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Kidney Week

Abstract: TH-PO778

A Case Series of Iodine-Induced Hypothyroidism in Children on Peritoneal Dialysis

Session Information

  • Pediatric CKD
    November 07, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
    Abstract Time: 10:00 AM - 12:00 PM

Category: Pediatric Nephrology

  • 1700 Pediatric Nephrology

Authors

  • Mannemuddhu, Sai Sudha, University of Florida. College of Medicine., Gainesville, Florida, United States
  • Morgans, Heather, Children''s Mercy Hospital, Kansas City, Missouri, United States
  • Tufan pekkucuksen, Naile, University of Florida, Gainesville, Florida, United States
  • Warady, Bradley A., Children's Mercy Kansas City, Kansas City, Missouri, United States
  • Shoemaker, Lawrence R., University of Florida, Gainesville, Florida, United States
Background

Young patients with end-stage renal disease who receive chronic peritoneal dialysis (CPD) are at increased risk for thyroid dysfunction. An extremely rare cause of thyroid dysfunction in these patients is iodine exposure. We report four patients who received CPD and developed Iodine overload and secondary hypothyroidism.

Methods

case series

Results

The 4 children, 3 weeks to 3.5 years of age, were cared for in two academic institutions in 2017-2019. Three patients were on automated cycler PD and one received manual flushes over a week and was on continuous PD. PD fill volumes ranged from 160 to 880 mL/m2 BSA. They had normal baseline thyroid stimulating hormone (TSH) levels or normal newborn screens. They were on PD for periods of 1 week to 27 months, with median age of 6 months at presentation. 3 out of 4 patients had high TSH values ranging from 15-875 mIU/L, 2 of the 4 had a low free T4 from 0.2- 0.21 ng/dL, and all 4 had high serum iodine levels: 222-557.5 mcg/L (normal: <100 mcg/L). In every case, a transfer set with betadine gauge was utilized as part of their PD procedure. One patient developed overt hypothyroidism and heart failure and one experienced growth failure, while the other two were asymptomatic. Two patients required temporary treatment with levothyroxine (2.5 months – 6 months).
Iodine levels decreased in all patients after switching them to continuous manual PD or by withdrawing the first 5 mL of iodine tinged fluid from the transfer set before connecting them to the PD cycler. Despite extensive investigation, no alternative sources of iodine exposure were detected.

Conclusion

Excessive iodine exposure and the potential for thyroid dysfunction, especially during infancy, is a poorly recognized complication of CPD. Increased awareness among nephrologists is needed so that prevention strategies and regular monitoring for this complication can be instituted.

Patient summary table. syringe and PD cap with iodine tinged fluid.