povidone-iodine and Hypothyroidism

Nosocomial infections are among the leading causes of mortality and morbidity in neonatal intensive care units. Prevention of healthcare-associated infections is based on strategies that aim to limit susceptibility to infections by enhancing host defences, interrupting trasmission of organisms by healthcare workers and by promoting the judicious use of antimicrobials. Strategies for the prevention of nosocomial infections include hand hygiene practices, prevention of central venous (cvc)-related bloodstream infections, judicious use of antimicrobials for therapy, enhancement of host defences, skin care and early enteral feeding with human milk. Major concerns about the use of alcoholic chlorhexidine are for the high risk of skin burns in extremely premature infants during the first days of life, when the skin is thin and not fully keratinesed. Aqueous chlorhexidine could be less irritant when used in very low birthweigth infants and thus could represent a good option. A recent prospective trial of adult patients showed similar effectiveness of alcoholic and aqueos solutions of chlorexidine. However, to date no study evaluated whether the aqueos formulation is less harmful and as effective as the alcoholic formulation in neonatal infants. The lack of evidence for neonatal patients prompts urgent need for large randomised controlled trials comparing effectiveness and safety of different skin disinfectants before CVC placement in neonates and particulary in very low birth-weight infants. Nosocomial infections are still of the most serious problems for the neonatal intensive care unit. Therefore every effort must be implemented to reduce the incidence of these infections, can not be considered a toll required hospitalization, as it may not be acceptable for a place of shelter and care as the hospital may itself be a source of disease.

Topics: Adult; Alcohols; Anti-Infective Agents, Local; Bacterial Infections; Catheter-Related Infections; Chlorhexidine; Contraindications; Cross Infection; Hand Disinfection; Humans; Hypothyroidism; Incidence; Infant, Newborn; Infant, Premature; Infant, Premature, Diseases; Infant, Very Low Birth Weight; Infection Control; Infectious Disease Transmission, Professional-to-Patient; Intensive Care, Neonatal; Povidone-Iodine; Skin; Skin Absorption; Solvents; Water

Iodine-induced hypothyroidism that develops in patients who gargle routinely with povidone iodine is well known. Usually the hypothyroidism is mild and resolves spontaneously upon cessation of gargling. Here, we report a 63-year-old patient with overt hypothyroidism that developed due to habitual gargling with povidone iodine for more than 10 years. The urinary excretion of iodine was estimated to be greater than 5 mg/day, based on values obtained from 18 normal subjects who gargled three times a day (4.6+/-2.1 mg, mean+/-SD). After discontinuation of the gargling, the patient has been euthyroid for more than 10 months.

Topics: Aged; Follow-Up Studies; Humans; Hypothyroidism; Iodine; Male; Middle Aged; Mouthwashes; Povidone-Iodine; Risk Assessment; Severity of Illness Index; Thyroid Function Tests

The high incidence of transient thyroid dysfunction in newborns from our hospital (0.6%), led us to investigate whether povidone perineal prep. during delivery and daily postpartum antisepsis, induced iodine overload in the newborn, and whether breast milk was the vehiccle. In a controlled randomized trial we used either povidone-iodine or clorhexidine in 36 mothers, and we investigated in them and in their newborns iodine levels and thyroid function. Iodine levels in cord blood, maternal urine and newborn urine were significantly higher in povidone treated group (p less than 0.001) up to the 4th postpartum day. These levels were also significantly higher in breast fed than in formula-fed babies within the group of povidone-iodine-treated mothers. Maternal prepartum urine iodine, and thyroid function in mothers and newborns were not significantly different in both groups.

Topics: Delivery, Obstetric; Disinfection; Female; Humans; Hypothyroidism; Infant, Newborn; Perineum; Povidone; Povidone-Iodine; Pregnancy

A high incidence of transient neonatal hypothyroidism has been observed in premature infants after routine skin cleansing with iodine. Because these reports have been predominantly from Europe, a borderline, iodine-deficient area, we wished to determine whether this was also true in North America, an iodine-sufficient area. A prospective, controlled study was performed in premature babies < or = 36 weeks gestation admitted to a neonatal intensive care nursery. Thyroxine (T4) and thyrotropin (TSH) were measured at day 1, days 4 to 6, and 10 to 12 after skin preparation with iodine or with a noniodine-containing antiseptic solution (chlorhexidine) that served as control. If repeat cleansing was required, this sequence was repeated. Urinary iodine was quantitated on days 1 to 3 to estimate iodine exposure. There was no difference in the mean T4 concentration at any of the time points evaluated nor in the incidence of transient hypothyroidism between the iodine-exposed (2/17) and control babies (0/14) despite urinary iodine excretion up to 88 times the control value. Unexpectedly 5 iodine-exposed but 0 control babies developed severe hypothyroxinemia (T4 < 40 nmol/L), compatible with the sick euthyroid syndrome; one of them died. We conclude that, unlike in Europe, transient hypothyroidism is not a common sequela of routine skin cleansing with iodine in premature newborn infants in North America. This difference in incidence may be due to prior iodine status. Whether excessive iodine absorption in premature infants is associated with thyroid-independent toxic effects remains to be clarified.

Topics: Anti-Infective Agents, Local; Chlorhexidine; Disinfection; Female; Humans; Hypothyroidism; Infant, Newborn; Iodine; Male; North America; Povidone-Iodine; Prospective Studies; Thyrotropin; Thyroxine; Time Factors

Cardiopulmonary bypass has profound effects on thyroid hormone metabolism. These effects may be exacerbated in infants because they are able to absorb large quantities of iodine transcutaneously. The purpose of this study was to test the hypothesis that preoperative povidone-iodine contributes to postoperative thyroid depression in infants who undergo cardiac surgery.. Prospective, randomized, controlled trial.. Children's Hospital and Medical Center, Seattle, WA.. Thirty-seven infants undergoing repair of congenital cardiac defects.. Infants requiring cardiopulmonary bypass were divided into two groups: Group 1 received povidone-iodine; group 2 received chlorhexidine as a topical preoperative antiseptic. Group 3 did not require cardiopulmonary bypass for repair of cardiac defects and received povidone-iodine as a preoperative antiseptic.. Thyrotropin (TSH), total triiodothyronine (T3), and thyroxine (T4) were measured at four intervals: a) before preparation for surgery; b) immediately after surgery; c) at 2 days after surgery; and d) at 5 to 8 days after surgery. There was a significant decrease in TSH concentrations immediately after surgery in the two bypass groups. This change was significantly greater than in the change in TSH concentration in the thoracotomy group. Total T3 and T4 concentrations decreased by postoperative day 2 in both groups 1 and 2, and the changes were significant compared with group 3. Total T3 and T4 concentrations increased significantly in all groups after postoperative day 2, with no significant difference between the three groups.. Cardiopulmonary bypass has a more significant effect on thyroid hormone metabolism than does the preoperative antiseptic.

Topics: Anti-Infective Agents, Local; Cardiopulmonary Bypass; Chlorhexidine; Female; Heart Defects, Congenital; Humans; Hypothyroidism; Infant; Male; Povidone-Iodine; Prospective Studies; Thyrotropin; Thyroxine; Time Factors; Triiodothyronine

The influence of topical iodine-containing antiseptics on thyroid function test results of premature infants was determined in two separate studies. Thyroxine and thyrotropin levels were measured on blood-spotted filter paper. Samples were obtained from 128 premature infants on their tenth day of life; the infants were treated in two neonatal intensive care units. Both units used similar treatment protocols; however, one routinely used topical iodinated antiseptic agents (n = 73), whereas the other used chlorhexidine-containing antiseptics (n = 55). There was no difference in the mean T4 levels between the two groups. The mean thyrotropin levels were elevated in preterm babies exposed to iodine (15.4 vs 7.8 mIU/L, p < 0.01). Among the iodine-exposed infants, elevated thyrotropin levels (> 30 mIU/L) were found in 13.7% of infants, compared with none in the chlorhexidine-treated group (p < 0.01). We then studied an additional 46 premature infants who were treated in one neonatal intensive care unit. Iodine-containing solutions were used in 24 infants and chlorhexidine was used in 22 infants. T4 and thyrotropin levels were measured weekly during the first 28 days, one every 2 weeks until the age of 60 days, and at the age of 90 days. Among iodine-exposed infants, 20.8% had thyrotropin values > 30 mIU/L, whereas none of the infants in the chlorhexidine group had elevated thyrotropin values (p < 0.05). The elevated thyrotropin levels correlated positively with the area of disinfection. Elevated urine iodine levels were present reflecting an abnormally high iodine absorption. This study suggests that iodine absorption from topical iodine-containing antiseptics may cause disturbances in thyroid function test results in premature infants. We recommend that caution be exercised in the use of iodine-containing antiseptics in premature infants.

Topics: Anti-Infective Agents, Local; Chlorhexidine; Cross-Over Studies; Female; Humans; Hypothyroidism; Infant; Infant, Newborn; Infant, Premature, Diseases; Intensive Care, Neonatal; Male; Povidone-Iodine; Retrospective Studies; Thyrotropin; Thyroxine

To evaluate the influence of the intravenous injection of iodine during cardiac catheterisation, and of topical iodine antiseptics during surgical procedures, on thyroid function in full term neonates.. Twenty one full term infants with major cardiac anomalies who survived for more than a month were studied. Thyroxine and thyrotropin concentrations were measured (by radioimmunoassay) before each procedure, 24 hours after the procedure, and every week thereafter until the age of 1 month or until normal. Thyroxine values less than 64.4 nmol/l were considered low, while thyrotropin values greater than 30 mU/l were considered high.. Thyroid function tests before iodine exposure were within normal limits in all infants. Following catheterisation or surgery six infants had raised thyrotropin concentrations; three had low thyroxine concentrations. Two of those infants were treated with L-thyroxine.. Iodine exposure during cardiac catheterisation or surgery may induce transient hypothyroidism in term infants.

Topics: Anti-Infective Agents, Local; Cardiac Catheterization; Contrast Media; Heart Defects, Congenital; Humans; Hypothyroidism; Infant, Newborn; Iodine; Povidone-Iodine; Prospective Studies; Thyrotropin; Thyroxine; Triiodobenzoic Acids

The high incidence of transient thyroid dysfunction in newborns from our hospital (0.6%), led us to investigate whether povidone perineal prep. during delivery and daily postpartum antisepsis, induced iodine overload in the newborn, and whether breast milk was the vehiccle. In a controlled randomized trial we used either povidone-iodine or clorhexidine in 36 mothers, and we investigated in them and in their newborns iodine levels and thyroid function. Iodine levels in cord blood, maternal urine and newborn urine were significantly higher in povidone treated group (p less than 0.001) up to the 4th postpartum day. These levels were also significantly higher in breast fed than in formula-fed babies within the group of povidone-iodine-treated mothers. Maternal prepartum urine iodine, and thyroid function in mothers and newborns were not significantly different in both groups.

Topics: Delivery, Obstetric; Disinfection; Female; Humans; Hypothyroidism; Infant, Newborn; Perineum; Povidone; Povidone-Iodine; Pregnancy

Topics: Acute Disease; Eating; Humans; Hypothyroidism; Povidone-Iodine

Iodine-based mouthwash and throat sprays contain povidone iodine (PVP-I) for disinfection. PVP-I mouthwash has been commonly used for decades in Japan and other countries and frequent and/or prolonged use of PVP-I mouthwash can induce transient hypothyroidism. To assess the amount of iodine ingested from an oral rinse, 22 healthy adult volunteers (mean age: 48.1, 29-70 years) were recruited for the study. The subjects were instructed to rinse for 15 s three times with 20 mL of commercially available PVP-I mouthwash diluted into 0.23% or pure water. This method is a standardized method of gargling recommended by the manufacturers. The total iodine in the PVP-I mouthwash was measured with inductively coupled plasma-mass spectrometry. Although the 7% PVP-I mouthwash contains 7 mg of effective iodine/mL, 24.3 mg/mL of iodine was detected in the solution. The median value and ratio of the total iodine ingested were 5.0 mg (range: 2.6-10.8 mg) and 20.5% (range: 10.6-44.5%), respectively. The iodine species released from the PVP-I mouthwash are effective iodine (PVP・nHI

Topics: Adult; Eating; Humans; Hypothyroidism; Iodides; Iodine; Mouthwashes; Povidone-Iodine

Topics: Chronic Disease; Humans; Hypothyroidism; Ointments; Povidone-Iodine; Skin Ulcer; Sugars; Ulcer

Urinothorax, an unusual and rare cause of pleural effusion, is usually secondary to urinary obstruction and abdominal trauma. We describe an uncommon case of left-sided urinothorax in a 35-year-old man with diabetes and hypothyroidism associated with an autoimmune disorder without obvious obstructive uropathy. Workup revealed pancytopenia, mild proteinuria, positive anti-nuclear and anti-dsDNA antibodies suggestive of probable systemic lupus erythematosus. Contrast-enhanced CT-chest and abdomen showed hepatosplenomegaly with bilateral renal abscesses and a fistulous connection between left superior calyx and left the pleural cavity. Patient was initially managed by intravenous antibiotics, intercostal tube drainage and ipsilateral double-J stent placement. The definitive management in the form of closure of nephropleural fistula was achieved with sclerotherapy using 0.1% povidone-iodine instillation, while oral steroids were started for the probable autoimmune disorder. To the best of our knowledge, this is the first case of spontaneous non-obstructive nephropleural fistula associated with an autoimmune disorder, managed by minimally invasive methods.

Topics: Adult; Anti-Bacterial Agents; Autoimmune Diseases; Diabetes Mellitus, Type 1; Drainage; Humans; Hypothyroidism; Male; Pleural Effusion; Povidone-Iodine; Rare Diseases; Respiratory Tract Fistula; Sclerotherapy; Tomography, X-Ray Computed; Treatment Outcome; Urinary Fistula

Iodine-containing disinfectants are widely used for skin preparation before caesarean section. Current evidence suggests that maternal exposure to these disinfectants results in thyroid dysfunction in the newborns, but its extent is not known.. The purpose of this study was to explain the quality of the effect of these disinfectants on the thyroid function of newborns.. This cohort study was performed on all the healthy mothers with a term pregnancy who underwent caesarean section in the obstetrics emergency department of an educational hospital affiliated with Tehran University of Medical Sciences from December 2013 to December 2014. We divided this 12-month period into two consecutive 6 months. Povidone-iodine 10% (PVP-I) and chlorhexidine gluconate 4% (CHX) were used in the first and second 6 months, respectively, for skin preparation before caesarean section and also for umbilical cord disinfection. Cord blood thyroid stimulating hormone (TSH) and thyroxine (T4) were assayed by the ELISA method.. We included 326 cases in this study, 153 in the PVP-I group and 173 in the CHX group. The incidence of cord blood TSH ≥ 10 mIU/L and T4 ≤ 7.3 µg/dL was significantly higher in the PVP-I than the CHX group. Cord blood TSH concentration showed a significant positive correlation with cord blood T4 concentration in the CHX group. Through selection of cases with cord blood T4 < 13 µg/dL, we found a negative correlation between cord blood TSH and T4 concentration in the PVP-I group.. It seems that PVP-I has the potential to cause false-positive screening-test results and increase recall rates, which should be evaluated in further studies.. Iranian Registry of Clinical Trials (IRCT) number IRCT201204289568N1.

Topics: Adult; Anti-Infective Agents, Local; Cesarean Section; Chlorhexidine; Disinfection; Enzyme-Linked Immunosorbent Assay; False Positive Reactions; Female; Fetal Blood; Humans; Hypothyroidism; Infant, Newborn; Iran; Maternal Exposure; Povidone-Iodine; Pregnancy; Thyrotropin; Thyroxine

Excessive iodine exposure during the fetal and neonatal periods can lead to neonatal hypothyroidism. This study was conducted to evaluate the level of iodine loading among newborns living in Kayseri province. A total of 59 newborns, who were admitted due to disorders in thyroid hormone levels, were included in the study. Materials and. Among the patients who applied with thyroid hormone dysfunction, newborns with a spot urine iodine level ≥ 20 μg/dL were included in the study between the years 2003 and 2013. Free T3 (fT3), free T4 (fT4), thyroid stimulating hormone (TSH), thyroglobulin (Tg), breast milk iodine, thyroid ultrasonography, and control measurements of fT3, fT4, TSH, and Tg levels were obtained accordingly from both groups of patients who received or did not receive treatment.. The average age of the patients was 15 days with a 36/23 girl to boy ratio. Statistically, no significant difference was noticed between all the girls and boys with respect to all the measured values. The etiologic search showed that out of 59 cases, in 18 cases (30.5%) only the mother and in 19 cases only the newborns (32.2%) had a history of povidone iodine exposure; in 8 cases both mothers and their babies had exposure to povidone iodine (13.6%). In 14 cases (23.7%), the source of iodine loading could not be determined. Levothyroxine (L-thyroxine) treatment was initiated in 56% of the patients (n = 33). Out of 33 patients who were under treatment with L-thyroxine, in 13 cases only the mother had history of povidone iodine exposure; in 12 cases, only the baby had a history of povidone iodine exposure; in 1 case, both mother and her baby had a history of povidone iodine exposure, but the etiology could not be found in 7 cases.. The use of antiseptics-containing iodine for mothers before and after birth and for newborns, especially for umbilical cleansing, can lead to iodine loading and hypothyroidism. If transient hypothyroidism develops within this period, then it may not be detected promptly. This can later lead to retardation in psychomotor development and disorder in learning skills during the childhood period.

Topics: Anti-Infective Agents, Local; Female; Humans; Hypothyroidism; Infant, Newborn; Iodine; Male; Milk, Human; Povidone-Iodine; Pregnancy; Prenatal Exposure Delayed Effects; Thyroglobulin; Thyroid Gland; Thyrotropin; Thyroxine; Triiodothyronine; Turkey; Ultrasonography

Till now there has not been reported data related to the influence of leflunomide on the thyroid gland function of the treated person. The authors described the case of woman with rheumathoid arthritis and hypothyroidism who revealed hyperthyroidism in 7 months after starting leflunomide tablets treatment containing povidone iodine as well. Also both autonomical tissue area in thyroid right lobe and hight TSHRAb level were found. Leflunomid tablets containing povidone iodine in its structure can cause hyperthyroidism in the person with previous hypothyroidism and nodular goiter, probably as a result of immunological reconversion and tissue nodular functional autonomisation. In persons with nodular goitre one should prefer free of povidone iodine leflunomide treatment and also monitor serum thyroid hormone contents and thyroid antibodies as well.

Topics: Antirheumatic Agents; Arthritis, Rheumatoid; Drug Combinations; Female; Humans; Hyperthyroidism; Hypothyroidism; Isoxazoles; Leflunomide; Middle Aged; Povidone-Iodine

To evaluate the influence of topical iodine-containing antiseptics on neonatal TSH in full-term infants born by Caesarean section in an iodine sufficient area.. Urinary iodide excretion (UIE) was estimated in 86 mothers on the second day after delivery by Caesarean section and their 86 full-term neonates. The mothers were divided into two groups according to the use of antiseptic to prepare Cesarean sections: 42 mothers who were prepared with povidone-iodine (Isosept, Bosnalijek) comprised the study group, and 47 mothers who were prepared with alcoholic solution (Skinsept color, Ecolab) formed the control group. Neonatal TSH was measured in whole blood drawn between day 3 and 5 of life, spotted on filter paper using a sensitive fluorometric assay (Delfia).. Maternal and neonatal UIE were significantly higher (p < 0.05) in the study group compared to the control group. No significant difference was found for neonatal TSH.. Our data suggest that perinatal iodine exposure of full-term neonates who were born by Caesarean section in an iodine sufficient area did not influence neonatal TSH, although median UIE was higher, suggesting optimal iodine intake during pregnancy. Further research is needed to define a critical value of urinary iodine concentrations in full-term neonates in an iodine sufficient area that may lead to the impairment of thyroid function.

Topics: Anti-Infective Agents, Local; Cesarean Section; Female; Humans; Hypothyroidism; Infant, Newborn; Iodine; Male; Postpartum Period; Povidone-Iodine; Pregnancy; Pregnancy Complications; Thyroid Gland; Thyrotropin

Use of iodinated skin disinfectants in the perinatal period can result in significant iodine overload of the neonate and transient hypothyroidism. The authors report a case of unusually severe hypothyroidism requiring L-thyroxine (L-T4) replacement therapy in a premature neonate after prolonged use of iodinated skin disinfectants for a complex skin lesion. Neonatal iodine overload should be minimized, and in cases with significant iodine exposure, thyroid-stimulating hormone should be monitored, especially in preterm neonates who are exquisitely sensitive to the antithyroid effects of iodine excess.

Topics: Anti-Infective Agents, Local; Dermatologic Agents; Humans; Hypothyroidism; Infant, Newborn; Infant, Premature; Male; Povidone-Iodine; Thyrotropin; Thyroxine

The aim of this prospective study was to examine whether providone-iodine used for sternal wound protection in infants with delayed sternal closure (DSC) influences the thyroid function.. Thyroid hormones (see bellow) and thyroxine binding globulin (TBG) were estimated by radioimmunoassay and ioduria by mass spectrometry in 20 infants in whom cutaneous povidone-iodine was continuously applied on the skin for 1-7 days before DSC after open heart surgery.. In the early postoperative period the median levels of total triiodothyronine (TT3), total thyroxine (TT4) and thyroxine-binding globulin (TBG) were below the lower limit of normal, while these of reverse triiodothyronine (rT3) were above normal. The median levels of free triiodothyronine (FT3), free thyroxine (FT4), and thyroid stimulating hormone (TSH) were normal. Two weeks after the sternal closure, the levels of TT3, TT4 and TBG increased significantly (P < 0.001), while these of rT3 decreased, but not significantly. The levels of TSH increased (P < 0.001), being above normal in 7 patients. Four weeks after the sternal closure, TSH levels remained markedly increased in 4 infants. These patients were considered to be hypothyroid and were started on thyroxine replacement therapy. Such replacement treatment was withdrawn at a median age of 6.5 months (range 5-8 months). Urinary iodine concentration on the last day of povidone-iodine exposure was several times higher (P < 0.001) than that in the control group of healthy infants.. Transient hypothyroidism was found in four of 20 infants with DSC who were exposed to povidone-iodine. It is suggested to monitor TSH level in these patients, optimally at 4 weeks after closure of the sternum, when findings may show true hypothyroidism.

Topics: Administration, Cutaneous; Anti-Infective Agents, Local; Cardiac Surgical Procedures; Follow-Up Studies; Humans; Hypothyroidism; Infant; Iodine; Postoperative Complications; Povidone-Iodine; Prospective Studies; Sternum; Thyroid Gland; Thyroid Hormones; Wound Healing

Topics: Administration, Topical; Breast Feeding; Female; Humans; Hypothyroidism; Infant, Newborn; Maternal Behavior; Povidone-Iodine

Povidone-iodine (PVP-I) is generally very safe, but cases of thyroid dysfunction induced by PVP-I have been reported. The effect of long-term treatment with PVP-I on thyroid function was to be assessed. In 40 inpatients of the department of neurology, the status of the use of PVP-I preparations and their effects on serum inorganic iodine levels and thyroid functions were investigated. In 27 patients treated with PVP-I for a long term, inorganic iodine levels were significantly increased as compared to those in 13 patients without PVP-I treatment. Out of 27 patients treated with PVP-I in the long term, subclinical hypothroidism was seen in 3 patients, mild hyperthroidism was seen in 1 patient, and subclinical hyperthyroidism was suspected in 7 patients. Patients treated with PVP-I for a long time should be observed carefully for any manifestation of thyroid dysfunction.

Topics: Amyotrophic Lateral Sclerosis; Anti-Infective Agents, Local; Catheterization, Central Venous; Female; Gastrostomy; Humans; Hyperthyroidism; Hypothyroidism; Iodine; Iodophors; Longitudinal Studies; Male; Middle Aged; Nasal Mucosa; Parenteral Nutrition; Povidone-Iodine; Safety; Skin Ulcer; Spinocerebellar Degenerations; Thyroid Gland; Thyrotropin; Thyroxine; Tracheotomy; Triiodothyronine; Urethra

To determine whether skin care practices with iodine-containing disinfectants are putting patients in the neonatal intensive care unit at risk for primary hypothyroidism. Cutaneous exposure to povidone-iodine antiseptic solutions may be a cause of primary hypothyroidism in neonates.. Prospective pilot study.. Level III neonatal intensive care unit of a university-affiliated hospital.. Sequential sample of 47 medial and surgical patients admitted to the neonatal intensive care unit who received cutaneous povidone-iodine applications in preparation for invasive or surgical procedures.. Seven to 10 days after iodine exposure, capillary blood samples were obtained on filter paper blots for thyroid function testing and urine samples were collected to determine quantitative iodine concentrations. A plasma creatinine level was determined for each subject.. A total of 47 patients were enrolled. The gestational ages of subjects ranged from 26 to 41 weeks (mean, 33.6 weeks); the male-to-female ratio was 28:19; and the birth weights ranged from 0.7 to 5.1 kg(mean, 2.42 kg). The thyroxine level ranged from 20 to 187 nmol/L (1.6 to 14.6 micrograms/dL) (mean, 102 nmol/L [7.9 micrograms/dL];reference, > or = 90 nmol/L [> or = 7 micrograms/dL]; and the thyrotropin level ranged from 0.1 to 16.5 mU/L (mean, 6.4 mU/L; reference, < 20 mU/L). The mean uridine iodine concentration was 2798.0 micrograms/dL (reference, < 40 micrograms/dL), and the mean plasma creatinine level was 60 mumol/L (0.69 mg/dL) (reference, < or = 50 mumol/L [ < or = 0.6 mg/dL] for males and < or = 40 mumol/L [ < or = 0.5 mg/dL] for females).. There was no documentation of primary hypothyroidism in our subjects despite elevated urine iodine levels. While it is still possible that patients who receive long-term iodine exposure in other settings (eg, cardiac catheterization) are at risk for primary hypothyroidism, our study suggests that the amount of iodine absorbed through routine neonatal intensive care unit procedures does not substantially alter thyroid function during the first 10 days of life. An important confounding variable is that seven patients were receiving dopamine hydrochloride infusions and four were receiving dexamethasone phosphate at the time of sample collection. We therefore cannot rule out the possibility that these medications masked a thyrotropin level elevation that would have occurred in a primary hypothyroid state. We discuss implications for the interpretation of the results of neonatal thyroid function tests.

Topics: Administration, Cutaneous; Anti-Infective Agents, Local; Confounding Factors, Epidemiologic; Female; Humans; Hypothyroidism; Infant, Newborn; Intensive Care Units, Neonatal; Male; Pilot Projects; Povidone-Iodine; Prospective Studies; Skin Care

Out of 1346 newborns screened for congenital hypothyroidism, 31 non-hypothyroid infants were summoned because of a thyroid stimulating hormone (TSH) level above 10 microU/ml. False-positive TSH levels were significantly more frequent in the babies treated with povidone-iodine (4.6%) than in those treated with either alcohol or triple dye (0.7%). CONCLUSION. Iodine containing solutions should be avoided in umbilical cord care of the newborn.

Topics: Humans; Hypothyroidism; Infant, Newborn; Neonatal Screening; Povidone-Iodine; Prospective Studies; Thyrotropin; Umbilical Cord

Four infants with spina bifida, who had not undergone surgical closure of a lumbar myelomeningocele, were assessed and investigated for hypothyroidism. From birth, all were treated once daily with an iodine-containing ointment (Betadine) as a local antiseptic applied to the spina defect. All infants showed excess urinary iodine concentration. Two infants, without clinical evidence of hypothyroidism or goitre, showed low serum free thyroxine and high thyroid stimulating hormone concentrations at a mean age of four weeks and were started on thyroxine replacement treatment. Betadine ointment and thyroxine were stopped simultaneously at a mean age of nine months, following which all infants remained euthyroid. Thyroid function tests should be monitored routinely if iodine is applied as a topical antiseptic to infants.

Topics: Administration, Topical; Bandages; Female; Humans; Hypothyroidism; Incidence; Infant; Iodine; Male; Povidone-Iodine; Prospective Studies; Referral and Consultation; Risk Factors; Spinal Dysraphism; Thyrotropin; Thyroxine

Topics: Catheters, Indwelling; Child, Preschool; Female; Humans; Hypothyroidism; Infant; Male; Peritoneal Dialysis, Continuous Ambulatory; Povidone; Povidone-Iodine; Thyroid Function Tests

The skin absorption of iodine products in neonates with inhibition of thyroid function has been documented in the past. The use of Povidone-Iodine is the most frequent cause of this type of intoxication. Three neonates in which Povidone-Iodine was used during and after surgery had hypothyroidism secondary to glandular inhibition. They were discovered during the routine Programme for Neonatal Metabolic Diseases and were treated as deficits persists on retesting at 14 days of age. Treatment was maintained during one year, and the follow up controls of TSH-T4 were normal. During the neonatal period the use of Iodine containing antiseptics should be avoided because the potential risk of intoxication and glandular inhibition.

Topics: Female; Humans; Hypothyroidism; Infant, Newborn; Male; Povidone-Iodine; Thyrotropin; Thyroxine

Between May 1977 and December 1986, the Victorian Thyroid Screening Programme tested approximately 570,000 newborns for congenital hypothyroidism. One hundred and sixty-six cases of primary hypothyroidism, confirmed by formal thyroid function tests, were identified, of which 24 were later found to be transient. In addition, there were two patients with permanent dyshormonogenesis who passed through a stage of being biochemically euthyroid and so could have been diagnosed mistakenly as transient hypothyroidism. Fourteen of the transient cases were due to excessive intake of iodine. In two, this was due to maternal ingestion of iodide during pregnancy and in 12 the babies received large amounts of topical iodine antiseptic. Two cases were caused by maternal anti-thyroid antibodies and in eight instances the cause was unknown. The large number of cases due to the topical application of iodine antiseptic emphasizes the need for caution when using this substance in neonates.

Topics: Female; Humans; Hypothyroidism; Immunoglobulin G; Immunoglobulins, Thyroid-Stimulating; Infant, Newborn; Iodine; Male; Mass Screening; Povidone-Iodine; Pregnancy; Prenatal Exposure Delayed Effects; Victoria

Topics: Humans; Hypothyroidism; Infant, Newborn; Povidone; Povidone-Iodine; Thyrotropin; Thyroxine

Topics: Drug Administration Schedule; Female; Humans; Hypothyroidism; Povidone; Povidone-Iodine; Pregnancy; Umbilical Cord

Skin disinfection with povidine-iodine (PVP-I) is widely used in obstetrics. We evaluated the influence of PVP-I in mothers at delivery on the serum thyroid stimulating hormone concentrations of their infants at the time of screening for congenital hypothyroidism. The study covered 4745 infants who were either breast fed (3659, 77%) or bottle fed (1086, 23%); 3086 (65%) of them were born to mothers with no iodine overload (controls) and 1659 (35%) to mothers with iodine overload. Compared with the control group, the breast and bottle fed infants born to mothers with iodide overload had a shift of neonatal thyroid stimulating hormone concentration towards high values. The shift was maximal in the breast fed infants with a 25 to 30 fold increase in the recall rate at screening for congenital hypothyroidism (serum thyroid stimulating hormone greater than 50 mU/l) while in the bottle fed infants, the recall rate was barely modified. In conclusion, the use of PVP-I in mothers at delivery induces a transient impairment of thyroid function in their infants, especially if breast fed. This situation is detrimental to screening for congenital hypothyroidism. Consequently PVP-I is not recommended in obstetrics.

Topics: Breast Feeding; Congenital Hypothyroidism; Delivery, Obstetric; Disinfection; False Positive Reactions; Female; Humans; Hypothyroidism; Infant, Newborn; Mass Screening; Povidone; Povidone-Iodine; Skin Absorption; Thyrotropin

A case of physiologic hypothyroidism caused by the topical application of povidone-iodine (PVPI) in a newborn with an omphalocele is presented. The literature on systemic absorption and effects of PVPI is reviewed. A management strategy is offered.

Topics: Administration, Cutaneous; Hernia, Umbilical; Humans; Hypothyroidism; Infant, Newborn; Male; Povidone; Povidone-Iodine

Povidone-iodine is frequently used as an antiseptic in patients on chronic dialysis. In order to determine if the use of povidone-iodine affects thyroid function in these patients, we measured serum iodine and thyroid hormone levels in dialysis patients prior to and following discontinuation of topical povidone-iodine antiseptics. Serum inorganic iodine levels were elevated initially in nearly 90% of the patients (19 on hemodialysis, 12 on continuous ambulatory peritoneal dialysis [CAPD]). Following discontinuation of povidone-iodine, iodine levels over a 3-month period decreased modestly in patients on CAPD (n = 5) and were unchanged in patients on hemodialysis (n = 5). Total and free thyroxine levels were frequently low but did not correlate with protein-bound or inorganic iodine levels and did not change after discontinuation of povidone-iodine. Thyrotropin levels correlated significantly (r = .62, P less than .01) with inorganic iodine levels in patients on hemodialysis, but not for patients on CAPD. We conclude that abnormal thyroid function tests are common in dialysis patients but are not related to iodine retention or to the routine use of topical povidone-iodine-containing antiseptics.

Topics: Adult; Aged; Female; Humans; Hypothyroidism; Iodine; Kidney Diseases; Male; Middle Aged; Peritoneal Dialysis, Continuous Ambulatory; Povidone; Povidone-Iodine; Renal Dialysis; Thyroid Function Tests; Thyroid Hormones; Thyrotropin; Thyroxine

The improvement in infusion therapy of burn patients in the last decades has led to a marked reduction of the early mortality rate and to an increase in the importance of severe wound infection and septicaemia. For the control of infection, detailed bacteriological monitoring is recommended. The main therapeutic fields for prevention of infection are: immunotherapy, antisepsis, aseptic techniques, and rapid restoration of the destroyed body surface. The most important part of antisepsis in burns is topical treatment. The good bacteriological and clinical results with povidone-iodine (PVP-I), in combination with open treatment are described. A possible disadvantage of this therapy was the extensive iodine resorption. However, no disorders of thyroid function were revealed, and the TRH test indicated no abnormal reactions of the hypothalamus-pituitary axis. The high serum and urine iodine levels returned rapidly to normal after discontinuing the PVP-I application.

Topics: Adolescent; Adult; Aged; Anti-Infective Agents, Local; Bacterial Infections; Burns; Humans; Hypothyroidism; Iodine; Middle Aged; Povidone; Povidone-Iodine; Silver Sulfadiazine; Time Factors

Topics: Alcohols; Female; Hernia, Umbilical; Humans; Hypothyroidism; Infant, Newborn; Povidone; Povidone-Iodine; Thyroid Function Tests

Topics: Humans; Hypothyroidism; Infant, Newborn; Male; Povidone-Iodine; Syndrome; Thyroid Gland

Topics: Disinfection; Female; Humans; Hypothyroidism; Infant, Newborn; Infant, Newborn, Diseases; Infant, Premature, Diseases; Male; Povidone; Povidone-Iodine; Preoperative Care; Prospective Studies; Sterilization; Thyrotropin; Thyroxine

Topics: Aged; Humans; Hypothyroidism; Male; Middle Aged; Peritoneal Dialysis; Peritoneal Dialysis, Continuous Ambulatory; Povidone-Iodine; Thyroid Hormones

Topics: Female; Hernia, Umbilical; Humans; Hypothyroidism; Infant, Newborn; Infant, Newborn, Diseases; Povidone; Povidone-Iodine; Thyroid Gland

While screening 30 000 children for congenital hypothyroidism by radioimmunological determination of thyroid stimulating hormone (TSH) in blood spotted on filter paper on the 5th day of life, 12 neonates were found with this condition. In addition 99 infants were found who showed temporarily elevated TSH levels (20-80 microU/ml). Seven of the transitory cases could be traced to a vaginal application of povidone-iodine in the mother. Alimentary iodine deficiency, which is known to exist in parts of Lower Saxony, may be another explanation for some of the others.

Topics: Congenital Hypothyroidism; Female; Humans; Hypothyroidism; Infant, Newborn; Infant, Newborn, Diseases; Iodine; Maternal-Fetal Exchange; Povidone-Iodine; Pregnancy; Surveys and Questionnaires; Thyrotropin

In 12 nonpregnant women, total iodine, protein-bound iodine, inorganic iodine, and thyroxine values were measured in serum before and 15, 30, 45 or 60 minutes after a two-minute vaginal disinfection with povidone-iodine (Betadine). Only 15 minutes after application, serum iodine levels were raised and remained significantly elevated 30, 45 and 60 minutes after disinfection. Serum concentrations of total iodine and inorganic iodine were increased up to fivefold to 15-fold, respectively; during the relative short period of observation, thyroxine levels were not altered. An overload of iodine can suppress thyroid hormonogenesis, and the fetal and neonatal thyroid glands are especially sensitive. In pregnant women, vaginitis should not be treated with povidone-iodine because of the possible development of iodine-induced goiter and hypothyroidism in the fetus and newborn. The risk is especially high when povidone-iodine is used repeatedly.

Topics: Absorption; Female; Fetal Diseases; Fetus; Goiter; Humans; Hypothyroidism; Infant, Newborn; Maternal-Fetal Exchange; Povidone; Povidone-Iodine; Pregnancy; Vagina

Severe iodine-induced hypothyroidism was recently diagnosed in several neonates raising the responsibility of the iodine antiseptic agents routinely used in these patients. Postnatal iodine overload due to cutaneous application of these agents (povidone iodine and fluorescinated alcoholic-iodine solution) was studied in 5 patients. Thyroid function studies were performed in iodine-overload neonates and in control neonates with comparable gestional age. Results indicated strong evidence of cutaneous absorption of iodine from the antiseptic agents used, leading to hypothyroidism in 12 of them. The frequency and the severity of thyroid dysfunction was closely related to the degree of prematurity. Full recovery was observed in all cases after withdrawal of the iodine-containing agents. It is therefore recommended to avoid any postnatal use of iodine preparations in neonates, mainly in preterm infants, and to use iodine antiseptic agents with great caution, when necessary during the neonatal period.

Topics: Anti-Infective Agents, Local; Benzalkonium Compounds; Female; Gestational Age; Humans; Hypothyroidism; Infant; Infant, Newborn; Infant, Newborn, Diseases; Infant, Premature; Iodine; Male; Povidone-Iodine; Retrospective Studies; Thyroid Function Tests

Topics: Adult; Female; Goiter; Humans; Hypothyroidism; Iodine; Povidone-Iodine