JOD-BASEDOW PHENOMENON: PHENOMENAL THYROTOXICOSIS?
Deucalione iodine is an essential mineral vital for the optimal function of the thyroid gland in human beings. Apart from being found in a variety of foods, it is a component of various medications, amiodarone and expectorants, iodine-based swabs used for skin cleaning before interventional and surgical procedures, and iodinated contrast media in medical settings. Jod-Basedow Phenomenon, also known as Jod-Basedow Syndrome or iodine-induced thyrotoxicosis, is a rare cause of thyrotoxicosis that characteristically refers to a paradoxical phenomenon in which large loads of exogenous iodine can cause hyperthyroidism. This phenomenon is mainly seen in populations already at risk for thyroid diseases, such as autoimmune thyroid diseases, prior thyroid surgical history, latent Graves' disease, and prior non-toxic diffuse or nodular goiter formation, or those with underlying kidney disease, such as chronic kidney disease and end-stage renal disorders, which can impact iodine excretion. Typically, it is recognized in those with the administration of a large iodine load, dietary supplement, iodinated contrast media used in conjunction with computed tomography scans, angiography, and various other imaging studies, iodinated antiseptic solutions and oral supplements, or a medication, mainly amiodarone, class III antiarrhythmic drug used in the treatment of recurrent severe ventricular arrhythmias, paroxysmal atrial tachycardia, atrial fibrillation and maintenance of sinus rhythm after cardioversion of atrial fibrillation. Prophylactic medical management of the phenomenon may include antithyroid drugs, methimazole, or perchlorate, to be considered for patients at risk for developing iodine-induced thyrotoxicosis that is scheduled for radio imaging modalities by using iodinated contrast media. Moreover, the preliminary management modality comprises cessation of iodine administration, avoiding further exposure, administration of beta-adrenergic antagonists, thionamides, corticosteroids, and rarely lithium. Prognosis is usually favorable, although a small percentage of cases could suffer permanent sequelae from iodine-induced thyrotoxicosis. Nevertheless, complications are remarkable including thyroid storm, permanent hyperthyroidism, atrial fibrillation, and fetal hypothyroidism with goiter development, in terms of ordering iodinated contrast media in pregnants. Jod-Basedow Phenomenon should not be overlooked and should be managed by an interprofessional healthcare team serving and officiating not only to treat it but also to concern themselves, actively in the relevant prophylaxis.
El-Shirbiny AM, Stavrou SS, Dnistrian A, Sonenberg M, Larson SM, Divgi CR. Jod-Basedow syndrome following oral administration of iodine and radioiodinated antibodies. J Nucl Med. 1997;38(11):1816–7.
Rose HR, Zulfiqar H. Jod Basedow Syndrome. In: StatPearls. StatPearls Publishing, Treasure Island (FL); 2021.
Sengul I, Sengul D, Pelikán A. Iodine-induced hyperthyroidism: Do you mind? Sanamed. 2020;15(2):215-7. doi: 10.24125/sanamed.v15i2.458
Andreucci M, Solomon R, Tasanarong A. Side effects of radiographic contrast media: pathogenesis, risk factors, and prevention. Biomed Res Int. 2014;2014:741018. doi: 10.1155/2014/741018.
Lee SY, Rhee CM, Leung AM, Braverman LE, Brent GA, Pearce EN. A review: Radiographic iodinated contrast media-induced thyroid dysfunction. J Clin Endocrinol Metab. 2015;100(2):376-83. doi: 10.1210/jc.2014-3292.
Wolf J, Chaikoff IL. Plasma inorganic iodide as a homeostatic regulator of thyroid function. J Biol Chem. 1948;174(2):555-64.
Galton VA, Pitt-Rivers R. The effect of excessive iodine on the thyroid of the rat. Endocrinology. 1959; 64(5):835-9. doi: 10.1210/endo-64-5-835.
Nagataki S, Ingbar SH. Relation between qualitative and quantitative alterations in thyroid hormone synthesis induced by varying doses of iodide. Endocrinology. 1964;74:731-6. doi: 10.1210/endo-74-5-731.
Dai G, Levy O, Carrasco N. Cloning and characterization of the thyroid iodide transporter. Nature. 1996;379(6564):458-60. doi: 10.1038/379458a0.
Eng PH, Cardona GR, Fang SL, Previti M, Alex S, Carrasco N, et al. Escape from the acute Wolff-Chaikoff effect is associated with a decrease in thyroid sodium/iodide symporter messenger ribonucleic acid and protein. Endocrinology. 1999;140(8):3404-10. doi: 10.1210/endo.140.8.6893.
Saberi M, Utiger RD. Augmentation of thyrotropin responses to thyrotropin-releasing hormone following small decreases in serum thyroid hormone concentrations. J Clin Endocrinol Metab. 1975;40(3):435-41. doi: 10.1210/jcem-40-3-435.
Markou KB, Paraskevopoulou P, Karaiskos KS, Makri M, Georgopoulos NA, Iconomou G, et al. Hyperthyrotropinemia during iodide administration in normal children and in children born with neonatal transient hypothyroidism. J Clin Endocrinol Metab. 2003;88(2):617-21. doi: 10.1210/jc.2002-020681.
Braverman LE. Iodine and the thyroid: 33 years of study. Thyroid. 1994;4(3):351-6. doi: 10.1089/thy.1994.4.351.
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. doi: 10.1089/1050725041517075.
Ordene KW, Pan C, Barzel US, Surks MI. Variable thyrotropin response to thyrotropin-releasing hormone after small decreases in plasma thyroid hormone concentrations in patients of advanced age. Metabolism. 1983;32(9):881-8. doi: 10.1016/0026-0495(83)90201-9.
Roti E, Uberti ED. Iodine excess and hyperthyroidism. Thyroid. 2001;11(5):493-500. doi: 10.1089/105072501300176453.
Stanbury JB, Ermans AE, Bourdoux P, Todd C, Oken E, Tonglet R, et al. Iodine-induced hyperthyroidism: occurrence and epidemiology. Thyroid. 1998;8(1):83-100. doi: 10.1089/thy.1998.8.83.
Skare S, Frey HM. Iodine induced thyrotoxicosis in apparently normal thyroid glands. Acta Endocrinol (Copenh). 1980;94(3):332-6. doi: 10.1530/acta.0.0940332.
Fricke E, Fricke H, Esdorn E, Kammeier A, Lindner O, Kleesiek K, et al. Scintigraphy for risk stratification of iodine-induced thyrotoxicosis in patients receiving contrast agent for coronary angiography: a prospective study of patients with low thyrotropin. J Clin Endocrinol Metab. 2004;89(12):6092-6. doi: 10.1210/jc.2004-0728.
Burman KD, Wartofsky L. Iodine effects on the thyroid gland: biochemical and clinical aspects. Rev Endocr Metab Disord. 2000;1(1-2):19-25. doi: 10.1023/a:1010004218052.
Higgs M, Hull E, Lujan E. A case report of post-operative Jöd-Basedow Phenomenon following oral and iv iodine contrast administration. Case Rep Endocrinol. 2014;2014:980283. doi: 10.1155/2014/980283.
Adler J, Colegrove DJ. Contrast-induced thyrotoxicosis in a patient with new-onset atrial fibrillation: a case report and review. J Atr Fibrillation. 2013;6(1):379. doi: 10.4022/jafib.379.
Azizi F, Daftarian N. Side-effects of iodized oil administration in patients with simple goiter. J Endocrinol Invest. 2001;24(2):72-7. doi: 10.1007/BF03343816.
Tonacchera M, Agretti P, Chiovato L, Rosellini V, Ceccarini G, Perri A, et al. Activating thyrotropin receptor mutations are present in non adenomatous hyperfunctioning nodules of toxic or autonomous multinodular goiter. J Clin Endocrinol Metab. 2000;85(6): 2270-4. doi: 10.1210/jcem.85.6.6634.
Mirmiran P, Kimiagar M, Azizi F. Three-year survey of effects of iodized oil injection in schoolchildren with iodine deficiency disorders. Exp Clin Endocrinol Diabetes. 2002;110(8):393-7. doi: 10.1055/s-2002-36425.
Henry RK,Chaudhari M. In iodine-induced thyrotoxicosis, steroid therapy today could keep the surgical knife at bay. J Pediatr Endocrinol Metab. 2018;31(5):585-8. doi: 10.1515/jpem-2017-0485.
Martino E, Bartalena L, Bogazzi F, Braverman LE. The effects of amiodarone on the thyroid. Endocr Rev. 2001;22(2):240-54. doi: 10.1210/edrv.22.2.0427.
Sengul I, Sengul D. Delicate needle with the finest gauge for a butterfly gland, the thyroid: Is it worth mentioning? Sanamed. 2021;16(2):173-4. doi: 10.24125/sanamed.v16i2.515.
Sengul D, Sengul I, Pelikán A. Paraphrase for the impact of repeat fine-needle aspiration in thyroid nodules categorized as atypia of undetermined significance or follicular lesion of undetermined significance: A single-center experience. Diagn Cytopathol. 2021;49(3):452-3. doi: 10.1002/dc.24685.
Sengul I, Sengul D. Focusing on thyroid nodules in suspense: 10-15 mm with repeat cytology, Category III, the Bethesda System for Reporting Thyroid Cytopathology, TBSRTC. Rev Assoc Med Bras (1992). 2021;67(2):166-7. doi: 10.1590/1806-9282.67.02.20200828.
Sengul D, Sengul I, Van Slycke S. Risk stratification of the thyroid nodule with Bethesda indeterminate cytology, category III, IV, V on the one surgeon-performed US-guided fine-needle aspiration with a 27-gauge needle, verified by histopathology of thyroidectomy: the additional value of one surgeon-performed elastography. Acta Chir Belg. 2019;119(1):38-46. doi: 10.1080/00015458.2018.1551769.
Sengul I, Sengul D. Blurred lines for management of thyroid nodules in the era of AUS/FLUS: Novel subdivisions of Category IIIA and IIIB in a possible forthcoming TBSRTC, 3rd ed.; amending vs. unnecessary? Rev Assoc Med Bras (1992). 2021;67(10):1385-6. doi: 10.1590/1806-9282.20210763.
Sengul D, Sengul I. A closer look at the size cutoff of 10 mm, under 10 mm in particular, in Thyroidology: Debate is still ongoing. Rev Assoc Med Bras (1992). 2021;67(11):1523-4. doi: 10.1590/1806-9282.20210856.
Sengul D, Sengul I. Reassessing combining real-time elastography with fine-needle aspiration biopsy to identify malignant thyroid nodules. Am J Med Case Rep. 2021;9(11):552-3. doi: 10.12691/ajmcr-9-11-9
Sengul D, Sengul I. Comments: Effect of the location and size of thyroid nodules on the diagnostic performance of ultrasound elastography: A retrospective analysis. Clinics (São Paulo). 2021;76:e2891. doi: 10.6061/clinics/2021/e2891.
Sengul I, Sengul D. Notes on "elastography for the diagnosis of high-suspicion thyroid nodules based on the 2015 American Thyroid Association guidelines: a multicenter study". North Clin Istanb. 2021;8(1):109-10. doi: 10.14744/nci.2020.74240.
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