Primary thyroid dysfunction after single intravenous iodinated contrast exposure in young children: a propensity score matched analysis.

Abstract

Data suggest an increased risk of thyroid dysfunction following iodine-based contrast material (IBCM) in children. To estimate the prevalence of thyroid stimulating hormone (TSH) abnormalities following exposure to a single dose of intravenous IBCM during computed tomography (CT) in young children. Inpatients ≤24months of age who underwent a single CT with intravenous IBCM (exposed cohort) or abdominal ultrasound (US) (unexposed cohort) examination and had a TSH value obtained within 90days after imaging between January 2009 to November 2018 were identified. Propensity score matching with 20 variables was performed. Primary thyroid dysfunction was defined by abnormally high or low TSH value. Multivariable logistic regression identified risk factors, including intravenous IBCM, for thyroid dysfunction. From the eligible 4,215 imaging examinations, 114 unique patients were included in the propensity matched population (n=57 per group). Thyroid dysfunction was identified in 14% (8/57) and 7% (4/57) of the IBCM-exposed and IBCM-unexposed cohorts, respectively. No patient in either cohort was started on thyroid hormone supplementation within the 3months after imaging. Intravenous IBCM exposure was not a significant predictor of thyroid dysfunction on univariable (odds ratio [OR]=2.16, 95% confidence interval [CI]=0.61-7.64, P=0.23) or multivariable (OR=2.61, 95% CI=0.65-10.55, P=0.18) analyses. Significant independent predictors of post-imaging thyroid dysfunction included height (OR=1.25, P=0.0095) and trisomy 21 (OR=4.04, P=0.019). Hospitalized children ≤24months of age who received a single dose of intravenous IBCM for CT examination had a similar prevalence of TSH abnormalities compared to a propensity score matched group who underwent abdominal US. One dose of intravenous IBCM likely does not cause prolonged TSH abnormalities; however, larger studies are needed.