Abstract
(1) Background: We recently showed that iodinated contrast media (ICM) reduced thyroid uptake of iodide independently of free iodide through a mechanism different from that of NaI and involving a dramatic and long-lasting decrease in Na/I symporter expression. The present study aimed at comparing the response of the thyroid to ICM and NaI using a quantitative proteomic approach. (2) Methods: Scintiscans were performed on ICM-treated patients. Micro Single-Photon Emission Computed Tomography (microSPECT/CT) imaging was used to assess thyroid uptakes in ICM- or NaI-treated mice and their response to recombinant human thyroid-stimulating hormone. Total thyroid iodide content and proteome was determined in control, NaI-, or ICM-treated animals. (3) Results: The inhibitory effect of ICM in patients was selectively observed on thyroids but not on salivary glands for up to two months after a systemic administration. An elevated level of iodide was observed in thyroids from NaI-treated mice but not in those from ICM animals. Exposure of the thyroid to NaI modulates 15 cellular pathways, most of which are also affected by ICM treatment (including the elF4 and P706SK cell signaling pathway and INSR identified as an upstream activator in both treatments). In addition, ICM modulates 16 distinct pathways and failed to affect thyroid iodide content. Finally, administration of ICM reduces thyroid-stimulating hormone (TSH) receptor expression which results in a loss of TSH-induced iodide uptake by the thyroid. (4) Conclusions: Common intracellular mechanisms are involved in the ICM- and NaI-induced reduction of iodide uptake. However, ICM fails to affect thyroid iodide content which suggests that the modulation of these common pathways is triggered by separate effectors. ICM also modulates numerous distinct pathways which may account for its long-lasting effect on thyroid uptake. These observations may have implications in the management of patients affected by differentiated thyroid carcinomas who have been exposed to ICM. They also provide the basis for the utilization of ICM-based compounds in radioprotection of the thyroid.
Highlights
In the thyroid, iodide is taken up from the blood plasma by follicular cells
The scintiscan of a patient treated with Iomeron showed a lack of fixation in the thyroid region two weeks after iodinated contrast media (ICM) injection
We provided an indirect but strong argumentation based on SPECT/CT imaging of 123I and 99mTc to demonstrate that ICM reduce thyroid uptake of iodide independently of free iodide [16]
Summary
Iodide is taken up from the blood plasma by follicular cells. This uptake is mediated by the Na/I symporter (NIS) protein present at the basolateral membrane of these cells [1]. The latest guidelines recommend delaying radioactive iodide treatment in patients who have been exposed to ICM [9,11,12,13] This reduced iodide uptake by thyroid tissues in response to ICM was attributed to the high amounts of free iodide associated with [17] and/or released from [9,18] the ICM formulation. Consistent with this hypothesis, urinary iodide content is elevated for four-to-six weeks before a return to normal levels [19,20,21,22]. Urinary iodide content has been used as a surrogate marker of the restoration of normal iodide uptake by thyroid tissues [12]
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