Its generally considered safe, and it is used to treat more than 70% of adults with hyperthyroidism. He had multiple pressure sores, which were treated with povidone iodine betadine soaks. Iodineinduced hyperthyroidisman old clinical entity that is. Hormone production may progress from subclinical to overt hyperthyroidism, and the administration of pharmacologic amounts of iodine to such patients may result in iodineinduced hyperthyroidism. Although she had been in the us for twenty years, she was born and grew up in a foreign country noted for low iodine levels. Serum iodine levels were elevated, explaining the lack of increase in radioiodine uptake in the thyroid gland. To summarize the mechanisms of iodineinduced hypothyroidism and hyperthyroidism, identify the risk factors for thyroid dysfunction following an iodine load, and summarize the major sources of excess iodine exposure. Pdf to summarize the mechanisms of iodineinduced hypothyroidism and hyperthyroidism, identify the risk factors for thyroid dysfunction. We report the case of a 72 year old female who developed. In 1972, however, iodine thyrotoxicosis was first reported from an iodine sufficient area 3. Aug 15, 2005 the proper treatment of hyperthyroidism depends on recognition of the signs and symptoms of the disease and determination of the etiology. Also, people who have graves disease, toxic multinodular goiter, or various types of thyroid adenoma are also at risk of jodbasedow effect when receiving iodine, because the thyroid will. Hyperthyroidism is an excessive concentration of thyroid hormones.
A young woman, brenda, was found to have essentially no urinary iodine excretion, indicating iodine deficiency. Iodineinduced hypothyroidism excessive dietary iodine intake can actually reduce t3 and t4 production if you already have sufficient stores of iodine in your body. In cases of established hyperthyroidism, administration of icm is contraindicated. The radioactive iodine enters the thyroid gland and while being made into thyroid hormone, it destroys some of the cells. Increased occurrence of hypothyroidism in moderatetosevere iodine deficiency. When the normal response to excess iodine, the acute wolffchaikoff effect, is impaired, thyroid dysfunction can occur. Hyperthyroidism and iodine deficiency thyroid center. Iodine induced hyperthyroidism can last from one month to 18 months and is treated by discontinuing iodine and, if indicated, administering a betaadrenergic antagonist, such as atenolol. Iodineinduced hyperthyroidism in a patient with a normal thyroid. This slowly destroys the cells of the thyroid gland that produce thyroid hormone. See iodine induced thyroid dysfunction and thyroid hormone synthesis and physiology. Iodineinduced hyperthyroidism in a patient with a normal thyroid gland.
Iodineinduced hyperthyroidism tshproducing pituitary adenomas toxic adenoma and toxic multinodular goiter. Increased prevalence of hyperthyroidism as an early and transient sideeffect of implementing iodine prophylaxis volume 10 issue 8 filip golkowski, monika buziakbereza, malgorzata trofimiuk, agata baldyswaligorska, zbigniew szybinski, bohdan huszno. The coexistence of hyperthyroidism and adrenal cortical insufficiency is unusual, relatively few cases having been cited in the literature. Iodine induced hyperthyroidism can develop even in the presence of an otherwise normal gland. Signs and symptoms vary between people and may include irritability, muscle weakness, sleeping problems, a. See iodineinduced thyroid dysfunction and thyroid hormone synthesis and physiology. Excess iodine intake can result in transient or permanent hyperthyroidism in susceptible individuals 26, 28, 29. Lack of iodine can lead to a disorder of the thyroid gland called as hypothyroidism.
This phenomenon is thus iodineinduced hyperthyroidism, typically presenting in a patient with endemic goiter due to iodine deficiency, who relocate to an iodineabundant geographical area. One of the less common sources of iodine is tablets of seaweed. Hyperthyroidism and other causes of thyrotoxicosis. Biochemical data were consistent with graves disease unmasked by topical iodine application. Jacques department of intensive care, the st george hospital, kogarah, new south wales abstract a 40yearold woman was admitted to the intensive care unit after a radical resection of a recurrent abdominal malignancy. These include how fast you burn calories and how fast your heart beats. The case we presented demonstrates that transient hyperthyroidism can be induced by excess iodine intake in persons with normal thyroid function. Iodine induced hyperthyroidism pdf download refriteferofra.
Thyrotoxicosis is the condition that occurs due to excessive thyroid hormone of any cause and therefore includes hyperthyroidism. This is the most acute effect of iodine on thyroid status, occurring within hours of the start of therapy. Prevention of iodineinduced thyrotoxicosis in highrisk patients is important, as treatment with thyrostatic drugs is hindered by the high iodide concentrations and complications are more frequent than in other forms of thyrotoxicosis. The use of iodine in hyperthyroidism sciencedirect. Guidelines by the us institute of medicine recommend a daily iodine intake of 150. It is known that prolonged exposure to or intake of high doses of the iodine containing drugs is accompanied by thyrotoxic reactions in the form of iodine induced hypothyroidism 64. The central role of iodide in thyroid physiology has been known for many years. We wish to report what may be the first described case of iodine induced hyperthyroidism resulting from cutaneous absorption of a topical preparation. Some of the symptoms of hyperthyroidism include nervousness, irritability, increased perspiration, heart racing, hand tremors, anxiety, difficulty sleeping, thinning of the skin, fine brittle hair, and muscular weaknessespecially in the upper arms and thighs. The other mechanism is due to the amiodarone molecule that induces a destruction of the thyroid follicles with a release of preformed hormones. Markers of endothelial dysfunction in patients with iodine. Radioactive iodine has been used to treat patients for hyperthyroidism for over 60 years and has been shown. Chronic excessive iodine supply can also lead to goiter 11 and may accelerate the development of subclinical thyroid disorders to overt. Healthy individuals with normal thyroid function should be cautioned to avoid kelp or other iodine rich containing herbal medicines or diets for weight loss.
Because amiodarone contains 37 percent iodine, type i is an iodine induced hyperthyroidism see above. The body does not make iodine, so it is an essential part of your diet. Rolleston 1 cites several early reports of skin pigmentation in advanced graves disease. This article has been cited by other articles in pmc. Exposure to excess iodine may come from several sources including enteral dietary supplements and iodinecontaining medications, topical iodine antiseptic solutions, and intravenous contrast radiographic agents 79.
Hyperthyroidism is associated with hypertension, coronary. Iodideinduced hyperthyroidism within four hours of iodide load. Excessive dietary iodine intake can actually reduce t3 and t4 production if you already have sufficient stores of iodine in your body. Iodine induced hyperthyroidism is usually seen in patients who already have an underlying abnormal thyroid gland. He had multiple pressure sores, which were treated with povidoneiodine betadine soaks. Prevention and treatment of iodineinduced thyrotoxicosis. Iodineinduced hyperthyroidism due to nonionic contrast radiography in the elderly. In some ways the jodbasedow phenomenon is the opposite of the wolffchaikoff effect, which refers to the short period of thyroidhormone suppression which happens in normal persons and in persons with thyroid disease, when comparatively large quantities of iodine or iodide are ingested. The aim of our study was to estimate chosen markers of endothelial dysfunction in iodine induced thyrotoxicosis iit. Patients with hyperthyroidism have increased risks of various cardiovascular problems, such as atrial fibrillation an irregular heart rhythm, hypertension, coronary artery disease, stroke and heart failure. It involves taking radioactive iodine by mouth as a capsule or liquid. Iodine induced thyrotoxicosis following povidineiodine.
In a consecutive series of 31 geriatric patients, who received potassium iodide for the same reason, biochemical. Information for behavioral health providers in primary care. As your thyroid hormone levels fall, your pituitary produces more tsh to stimulate increased production of t3 and t4, but your thyroid is impaired by iodine excess and cannot respond normally to tsh. Radioiodine therapy is a common and effective treatment for hyperthyroidism. Iodide induced hyperthyroidism iodide induced hyperthyroidism is not a single etiologic entity. Scientific update on the iodine content of portuguese foods. Madison, wisconsin in the light of our present knowledge, of the use of iodine in hyperthyroid ism, it seems to me that the following twelve questions offer material for discussion. Iodine deficiency disorders and the therapeutic use of iodine in patients with hyperthyroidism are discussed separately. Iodineinduced hyperthyroidism has been described previously in the medical literature. Iodineinduced hyperthyroidism in a patient with a normal. Hypothyroidism can easily be treated with a thyroid hormone supplement taken once a day see hypothyroidism brochure.
Contrast induced hyperthyroidism due to iodine excess. This condition is called amiodaroneinduced destructive thyrotoxicosis or type ii thyrotoxicosis. Iodine is an element that is needed for the production of thyroid hormone. In this disorder, production of the thyroid hormones, such as thyroxine, is suppressed. Iodine induced thyrotoxicosis following povidineiodine dressings. Topical iodine and hyperthyroidism annals of internal. Both iodine deficiency and excess can cause thyroid dysfunction. Elimination of iodine deficiency has been a major goal of the iodine global network, unicef, and the world health. Since the initial description by coindet in 1821 18 and the subsequent definition by breuer and kocher in 1904, iodine induced hyperthyroidism has been reported in pa. Management guidelines of the american iodine induced hyperthyroidism ataaace guidelines. Hyperthyroidism may be asymptomatic or present with significant symptoms. One of the less common sources of iodine is tablets of seaweed, sold over the counter without prescription. Amiodarone induced hyperthyroidism was considered but was thought to be unlikely as the drug was stopped a year ago. Nov 12, 2018 see iodine induced thyroid dysfunction and thyroid hormone synthesis and physiology.
Thyrotoxicosis induced by topical iodine application. Thyrotoxicosis induced by topical iodine application jama. Iodineinduced hyperthyroidisman old clinical entity that is still. Hyperthyroidism results from excessive secretion of thyroid hormone. Transient hyperthyroidism following the ingestion of complem. Jun 28, 2019 this phenomenon is thus iodine induced hyperthyroidismtypically presenting in a patient with endemic goiter due to iodine deficiencywho relocate to an iodine abundant geographical area. In 1972, however, iodine thyrotoxicosis was first reported from an iodinesufficient area 3. Mar 17, 2019 the term hyperthyroidism refers to any condition in which there is too much thyroid hormone produced in the body.
Hyperthyroidism induced by topical iodine endocrinologia y. However, it may also occur in patients with and without previous thyroid disease residing in iodine sufficient areas. Since the initial description by coindet in 1821 18 and the subsequent definition by breuer and kocher in 1904, iodineinduced hyperthyroidism has been reported in pa. Iodine in the treatment of hyperthyroidism uptodate. Iodine induced hyperthyroidism has been reported with exposure to iodine containing drugs, povidone iodine, 2 dietary supplements kelp, seaweed, and radiographic contrast dyes.
Perchlorate is an effective treatment of iodineinduced hyperthyroidism in some patients, with few adverse effects when a low dosage graves hyperthyroidism remission with iodine case report by jeffrey dach md. Over the last 80 years, worldwide efforts have been made to eliminate iodine deficiency. Hyperthyroidism developed in three patients during the administration of potassium iodide given for the purpose of blocking the thyroid uptake of radioactive iodine liberated in the course of the 125 ifibrinogen test. Iodine induced hyperthyroidism can also result from high iodine intakes, usually when iodine is administered to treat iodine deficiency. Jeffrey dach md iodine induced hyperthyroidism by jeffrey. Prevalence of thyroid dysfunction and effect of contrast medium on thyroid metabolism in cardiac patients undergoing coronary angiography. Iodineinduced hyperthyroidism april 15, 2009 a 33yearold woman began experiencing increased rate of hair loss, anxiety, insomnia, palpitations, heat intolerance and tremor in october. Almost everyone who has radioactive iodine treatment later develops. Germline mutations of the thyroidstimulating hormone tsh receptor resulting in constitutively activating gainof.
We present a case of iodineinduced hyperthyroidism in a critically ill icu patient caused by excessive iodine containing antiseptic solution washes and contrast. Consequences of excess iodine iodine global network. Graves disease, an autoimmune disorder, is the most common cause. In hyperthyroid patients, iodine acutely inhibits hormonal secretion, but the responsible mechanisms are uncertain. One form of iodine, iodine1, is radioactive and can be used to treat hyperthyroidism. Iodine is required for the synthesis of the thyroid hormones. The most common cause of hyperthyroidism is graves disease. Prevention of iodine induced thyrotoxicosis in highrisk patients is important, as treatment with thyrostatic drugs is hindered by the high iodide concentrations and complications are more frequent than in other forms of thyrotoxicosis. Radiographic iodinated contrast mediainduced thyroid. It is known that prolonged exposure to or intake of high doses of the iodinecontaining drugs is accompanied by thyrotoxic reactions in the form of iodineinduced hypothyroidism 64. Excess iodine is generally well tolerated, but individuals with underlying thyroid disease. As with many diseases, it is better to prevent the problem rather than have to treat it. People who have graves diseasetoxic multinodular goiteror various types of thyroid adenoma are also at risk of jodbasedow effect when they ingest extra iodine.
Exposure of the body to large amounts of iodine sometimes causes thyroid function changes, and may result in both hyperthyroidism and hypothyroidism. Gd is the most common cause of hyperthyroidism in the. Iodideinduced hyperthyroidism iodideinduced hyperthyroidism is not a single etiologic entity. Perchlorate is an effective treatment of iodine induced hyperthyroidism in some patients, with few adverse effects when a low dosage iodine induced hyperthyroidism has been frequently described when iodine is introduced into an iodine deficient area. The term hyperthyroidism refers to any condition in which there is too much thyroid hormone produced in the body. Certain medications, such as amiodarone cordarone, which is used in the treatment of heart problems, contain a large amount of iodine and may be associated with thyroid function. Hyperthyroidism is the condition that occurs due to excessive production of thyroid hormone by the thyroid gland.
Iodineinduced hyperthyroidism definition of iodineinduced. Amiodaroneinduced hyperthyroidism endocrinology jama. This condition is an iodineinduced thyrotoxicosis or type i amiodaroneinduced thyrotoxicosis. Iodine induced hyperthyroidism is a thyrotoxic condition caused by exposure to excessive iodine. We wish to report what may be the first described case of iodineinduced hyperthyroidism resulting from cutaneous absorption of a topical preparation.
If your thyroid is too active, it makes more thyroid hormones than your body needs. Patients with hyperthyroidism have increased risks of various cardiovascular problems, such as atrial fibrillation an irregular heart rhythm, hypertension. Carol is a 56 year old real estate agent who noticed a feeling of nervousness, warmth and rapid heart rate which worsened over a few days. Hyperthyroidism is more common in women, people with other thyroid problems, and those over 60 years old. Amiodarone is the most common source of iodine excess in the united states. Iodineinduced hyperthyroidism is usually seen in patients who already have an underlying abnormal thyroid gland.
Increased prevalence of hyperthyroidism as an early and. Iodineinduced hyperthyroidism can develop even in the presence of an otherwise normal gland. The radioactive iodine assessment should help to distinguish graves hyperthyroidism from iodine induced hyperthyroidism. Five patients with iodine induced hyperthyroidism seen in a 12month period are described. Apr 15, 2009 iodine induced hyperthyroidism april 15, 2009 a 33yearold woman began experiencing increased rate of hair loss, anxiety, insomnia, palpitations, heat intolerance and tremor in october.
Iodineinduced hyperthyroidismcan develop even in the presence of an otherwise normal gland. Pdf iodineinduced thyroid dysfunction researchgate. Iodideinduced hyperthyroidism within four hours of. Doctors have used radioactive iodine to treat hyperthyroidism for over 60 years. Because amiodarone contains 37 percent iodine, type i is an iodineinduced hyperthyroidism see above. Autonomous hormone production is caused by somatic, activating mutations of genes regulating follicular cell activities. Iodine induced hyperthyroidism information including symptoms, causes, diseases, symptoms, treatments, and other medical and health issues. Management guidelines of the american iodineinduced hyperthyroidism ataaace guidelines. It has been reported that hyperthyroidism is associated with an altered endothelial function and increased risk of arterial thromboembolism. Iodine is vital for the development of our brain cells and for the regulation and production of the thyroid hormones.
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