Effects of Iodinated Contrast-enhanced CT on Urinary Iodine Levels in
Postoperative Patients with Differentiated Thyroid Cancer
Authors: Fang Shengwei , Han Suyang , Zhang Peipei , Zhao Chunlei 
Published: May 2024

Aims:
This study aims to observe the fluctuating urine iodine levels in patients with differentiated thyroid cancer (DTC) following iodinated contrastenhanced
computed tomography (eCT) scans.

Background:
The presence of iodine in iodinated contrast agents (ICAs) can impede the effectiveness of radioactive iodine treatment (RAIT) and diagnostic
scans in individuals diagnosed with DTC, as it can engage in competitive interactions with 131I. According to established guidelines, it is
recommended to postpone RAIT for a period of three to four months in individuals who have had prior exposure to ICAS. The measurement of
spot urine iodine concentration is a valuable indicator for assessing the overall iodine content throughout the body.

Objective:
The objective is to identify the optimal timing for administering postoperative RAIT in DTC patients.

Methods:
At various time points after surgery, a cohort of 467 random urine samples (126 male samples, 341 female samples, age (45±12 years)) was
obtained from 269 DTC patients. The samples were analyzed for urinary iodine and urinary creatinine levels, and the urinary iodine/urine
creatinine ratio (I/Cr) was computed. All samples were divided into two groups according to whether eCT before operation: the non-enhanced CT
(eCT-) group and the enhanced CT (eCT+) group. The urine samples in the eCT- group were categorized into four subgroups according to the
duration of strict low iodine diet (LID): (eCT-I+) no LID; (eCT-I-2W) 2 weeks of LID; (eCT-I-4W) 4 weeks of LID; and (eCT-I-6W) 6 weeks of
LID. The last three groups were merged into the eCT- and effective LID group (eCT- I-). The urine samples from the eCT+ group were categorized
into five subgroups: (0.5M eCT+)0.5 month after eCT+; (1M eCT+)1 month after eCT+; (2M eCT+) 2 months after eCT+; (3M eCT+) 3 months
after eCT+; (≥4M eCT+) ≥4 months after eCT+. In addition, the patients within 2 months after eCT+ were divided into 2 groups according to their
LID: no effective LID group (eCT+ I+) and effective LID group (eCT+ I-). Utilizing the Kruskal-Wallis and Mann-Whitney U rank sum tests, the
differences in I/Cr between groups were compared.

Results:
In the eCT-group, the I/Cr ratios of eCT-I-2W, eCT-I-4W, and eCT-I-6W were significantly lower than those of eCT-I+ (χ2 values: 4.607.99, all P
0.05). However, there was no significant difference in I/Cr between eCT-I-2W, eCT- I-4W, and eCT-I-6W (2 values: 0.591.31, all P > 0.05).
Significantly higher I/Cr values were observed in 0.5M eCT+ and 1M eCT+ than in eCT-I+ (χ2 values: 3.22 and 2.18, respectively, all P<0.05).
There was no significant difference in I/Cr between 2M eCT+ and eCT-I+ (χ2 = 0.76, P = 0.447). The I/Cr rations of 3M eCT+, ≥4M eCT+ were
not significantly different with eCT-I- (χ2 values: 1.76; 0.58; all P > 0.05). However, they were considerably lower than eCT-I+ (χ2 values: 7.03;
5.22; all P<0.05). The I/Cr for patients who underwent eCT within two months (eCT+ I-, eCT+ I+) did not differ significantly (χ2 = 1.79, P =
0.073).

Conclusion:
For patients who are considering receiving radioactive iodine therapy (RAIT) following a diagnosis of differentiated thyroid cancer (DTC), it is
recommended that the interval between RAIT treatment and enhanced computed tomography [eCT] scans be conducted at least three months.