88 Chapter 5 Thyroid dysfunction Table 2 shows four cohort studies and four case reports/series on maternal thyroid function after HSG with the use of oil-based contrast. Three cases of fetal goitre following an HSG with oil-based contrast were reported. In two of the cases the HSG had been performed in the month of conception (10 ml of Lipiodol and an unknown volume of unspecified oil-based contrast was used); in the third case three HSGs had been performed in the year before conception. In one case intra-amniotic levothyroxine was administered as treatment. After birth, hypothyroidism was diagnosed in one of the newborns, which resolved by day 7. The other neonates were euthyroid. One of the mothers had hypothyroidism during pregnancy; two were euthyroid. In one of the mothers, oil remnants were present in the abdominal cavity on a post-partum X-ray (81, 93, 116). One retrospective cohort study (94) from Japan evaluated the neonatal thyroid function after HSG with the use of Lipiodol. Abnormal congenital thyroid screening was seen in 2.4% (5/212); three cases of subclinical hypothyroidism and two cases of overt hypothyroidism. The median volume of contrast in the group with thyroid dysfunction was significantly higher than the group with normal thyroid function (20 ml [range 10–20 ml] versus 8 ml [range 3–25 ml], P = 0.033). However, the volume was only reported for three out of five neonates with abnormal thyroid function test results. Another retrospective cohort study investigated the thyroid function of 140 neonates born after a preconceptional HSG with oil-based contrast, Lipiodol Ultra Fluid (n = 76) or water-based contrast, Telebrix Hystero® (n = 64). None of the neonates tested positive during the congenital hypothyroidism screening. Furthermore, the volume of contrast used did not influence the thyroid function (median of 9.0 ml of oil-based contrast) (108).
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