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Accelerated Thyrotoxicosis Induced by Iodinated Contrast Media in Metastatic Differentiated Thyroid Carcinoma

Division of Nuclear Medicine, Department of Radiology, and Division of Endocrinology, Department of Medicine, Mount Sinai School of Medicine, New York, New York

Correspondence: For correspondence or reprints contact: Mordechai Lorberboym, MD, Department of Nuclear Medicine, Mount Sinai Medical Center, One Gustave L. Levy PI., New York, NY 10029.

ABSTRACT

A 67-yr-old woman who underwent total thyroidectomy 32 yr ago developed accelerated hyperthyroidism after injection of iodinated contrast media to evaluate a left hemipelvis mass. The patient was managed with propylthiouracil, beta-blockers and digoxin. Whole-body ²⁰¹Tl and ¹³¹I scans demonstrated a functioning metastasis in the left hemipelvis where biopsy revealed a well differentiated follicular thyroid carcinoma. Palliative external beam radiotherapy was administered. The patient then received radioiodine treatment with granulocyte colony-stimulating factor to minimize bone marrow toxicity. Clinically significant thyrotoxicosis occurring in metastatic thyroid carcinoma is rare and results from abnormal ectopic thyroidal tissue iodine metabolism. Iodide-containing medications and contrast media should be avoided in patients with functioning thyroid metastases to prevent abrupt increases in circulating thyroid hormone levels.

Key Words: thyroid carcinoma • thyrotoxicosis • granulocyte colony-stimulating factor

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