Iodine-induced hypothyroidism (IIH) in paediatric patients receiving peritoneal dialysis: Is risk mitigation possible?

Creator(s)

Sai Sudha Mannemuddhu
Heather A. Morgans, Children's Mercy HospitalFollow
Bradley A. Warady, Children's Mercy HospitalFollow

Document Type

Article

Publication Date

1-2024

Identifier

DOI: 10.1177/08968608231183853

Abstract

Children with kidney failure who receive maintenance peritoneal dialysis (PD) are at increased risk for thyroid dysfunction. A poorly appreciated cause of hypothyroidism related to PD is iodine overload from exposure to iodine-containing cleaning solutions, iodinated contrast agents or povidone-iodine-containing PD caps, particularly in infants and small children. An international survey was conducted to understand current practices regarding iodine exposure in PD patients, the frequency of iodine-induced hypothyroidism (IIH) in patients receiving PD, and to assess awareness of this issue among paediatric nephrologists. Eighty-nine paediatric nephrology centres responded to the survey. Hypothyroidism in PD patients was diagnosed in 64% (n = 57) of responding centres, although only 19 of these centres (33%) suspected or diagnosed IIH. Aetiologies of IIH included exposure to povidone-iodine-containing PD caps (53%), cleaning solutions with iodine (37%) and iodinated contrast (10%). While most centres (58%, n = 52) routinely evaluate thyroid function, only 34% (n = 30) specifically aim to limit iodine exposure. Of centres not routinely evaluating for or utilising methods to prevent iodine exposure and hypothyroidism, 81% reported being unaware of the risk of IIH in PD patients. Hypothyroidism is diagnosed in a substantial percentage of paediatric PD programmes internationally. Increased education on the risk of iodine exposure in children receiving PD may decrease the incidence of IIH as an aetiology of hypothyroidism.

Journal Title

Peritoneal dialysis international : journal of the International Society for Peritoneal Dialysis

Volume

44

Issue

1

First Page

73

Last Page

77

MeSH Keywords

Infant; Humans; Child; Povidone-Iodine; Peritoneal Dialysis; Hypothyroidism; Anti-Infective Agents, Local; Iodine; Contrast Media

Keywords

Hypothyroidism; iodine overload; paediatric nephrology; peritoneal dialysis

Recommended Citation

Mannemuddhu SS, Morgans HA, Warady BA. Iodine-induced hypothyroidism (IIH) in paediatric patients receiving peritoneal dialysis: Is risk mitigation possible?. Perit Dial Int. 2024;44(1):73-77. doi:10.1177/08968608231183853