Comparison and assessment of thyroid morphology and function in inhabitants of Lower Silesia before and after administration of a single dose of iodine-containing contrast agent during cardiac intervention procedure.

INTRODUCTION: Inhabitants living in areas with endemic dietary iodine intake deficiency develop nodular goitre. The aim of our study was to evaluate thyroid morphology and function among adults residing in Lower Silesia and to assess the effect on the thyroid gland of an iodine-based contrasting agent administered during a cardiac intervention procedure. MATERIALS AND METHODS: The first part of the study (evaluation of thyroid gland) was carried out on 120 subjects (78 men and 42 women). From among this group, invasive cardiac procedures were performed on 60 subjects (38 men and 22 women) during the second part of the study. Endocrine tests were repeated one, three, and six months after the invasive procedure. RESULTS: 1) Within the studied group, pathological changes in thyroid morphology were found in 49.1%, and thyroid function disturbances in 9.3%, of all subjects. 2) A decrease in TSH concentration with a corresponding increase in fT3 concentration was seen at the second visit (four weeks after iodine administration) leading to the diagnosis of hyperthyroidism in 15% of subjects. CONCLUSIONS: 1) Considering the multitude of silent thyroid pathologies, particular care is required before administering an iodine-based medium. 2) It is reasonable and advisable to monitor TSH and fT3 levels before and at four weeks after administration of an iodine-containing contrast agent. 3) Thyroid morphology and function disturbances after iodine administration do not necessitate treatment, as they are of transient character and only require monitoring.

Borderline coronary lesions may lead to serious coronary events--long-term outcome in 65 conservatively treated patients.

BACKGROUND: The choice of optimal therapy in a patient with borderline coronary lesion is difficult. The long-term outcome of conservatively treated patients has not yet been well defined. AIM: To analyse long-term outcome in patients with a borderline lesion in a single coronary artery who were selected for conservative treatment. METHODS: The study group consisted of 65 patients (mean age 59.4+/-7.4 years, 48 males) with (1) stable angina (CCS class I/II), (2) isolated single borderline coronary lesion (40-70% stenosis demonstrated by quantitative coronary angiography) and (3) no demonstrable ischaemia during non-invasive tests. Patients with heart failure, left ventricular ejection fraction <50% or acute coronary syndrome within 6 months preceding the study were not included. All patients were prescribed statins, angiotensin converting enzyme inhibitors and aspirin. Follow-up end-points included cardiac death, new myocardial infarction (MI) with or without ST segment elevation and revascularisation of the target coronary artery. RESULTS: The follow-up duration was 18.4+/-8.5 months (range 12-33, median 18 months). Forty nine (75%) patients remained free from angina during daily activity. Coronary events occurred in 16 (25%) patients, including three (5%) serious complications -- sudden death, new MI with ST elevation and new MI without ST elevation. The remaining 13 (20%) patients underwent percutaneous revascularisation of the target coronary artery. Coronary angiography was repeated in 16 (25%) patients. When the patients were divided into two groups according to the follow-up results (with or without coronary event), no differences in the clinical characteristics, lesion localisation and length or degree of stenosis were noted. CONCLUSIONS: (1) Conservatively treated patients with stable angina and borderline coronary stenosis have a high rate of coronary events, especially revascularisation, during a long-term follow-up. (2) Clinical parameters and quantitative coronary angiography do not identify those patients with borderline coronary lesions who are at increased risk of future coronary events.