Accelerated thyrotoxicosis induced by iodinated contrast media in metastatic differentiated thyroid carcinoma.
A 67-yr-old woman who underwent total thyroidectomy 32 yr ago developed accelerated hyperthyroidism after injection of iodinated contrast media to evaluate a left hemipelvis mass. The patient was managed with propylthiouracil, beta-blockers and digoxin. Whole-body 201TI and 131I scans demonstrated a functioning metastasis in the left hemipelvis where biopsy revealed a well differentiated follicular thyroid carcinoma. Palliative external beam radiotherapy was administered. The patient then received radioiodine treatment with granulocyte colony-stimulating factor to minimize bone marrow toxicity. Clinically significant thyrotoxicosis occurring in metastatic thyroid carcinoma is rare and results from abnormal ectopic thyroidal tissue iodine metabolism. Iodide-containing medications and contrast media should be avoided in patients with functioning thyroid metastases to prevent abrupt increases in circulating thyroid hormone levels.
Lorberboym
M
M
Department of Radiology, Mount Sinai School of Medicine, New York, New York 10029, USA.
Mechanick
J I
JI
D018263:Adenocarcinoma, Follicular / Q000000981:diagnostic imaging / Q000556:secondary* / Q000628:therapy; D000368:Aged; D002828:Choristoma / Q000150:complications; D003287:Contrast Media / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007455:Iodine / Q000009:adverse effects; D007457:Iodine Radioisotopes; D010386:Pelvic Neoplasms / Q000000981:diagnostic imaging / Q000556:secondary* / Q000628:therapy; D011877:Radionuclide Imaging; D013794:Thallium Radioisotopes; D013961:Thyroid Gland; D013964:Thyroid Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology* / Q000628:therapy; D013965:Thyroidectomy; D013971:Thyrotoxicosis / Q000139:chemically induced*
D003287:Contrast Media; D007457:Iodine Radioisotopes; D013794:Thallium Radioisotopes; D007455:Iodine