sodium-perchlorate and Goiter--Nodular

Three patients with subclinical hyperthyroid goitre, women aged 63, 72 and 75 years following intravenous administration of an iodinated contrast medium developed hyperthyroidism with a marked rise of the concentration of free T4. Thyreostatic agents were unsuccessful in two patients, the third was left untreated. Hyperthyroidism improved spontaneously in all three. Iodine-induced hyperthyroidism is rare and is usually encountered in patients with a pre-existent autonomous thyroid function. Treatment of iodine-induced hyperthyroidism is essentially exclusively symptomatic. Prophylaxis with sodium perchlorate should be considered in cardiac patients with a goitre and a subnormal level of thyroid-stimulating hormone (TSH).

Topics: Aged; Antithyroid Agents; Contrast Media; Drug Hypersensitivity; Female; Goiter, Nodular; Humans; Hyperthyroidism; Iodine Compounds; Middle Aged; Perchlorates; Remission, Spontaneous; Sodium Compounds

A 78-year-old woman is presented with a multinodular toxic goiter and euthyroidism under continuous low-dose treatment with antithyroid drugs. A period of hyperthyroidism had been documented 3 years previously. In the preoperative management, prior to resection of a benign ovarian tumour, an intravenous urogram was performed. Perchlorate was given for thyroid protection. One day after surgery the clinical signs of thyroid storm were observed. Immediately, high-dose antithyroid drug therapy was started. Nevertheless, the patient died of acute cardiovascular failure 3 days later. This case report focuses on the risk of thyroid storm following iodine excess in the presence of relevant functional thyroid autonomy without adequate thyroid protection.

Topics: Aged; Cystadenoma; Fatal Outcome; Female; Goiter, Nodular; Humans; Hysterectomy; Iodine; Methimazole; Ovarian Neoplasms; Perchlorates; Postoperative Complications; Sodium Compounds; Thyroid Crisis; Thyroid Function Tests; Urography