Impact of Computed Tomography Scans on the Risk of Thyroid Disease in Minor Head Injury Patients: A Population-Based Retrospective Cohort Study

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Abstract

We investigated the association between head computed tomography (CT) scans and the risk of noncancer thyroid diseases in patients with minor head injury in a Taiwanese healthcare setting. For this retrospective population-based cohort study, the 2009–2013 Longitudinal Health Insurance Database was used to include patients with a minor head injury at admission or emergency visit between 2009 and 2013. Multivariate analysis with a multiple Cox regression model was applied to analyze the data. According to whether a CT scan was conducted within 14 days of admission, patients were divided into a CT scan group (n = 14,041) or a non-CT scan group (n = 34,684). No increased incidence of thyroid diseases was observed in the CT scan group regardless of the number of CT scans performed. The incidence rate ratio for one scan was 1.10 (95% confidence interval: 0.94–1.29) and for two or more scans was 1.09 (95% confidence interval: 0.93–1.28). In conclusion, this population-based cohort study showed that a head CT scan is not associated with increased risk of thyroid disease in patients with minor head injury. The short-term adverse effects on the thyroid could be mild when a regular CT scan is appropriately performed.

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Indications for computed tomography in patients with minor head injury.

M J Haydel, C Preston, T. J. Mills … (2000)

Computed tomography (CT) is widely used as a screening test in patients with minor head injury, although the results are often normal. We performed a study to develop and validate a set of clinical criteria that could be used to identify patients with minor head injury who do not need to undergo CT. In the first phase of the study, we recorded clinical findings in 520 consecutive patients with minor head injury who had a normal score on the Glasgow Coma Scale and normal findings on a brief neurologic examination; the patients then underwent CT. Using recursive partitioning, we derived a set of criteria to identify all patients who had abnormalities on CT scanning. In the second phase, the sensitivity and specificity of the criteria for predicting a positive scan were evaluated in a group of 909 patients. Of the 520 patients in the first phase, 36 (6.9 percent) had positive scans. All patients with positive CT scans had one or more of seven findings: headache, vomiting, an age over 60 years, drug or alcohol intoxication, deficits in short-term memory, physical evidence of trauma above the clavicles, and seizure. Among the 909 patients in the second phase, 57 (6.3 percent) had positive scans. In this group of patients, the sensitivity of the seven findings combined was 100 percent (95 percent confidence interval, 95 to 100 percent). All patients with positive CT scans had at least one of the findings. For the evaluation of patients with minor head injury, the use of CT can be safely limited to those who have certain clinical findings.

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Drugs that suppress TSH or cause central hypothyroidism.

Bryan Haugen (2009)

Many different drugs affect thyroid function. Most of these drugs act at the level of the thyroid in patients with normal thyroid function, or at the level of thyroid hormone absorption or metabolism in patients requiring exogenous levothyroxine. A small subset of medications including glucocorticoids, dopamine agonists, somatostatin analogues and rexinoids affect thyroid function through suppression of TSH in the thyrotrope or hypothalamus. Fortunately, most of these medications do not cause clinically evident central hypothyroidism. A newer class of nuclear hormone receptors agonists, called rexinoids, cause clinically significant central hypothyroidism in most patients and dopamine agonists may exacerbate 'hypothyroidism' in patients with non-thyroidal illness. In this review, we explore mechanisms governing TSH suppression of these drugs and the clinical relevance of these effects.

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Cancer risk in patients with Hashimoto's thyroiditis: a nationwide cohort study

David Y-K Chen, V C-L Lin, F Cheng … (2013)

Background: This study examined the risk of cancer in patients with Hashimoto's thyroiditis (HT). Methods: The Taiwanese National Health Insurance Research Database (NHIRD) was used to identify 1521 newly diagnosed HT patients from 1998–2010, and 6084 frequency-matched non-HT patients. The risk of developing cancer for HT patients was measured using the Cox proportional hazard model. Results: The incidence of developing cancer in the HT cohort was 5.07 per 1000 person-years, which was 1.68-fold higher than that in the comparison cohort (P 55 years: HR=9.66). After adjusting for sex, age, and comorbidities, the HT cohort had HRs of 4.76 and 11.8 for developing colorectal cancer and thyroid cancer, respectively, compared with non-HT cohort. Furthermore, the HT cohort to non-HT cohort incidence rate ratio (IRR) of thyroid cancer was higher in the first 3 years (48.4, 95% confidence interval (CI)=35.0–66.3), with an adjusted HR of 49.4 (95% CI=6.39–382.4). Conclusion: Hashimoto's thyroiditis patients have a higher risk of thyroid cancer and colorectal cancer. The thyroid cancer prevention effort should start soon after HT is diagnosed, while being cautious of colorectal cancer increases with time.

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Journal

Journal ID (nlm-ta): Int J Environ Res Public Health

Journal ID (iso-abbrev): Int J Environ Res Public Health

Journal ID (publisher-id): ijerph

Title: International Journal of Environmental Research and Public Health

Publisher: MDPI

ISSN (Print): 1661-7827

ISSN (Electronic): 1660-4601

Publication date (Electronic): 29 May 2020

Publication date (Print): June 2020

Volume: 17

Issue: 11

Electronic Location Identifier: 3873

Affiliations

[1 ]Department of Biomedical Engineering, Chung Yuan Christian University, Taoyuan 320, Taiwan; 117223@ 123456cch.org.tw (S.-L.T.); wtli@ 123456cycu.edu.tw (W.-T.L.)

[2 ]Department of Anesthesiology, Changhua Christian Hospital, Changhua 500, Taiwan; 68990@ 123456cch.org.tw

[3 ]Institute of Medicine, Chung Shan Medical University, Taichung 402, Taiwan; jeff80329@ 123456hotmail.com (Y.-Y.C.); wchinyang@ 123456gmail.com (J.-Y.H.)

[4 ]Department of Surgery, Chung Shan Medical University Hospital, Taichung 402, Taiwan

[5 ]Department of Medical Research, Chung Shan Medical University Hospital, Taichung 402, Taiwan

[6 ]Department of Emergency Medicine, School of Medicine, Chung Shan Medical University, Taichung 402, Taiwan

[7 ]Department of Emergency Medicine, Chung Shan Medical University Hospital, Taichung 402, Taiwan

Author notes

[* ]Correspondence: ysf@ 123456csmu.edu.tw (S.-F.Y.); sky5ff@ 123456gmail.com (C.-B.Y.)

[†]

These authors contributed equally to the work.

Author information

Liang-Tsai Yeh https://orcid.org/0000-0002-3485-6937

Jing-Yang Huang https://orcid.org/0000-0002-0794-9388

Wen-Tyng Li https://orcid.org/0000-0002-5675-515X

Shun-Fa Yang https://orcid.org/0000-0002-0365-7927

Chao-Bin Yeh https://orcid.org/0000-0002-3978-5576

Article

Publisher ID: ijerph-17-03873

DOI: 10.3390/ijerph17113873

PMC ID: 7312589

PubMed ID: 32486020

SO-VID: cab833d1-e6e9-4ab7-aa71-368fe8330d0f

License:

Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license ( http://creativecommons.org/licenses/by/4.0/).

Impact of Computed Tomography Scans on the Risk of Thyroid Disease in Minor Head Injury Patients: A Population-Based Retrospective Cohort Study

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Most cited references 20

Indications for computed tomography in patients with minor head injury.

Drugs that suppress TSH or cause central hypothyroidism.

Cancer risk in patients with Hashimoto's thyroiditis: a nationwide cohort study

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