managed medically with intravenous steroids, neomercazole and propranolol. Jod-Basedow phenomenon is a rare condition where thyroid eye disease reactivates after a large iodine bolus. It is important for clinicians to be aware of this when considering special investigations, such as contrast scans, where iodine is given in large doses.
Highlights
Thyroid eye disease (TED) is an autoimmune disease that represents the most common extrathyroidal manifestation of Graves’ disease (GD).[1,2] The annual incidence of GD is 16 out of 100 000 females and 3 out of 100 000 males, with visually significant GD in 3% – 5% of cases.[1]
JodBasedow phenomenon is a rare cause of hyperthyroidism that can develop after an iodine bolus in a susceptible patient.[3,4,5,6]
The physiological response to excess iodine is the Wolff-Chaikoff effect, where there is a transient decrease in hormone production; some individuals develop hyperthyroidism, which is known as the Jod-Basedow phenomenon.[3,7]
Summary
Thyroid eye disease (TED) is an autoimmune disease that represents the most common extrathyroidal manifestation of Graves’ disease (GD).[1,2] The annual incidence of GD is 16 out of 100 000 females and 3 out of 100 000 males, with visually significant GD in 3% – 5% of cases.[1]. The average amount of free iodine in a single dose of iodinated contrast medium for computed tomography (CT) is 13 500 μg, making it more than ten times the recommended daily dose in a single bolus.[4,7] The physiological response to excess iodine is the Wolff-Chaikoff effect, where there is a transient decrease in hormone production; some individuals develop hyperthyroidism, which is known as the Jod-Basedow phenomenon.[3,7] This phenomenon is based on the premise that there are autonomously functioning areas of the thyroid gland resulting in an excess in hormone production when there is an iodine overload in the body.[9] Amiodarone is one of the most common causes of this phenomenon, but there are a number of papers reporting this phenomenon after intravenous iodinated contrast administration.[9,10] The average duration from intravenous contrast medium administration and onset of hyperthyroidism is 3–10 weeks. She subsequently underwent a bilateral orbital decompression that improved the proptosis
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