Session: SUN 596-623-Case Reports: Pediatric Endocrinology & Metabolism
Poster Board SUN-622
Case 1: A full-term infant with CHD who had a normal NBS TSH received 6.2 mL/kg of Optiray 350 (6,900 mg iodine) for cardiac catheterization on day 3 of life. Subsequent serum thyroid function tests: TSH 18.1 mIU/L (1.7-9.1), TT4 4.1 µg/dL (>5) [day 12]; TSH 63.7 mIU/L, TT4 3.2 µg/dL [day 20]; TSH 175 mIU/L, FT4 0.3 ng/dL (0.9-2.3) [day 25]. Day 25 blood spot filter paper iodine was elevated to 0.020 µg (<0.01) and spot urine iodine to 835 µg/L (150-220). Thyroid hormone replacement (12 µg/kg/d) was initiated on day 26; the infant continues to receive thyroid replacement therapy.
Case 2: A full-term infant with CHD who had a normal NBS TSH underwent cardiac catheterizations on days 2 and 3 of life, with a cumulative Optiray 350 dose of 9.7 mL/kg (10,900 mg iodine). On day 13, TSH was 42.7 mIU/L and FT4 was 1.44 ng/dL. Serum iodine was markedly elevated to 888 ng/mL (40-92), spot filter paper blood iodine to 0.085 µg (<0.01), and spot urine iodine to 2,664 µg/L (150-220). Thyroid replacement therapy (12 µg/kg/d) was initiated and thyroid function normalized by day 23, after which the infant began to wean off therapy.
Case 3: A full-term infant with CHD who had a normal NBS TSH underwent cardiac catheterization with 5.6 mL/kg of Optiray 350 (5,500 mg iodine) on day 17 of life. Serum TSH was 30.1 mIU/L, TT4 12.3 µg/dL, and spot urine iodine 13,827 µg/L (day 31). Thyroid function normalized on day 45 without treatment.
All 3 infants had left-sided structural heart disease. There was no history of maternal thyroid dysfunction, excess iodine ingestion, or exposure to iodine-containing antiseptics.
Conclusion: Iodine excess from iodinated contrast use during cardiac catheterization can result in hypothyroidism in neonates with CHD. Thyroid function should be routinely monitored in infants undergoing such procedures during this critical period of early development.
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