Abstract
La exposición a cantidades excesivas de yodo bloquea la actividad de la enzima peroxidasa tiroidea (TPO), un fenómeno conocido como efecto de Wolff-Chaikoff. Clínicamente, éste puede llevar a hipotiroidismo. Por el contrario, cuando un tirocito contiene valores bajos de yodo y es expuesto a elevadas concentraciones del mismo, aumenta de forma significativa la producción de hormona tiroidea, llevando frecuentemente a hipertiroidismo clínico y bioquímico, fenómeno conocido como efecto de Jod-Basedow. Tanto el hiper como el hipotiroidismo aumentan el riesgo de enfermedad arterial coronaria, miopatía ventricular izquierda, anormalidades electrofisiológicas, además de incrementar la mortalidad cardiovascular y por todas las causas.
Abstract
Exposure to excessive amounts of iodine blocks the activity of the enzyme thyroid peroxidase (TPO), a phenomenon known as Wolf-Chaikoff effect. Clinically, this effect can lead to hypothyroidism. On the other hand, when thyrocites have low iodine levels and are exposed to a high iodine concentration, they increase significantly their production of thyroid hormone thus leading to hyperthyroidism, a phenomenon known as Jod-Basedow effect. Both hypothyroidism and hyperthyroidism increase the risk of coronary artery disease, left cardiomyopathy, electrophysiological abnormalities, and all-cause mortality.
References
2. Van der Molen AJ, Thomsen HS, Morcos SK. Effect of iodinated contrast media on thyroid function in adults. Eur Radiol 2004;14(5):902-907.
3. Rhee C.M, Bhan I, Alexander E.K, Brunelli S.M. Association between iodinated contrast media exposure and incident hyperthyroidism and hypothyroidism. Archives of Internal Medicine 2012;172(2): 153-159.
4. Katzberg RW, Haller C. Contrast-induced nephrotoxicity: clinical landscape. Kid- ney Int Suppl 2006;100:S3-S7.
5. Marraccini P, Bianchi M, Bottoni A, Mazzarisi A, Coceani M, Molinaro S, Lorenzoni V, Landi P y Iervasi G. Prevalence of thyroid dysfunction and effect of contrast medium on thyroid metabolism in cardiac patients undergoing coronary angiography. Acta radiol 2012;54(1):42-7.
6. Haentjens P, Van Meerhaegue A, Poppe K, Velkeniers B. Subclinical thyroid dysfunction and mortality: an estimate of relative and absolute excess all-cause mortality based on tie-to-event data from cohort studies. Eur J Endocrinol 2008;159(3): 329-341.
7. Sgarbi JA, Matsumura LK, Kasamatsu TS, Ferreira SR y Maciel RMB. Subclinical thyroid dysfunctions are independent risk factors for mortality in a 7.5- year follow- up: The Japanese-Brazilian thyroid study. Eur J Endocrinol 2010;162(3): 569-77.
8. Moisey RS, McPherson S, Wright M, Orme SM. Thyroiditis and iodide mumps following an angioplasty. Nephrol Dial Transplant 2007;22(4):1250-1252
9. Almandoz JP y Gharib H. Hypothyroidismo: etiology, Diagnosis, and management. Med Clin North Am 2012;96(2):203-221.
10. Roti E, Uberti ED. Iodine excess and hyperthyroidism. Thyroid 2001;11(5):493– 500.
11. Woeber KA. Iodine and thyroid disease. Med Clin North Am 1991;75(1):169–78.
12. Van der Molen AJ. Effect on thyroid function. Medical Radiology 2009;139-146.
13. Hintze G, Bolmbach O, Fink H, Burkhardt U y Kobberling J. Risk of iodine-induced thyrotoxicosis after coronary angiography: an investigation in 788 unselected subjects. Eur J Endocrinol 1999;140(3):264-267.
14. Grainger RG, Pennington GW. A study of the effect of sodium/meglumine ioxaglate (Hexabrix) on thyroid function. Br J Radiol 1981;54(645):768–772
15. De Bruin TJW. Iodide induced hyperthyroidism with computed tomography contrast fluids. Lancet 1994; 343(8906):1160–1161.
16. Nygaard B, Nygaard T, Jensen LI et al. Iohexol: effects on uptake of radioactive iodine in the thyroid and on thyroid function. Acad Radiol 1998;5(6):409–414.
17. Martin FI, Tress BW, Colman PG, Deam DR. Iodine-induced hyperthyroidism due to non-ionic contrast radiography in the elderly. Am J Med 1993;95(1):78–82.
18. Martin FI, Deam DR. Hyperthyroidism in elderly hospitalized patients. Clinical features and treatment outcomes. Med J Aust 1996;164(4):200–203.
19. Stiedle B. Iodine-induced hyper-thyroidism after contrast media. Animal experimental and clinical studies. Fortschr Geb Rontgenstrahlen Nuklearmed Ergan- zugsbd 1989;128:6–14.
20. Hintze G, Blombach O, Fink H, Burkhardt U, Köbberling J. Risk of iodine-induced thyrotoxicosis after coronary angiography: an investigation in 788 unselected subjects. Eur J Endocrinol 1999;140(3):264–267.
21. Hehrmann R, Klein D, Mayer D et al. Hyperthyreoserisiko bei Kontrastmittelun- tersuchungen. Aktuel Radiol 1996;6:243–248.
22. Fassbender WJ, Vogel C, Doppl W et al. Thyroid function, thyroid immunoglobulin status, and urinary iodine excretion after enteral contrast-agent administration by endoscopic retrograde cholangiopancreatography. Endoscopy 2001;33(3):245–252.
23. Gartner W, Weissel M. Do iodine-containing contrast media induce clinically relevant changes in thyroid function parameters of euthyroid patients within the first week? Thyroid 2004;14(7):521–4.
24. Roberts CG, Ladenson PW. Hypothyroidism. Lancet 2004;363(9411):793–803.
25. Mekaru K, Kamiyama S, Masamoto H, Sakumoto K, Aoki Y. Thyroid function after hysterosalpingography using an oil-soluble iodinated contrast medium. Gynecol Endocrinol. 2008;24(9):498-501.
26. Seigel SC, Hodak SP. Thyrotoxicosis. Med Clin North Am 2012;96(2):175-201.
27. Ozkan S, et al. Thyroid functions after contrast agent administration for coronary angiography: a prospective observational study in euthyroid patients. Anadolu Kardiyol Derg. 2013;13:363–369.
28. Del Cerro Marín J, et al. Alteraciones de la función tiroidea en niños con cardiopatía congénita tras la realización de cateterismo con contraste yodado. Rev Esp cardio 2000;53:517-24.
29. Pearce EN. Iodine-induced thyroid dysfunction: comment on “association between iodinated contrast media exposure and incident hyperthyroidism and hy- pothyroidism”. Arch Intern Med. 2012 Jan 23;172(2):159-61.
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